Care Home: Chrislyn House

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What the care home does well The service aims to inform people considering moving into the home and to understand how they will need to be supported. Care plans are completed that set out instructions for staff in meeting people’s needs. There is a greater emphasis on the person as a whole in both the care plans and the staffs recording of their daily lives. The service continues to develop the environment to a very good standard.Chrislyn HouseDS0000017793.V376669.R01.S.docVersion 5.2Carers were seen to go about their tasks in a friendly, polite and helpful manner and this indicated there was a relaxed, caring and supportive environment. Residents spoken with were content, confident and relaxed and this reflects the ethos and management approach of the service. People living at the service enjoy their experience and some comments included “I can’t fault them on what they do” and “I am very happy here and have nothing to complain about”. What has improved since the last inspection? Appropriate risk assessments are put in place for residents especially where residents are smokers. The storage facilities for medication have been reviewed to ensure that the home has appropriate facilities to store medications. Recruitment of carers is now in accordance with regulatory requirements to safeguard residents. The Registered Person ensures that there is a consistent staff training and development programme that meets the changing needs of residents. The home’s policies and procedures are all in the process of being redeveloped and staff are made aware of these policies to ensure they provide care and practice to clear defined guidelines. Further decoration, furniture and other improvements have been progressed and a continuing maintenance programme is in place. The improvements to the environment are to a very good standard. The regular supervision of carers has started and there are plans to implement the Skills for Care induction process to meet with National Minimum Standards. The quality assurance and monitoring systems are being reviewed and a programme is currently being begun. This should enable the home to assess how quality outcomes can be achieved and that they are meeting service users needs. What the care home could do better: The home should refrain from pureeing food so it is all mixed in together and serve it in individually pureed portions so it looks appetising and ensuring the service user can choose whether they wish to eat it.Chrislyn HouseDS0000017793.V376669.R01.S.docVersion 5.2An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that other possible medication issues can be monitored and good practice is always adhered to. It is recommended that the premises be assessed by a competent person who has specialist knowledge of older people to ascertain the appropriateness of use by older people with a learning disability. The home must have an effective staff team with sufficient numbers and complimentary skills to support residents’ needs at all times. This must be reviewed in line with any increase in residents or any changes in dependency levels. The workforce must be regularly updated with training to ensure they are skilled and knowledgeable as to how to deliver appropriate support to residents. Key inspection report CARE HOME ADULTS 18-65 Chrislyn House 14 Rosemary Road Clacton On Sea Essex CO15 1NX Lead Inspector Helen Laker Key Unannounced Inspection 27th July 2009 10:00 Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chrislyn House Address 14 Rosemary Road Clacton On Sea Essex CO15 1NX 01255 428301 F/P 01255 428301 chrislynhouse1@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Flat Mead Limited Mrs Karen E Stanton Care Home 26 Category(ies) of Learning disability (26), Learning disability over registration, with number 65 years of age (26) of places Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th July 2008 Brief Description of the Service: Chrislyn House is a converted property, consisting of a main house and adjoining mews. It is situated in the centre of Clacton and has access to the facilities and services provided in the town, including the seafront, library, shops and cafes. Currently the main building has accommodation for 22 residents, whilst the mews is intended for the use of 4 residents who are more independent. The proprietor advises us that because of the refurbishment and works being undertaken in the main building there is an intention to reduce overall numbers to 19 residents, and 3 residents in the mews as one resident has what was a double room but it is currently being used as a single. The current range of fees, were not available at this inspection visit and we were advised that toiletries, newspapers, hairdressing and chiropody are an extra cost, at cost. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10:00 and 16:00. The registered manager and deputy were not available on the day of inspection however the staff were present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some progress be noted as this contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as three staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of Chrislyn House was undertaken and seven residents, four members of staff as well as the domestic staff were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What the service does well: The service aims to inform people considering moving into the home and to understand how they will need to be supported. Care plans are completed that set out instructions for staff in meeting people’s needs. There is a greater emphasis on the person as a whole in both the care plans and the staffs recording of their daily lives. The service continues to develop the environment to a very good standard. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 6 Carers were seen to go about their tasks in a friendly, polite and helpful manner and this indicated there was a relaxed, caring and supportive environment. Residents spoken with were content, confident and relaxed and this reflects the ethos and management approach of the service. People living at the service enjoy their experience and some comments included “I can’t fault them on what they do” and “I am very happy here and have nothing to complain about”. What has improved since the last inspection? What they could do better: The home should refrain from pureeing food so it is all mixed in together and serve it in individually pureed portions so it looks appetising and ensuring the service user can choose whether they wish to eat it. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 7 An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that other possible medication issues can be monitored and good practice is always adhered to. It is recommended that the premises be assessed by a competent person who has specialist knowledge of older people to ascertain the appropriateness of use by older people with a learning disability. The home must have an effective staff team with sufficient numbers and complimentary skills to support residents’ needs at all times. This must be reviewed in line with any increase in residents or any changes in dependency levels. The workforce must be regularly updated with training to ensure they are skilled and knowledgeable as to how to deliver appropriate support to residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into the home can be assured that their needs will be considered before any agreement to their admission and can be confident they will receive information to enable them to make a positive and informed choice about where they wish to live. EVIDENCE: The Statement of Purpose remains unchanged since the previous inspection however was noted to need updating in line with current regulatory body changes, for example the new address of the CQC. The Service User’s Guide is available in the reception area and residents have a copy each in their care plans. Both documents have been reviewed at previous inspections and found to meet regulatory requirements. Service users spoken with were unclear as to what a statement of purpose or service users guide was, however they did confirm that anything in their care plan was discussed with them. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 10 It is recognised that because of some service user’s disabilities they may have difficulties understanding this document fully therefore signatures were not evidenced in all cases. The AQAA states, “We provide a service that promotes independence, encourages individuality and ensures that the service user is at the centre of everything we do.” Out of three service user files reviewed, all had a signed and dated contract and this indicated the fees payable each week, methods of payment and the terms and conditions of residence. These documents were not part of the Service Users Guide and were kept separately in a locked cabinet, as the information contained within the contract was considered confidential. At the time of the inspection no new residents had been admitted to the home since the previous inspection. An admission policy and procedure was available to review and was satisfactory. The home provides facilities and staff training appropriate to the needs that the home aims to meet. Residents spoken to were satisfied that the home had the skills and resources to meet their needs. One service user stated “They know exactly how I like things” A staff member spoken with also stated that they “understand the person’s needs and provide appropriate care and support.” The evidence available to ascertain the current practice of the home in admission procedures was found to meet National Minimum Standards. At this inspection the home had six vacancies. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be supported by their care plan arrangements because they are consulted about the things that affect their lives and they are protected by the arrangements for the assessment of risk. EVIDENCE: Four service user’s files were examined on a case-tracking basis. The care records indicated a comprehensive set of care decision sheets that included care outcomes and methods for the way carers should support the person. The local authority had undertaken annual reviews and care plans are reviewed routinely every three months. There was evidence to indicate that the person using the service was part of the decision making process and was present at reviews via monthly reviews of care plans. Notes of the meeting Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 12 indicated the person had signed their name and was aware of the decisions where appropriate. The care plans have been reviewed since the last inspection and are now more person centred and comprise of two parts. One part contains assessment data and care plan decisions that are chiefly needs lead, periodic reviews and records etc. The second part is a ‘Person Centred Plan’ (PCP), the documentation is more service user focussed in its layout and the language used is appropriate. The decisions in this part of the plan are mainly long-term outcomes and describe the service user’s aims and wishes. The PCP document is user friendly and is used in accordance with current thinking and empowering people to take more control of their lives and the decisions to be made. Staff spoken with advised that although the care plans are in separate parts the staff understand them and they are workable and understandable documents. Additionally the care plans were noted to include life stories, details on strengths and wants, checklists of areas of need, ‘how I spend my time’, PCP meetings, progress reviews, holiday newsletters and management strategies for behaviours. The AQAA confirms that “We provide a service that promotes independence, encourages individuality and ensures that the service users are at the centre of everything we do, one example of this is those who are able, are supported to write their weekly shopping list and do their own shopping, demonstrating their control over their finances”. The care plan pathway overall has all the required elements of assessment, decision-making, monitoring and review. Reviews are undertaken monthly and involvement directly with the service user in all plans except one, was evident. The individual plans seen were consistent with the needs of the person for whom they were intended. The daily recordings were generally clear and from the sample taken indicated that daily narratives were outcome focussed and made improved links to decision making. It was however noted that some one word answers such as ‘OK’ and ‘Fine ‘ were used. The use of more descriptive wording to clarify actions was discussed with the staff on duty, who said they agreed some of the daily narratives were brief and non specific. All of the plans reviewed made reference to service user choice regarding bathing, choice of clothes or visits out. One service user stated “I only wear what I want”. In one care plan it was clear that an independent advocate had been involved in the care planning process with the person and a pre-review ‘progress report’ had been completed by the person indicating active involvement in the care planning process and that an independent supporter had been involved to support the person. This is generally consistent with all service users where capabilities allow. In discussion with people living at the home it was evident that the level of support and risk taking is proportionate to the capacity of the individual and this is achieved by a combination of formal risk assessment and intuitive judgement based upon knowledge and understanding of the person. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 13 One example was evidenced with regard to 4 out of 16 residents being smokers and risk assessments and safety checks being made. A further example of this was a risk assessment in place for craft work and the potential injury from equipment or materials. The extent of the primary risk assessment by the staff member was suitable to ascertain whether the person was likely to be at known risk. The home has a policy on smoking and the activity is restricted to a room with an outside door for ventilation. The risk assessment framework within the service must have the capability of periodically testing the capacity of the person as their needs change and that any risk factors are incorporated within the plan. The care planning arrangements seen support the view that this is generally undertaken at the time of a 3 monthly review, and the home is now ensuring that the system being used has the capacity to change a risk rating at any time to reflect changing circumstances. In house care plan training now has a more formalised structure to ensure consistency and staff spoken with confirmed their attendance at this training course. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have good opportunities for personal development and engage in appropriate leisure activities. EVIDENCE: The location of the home is within central Clacton town centre and for this reason it is ideal for service users to access a variety of facilities within the town including seasonal entertainment, day drop in centres and general shopping. A significant proportion of service users have lived within the area for many years and are able to access services alone or with minimum help from carers. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 15 Such activity is encouraged by the home to maintain independent lifestyles and to reflect the principles of an ‘ordinary life’. Service users commented that carers are kind and that they feel well supported. The interaction between those who live and work at the home was friendly and supportive. The AQAA states “We provide a service that promotes independence, encourages individuality and ensures that the service user is at the centre of everything we do, some examples of this are: respect of privacy by being able to lock their bedroom door, recieving and dealing with their own correspondance, meeting with visitors or professionals in privacy, actively being involved in the running of the home and going on holiday to a venue of their choosing and with a staff member of their choice.” Additionally it states “We have a full activity programme which is reviewed regulary with service users. This has items such as themed evenings, special suppers, etc. The service users are supported to attend local productions (shows) at the church or local theatres. We have two volunteers who support the home with art therapy on a weekly or monthly basis and some service users have family who live locally and activly support them to vist and go out for lunch. In addition to this we have a weekly programme called our Happy Hour Programme this supports and enables all those who cannot go out alone to agree a time frame for staff to be available to go with them for shopping, lunch or any where they would like to or need to visit. Where transport is required some have a bus pass and utilise the train while others use the dial-a-ride service or access taxis.” Of the people spoken with few were sufficiently confident to use the local community without support although some do use the town by walking to the local shop, for example, to buy a newspaper. Overall, practice observed indicated that the regime supported individual rights. Some service users have chosen to lock their own rooms and retain the key, for example. Information obtained from records and by discussion with people indicated that various indoor activities were available. A theatre production company visits, country and western singers, coffee mornings, barbeques and annual tinsel and turkey visit is planned. At the time of this inspection 5 service users had been on a holiday to Vauxhall holiday camp in Great Yarmouth and residents spoken to on the day who went said they enjoyed it very much. Service users are increasing in age and it is understood that none now attend occupation based day placements, as most are post retirement age. Some however attend day centres and one person has a part time job helping out at a pub Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 16 Few people at the home have relatives although those that do are in regular contact with them and this is encouraged by the home. Service users who have experienced bereavement have had counselling arranged to assist with their losses. All service users spoken with stated they considered the food to be good and for the most part enjoyed the meals. Service users are given a choice and one service user who refuses to eat anything other than chicken, green beans and potatoes is accommodated adequately even on holiday this is pre arranged for them. The menu was varied and is planned in advance with the input of the residents, and food stock is delivered two weekly although some items such as meat are purchased locally. The daily record of food served is noted in individual diaries and is adequately detailed to ensure that a suitable record is kept. The odd takeaway is also included. It was noted that one resident who had a pureed diet was having it all pureed together and their meal therefore looked very unappetising. This was discussed with the staff on duty on the day of inspection and advised that this practice must change and any pureed food should be served separately on the plate. The home employs a cook to work Tuesdays to Fridays and a senior carer cooks in the kitchen Saturdays to Mondays. This inspection took place on a Monday and the care worker cooking in the kitchen on that day was observed to display good practices such as the washing of hands and changes of appropriate clothing. This did not appear to detract from the care of residents either but the home is reminded that should their client base increase staff ratio’s may need to increase to accommodate the current catering staff requirements. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect good support and assistance with health and personal care enabling appropriate consultation and respect of individual choice. EVIDENCE: Files examined showed that consent for the home to administer medicines was in place, and we were advised that no one self-administers medication. Healthcare monitoring was well organised and a clear chronology of information has been compiled regarding medical and primary healthcare services. These included Optician, Dentist and GP. Some very positive and supportive work has been undertaken previously to assist a person who needed help with transportation to a pre operative assessment to have an operation and another resident who has a fear of hospitals. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 18 Close work was undertaken which included gradual visits to the hospital to have refreshments in the cafeteria and building upon this to meeting nurses and gradually enabling the person to be less anxious upon admission. The medicines were a monitored dosage type and were being well managed and securely held. The administration records were overall accurately completed using the carer’s signature or a code designed to be used with the medicine administration form, called a ‘system code’. as appropriate. Information about the side effects of medicines being taken was held within individual plans of care. Only senior carers who have received training undertake the tasks associated with prescribed medicines to ensure the safety of service users. It was noted that where transcribed medications have been documented, two signatures were not in place to ensure safety in checking procedures. There are no controlled drugs in use at present, and current storage does now meet the requirements for storage of controlled drugs should any be prescribed. The home was required at the previous inspection to provide a metal cupboard as the Royal Pharmaceutical Society Guidelines advised and this has now been provided. The personal support provided was appropriate and consultative in approach. Carers were seen to knock on bedroom doors before entering and conversations between carers and people living at the home were relaxed and informal but appropriately respectful. In speaking to people all were confident and at ease in their surroundings. One service user said, “I do not know what I would do without them it is lovely here”. Some of the carers had been working at the home for some years and have built up positive friendly and supportive relationships. One staff member interviewed stated, “In a year I have learn’t a lot and it is very satisfying knowing you can help people in this way. It is like having another family” One relative survey stated “My relative is very happy at Chrislyn House and I have never felt in the way” Another stated, “They are always there to help with any problems you may have”. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect that they will be listened to through the home’s complaints and safeguarding adults systems and their concerns acted on. They can also be assured that all carers are adequately trained to safeguard their welfare. EVIDENCE: The home has an appropriate complaints policy and procedure, which promotes complaints are taken seriously and responses to them handled efficiently. Residents spoken to felt able to raise concerns, and were clear that they would speak to the manager or staff if they had any complaints. One service user stated “I don’t have any but if I do I just ask and they deal with it” Another who had had some issues stated “They do sort it out and help, so that is good”. The home maintains records of complaints received: these records showed that any complaints would be responded to. The provision of the complaints procedure in alternative formats was discussed on this visit. However service users spoken with did display an awareness and understanding of the current policy. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 20 The home has the current safeguarding adult’s policy and procedure provided by the local authority. A whistle blowing procedure was located within the policies and procedures file within the office. This procedure is given to each carer as part of the induction process to ensure that each person is able to access the information without the need to access the main office, which is sometimes locked. A copy is located in the foyer area and staff spoken with confirmed that they have all received copies. Documents meet the expectation of the local guidance and the National Minimum Standards for Care Homes 2001. There have not been any reported safeguarding issues for this service in the last twelve months and one complaint received by the commission was dealt with appropriately by the home. Staff training records showed that all staff had attended training in abuse awareness over the last two years and the AQAA details “We have a clear and effective complaints procedure which is high lighted to the service user during our monthly meetings and at any time that a service user brings an issue of concern to the office. All staff have training to safe guard and protect the service user from danger, harm and all forms of abuse.” Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect all areas of the home to be of a good quality standard and to live in a clean and safe environment and that the maintenance of the home protects their health and welfare. EVIDENCE: A tour of the building was undertaken and communal areas, some toilets, bathrooms and bedrooms were visited. At the last inspection approximately 12 months ago, it was noted that most of the ground and upper floor has been refurbished, carpets replaced and fixtures and fittings renewed. Since then more improvements have been made. All but two bedrooms on the upper floors have been refurbished and a snoozelum/ multi sensory room is being developed on the ground floor and a further toilet has been installed. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 22 This has been achieved to a very good standard and the AQAA advises that there are plans to “repair and re-felt flat roof to enable us to create 2 bedrooms with ensuite facilities in the penthouse and create a disabled access bathroom.” We were told that finances allowing the refurbishment programme is going ahead as planned and there are also plans to purchase a new cooker hood, replace all windows systematically. There is a lot of hard work being put into the refurbishment of the building and we were told that every time a room is completed there is an official opening ceremony in the home involving the service users. Those spoken with on the day of inspection were happy with the ongoing improvements in the home and one stated, “I love my new room, it’s very clean and fresh”. The windows on the upper floors including all the new ones fitted noted at the home’s last inspection to require window restrictors to ensure service user safety and security of the home, have now been fitted. The lounge area has been refurbished as part of the plan and a new wide screen wall TV has been fitted. A breakfast bar type fixture has been retained, to reflect the historical use of this room being formerly a ‘bar’. The feature of this is for some practical use also as it is used for storage of activity items, games etc. the lounge is a well decorated and well furnished room. The dining room, office and area immediately adjacent to it, including a staff toilet have also been completely refurbished as part of the plan with new furniture, flooring, lighting and redecoration to a good standard. The room designated as a smoking area for residents does not yet have adequate air extraction and this has again been recommended. The premises are set out on various floors and a passenger lift has been installed to reach most rooms with ground floor equivalent access. Service users can use this independently or supervised by a member of staff. The average age of persons living at the home continues to increase and the majority of people are now over the age of 65 years. The registered person has acknowledged this movement in the way the home is preparing for different challenges that onset of age brings by the relatively recent fitting of the passenger lift and other moving and handling equipment. It is recommended, however, that advice is sought from a professional or organisation that is knowledgeable about the needs of older people regarding the layout of the home, since further alterations and improvements are planned. It is important that such changes are made with the benefit of suitable advice in this way to ensure the proposals are fully in accord with the needs of older people. The extent of improvements over the preceding 24 month period is impressive and the home presents as very well appointed overall. The home was well maintained and clean and hygienic on the day of inspection. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment processes of the home have sufficient safeguards in place to ensure residents are protected. EVIDENCE: The home maintains staffing levels appropriate to the needs and number of people living there. Individuals consulted felt that there are always sufficient staff available when they need them, and relatives consulted felt that staff have the right skills and experience to look after residents properly. Some staff members stated that at busy times it would be beneficial to have extra members of staff on duty at times as it can become busy. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 24 A sample of three care staff recruitment files were examined to determine the home’s practice regarding recruitment. The scrutiny of records confirmed that the service is proactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. Staff files were examined to determine how the service carried out its recruitment process. The documents on the files seen demonstrated a robust approach with checks made on the persons Criminal Records Bureau (CRB) check, and the Department of Health Safeguarding POVA first list, as well as two written references, and proof of the person’s identity. These with the completed application form assist the service to determine whether the person is of a suitable background to work with vulnerable people. All the files inspected had a health declaration form in place. Eleven care staff are employed. The AQAA tells us “Two staff have embarked on NVQ2 and two staff have completed NVQ3. One carer has completed NVQ2 and 1 senior has just started NVQ3.” The proprietor and manager both have the registered managers award NVQ Level 4. In reviewing the overall range of presenting needs of service users and then comparing these with the training and development information of carers, there were a minor number of training and development area ‘gaps’ still including, for example, moving and handling, POVA training, food hygiene training, continence management, challenging behaviours, and pressure area care. The AQAA states “All staff are trained in the core training requirements such as, fire and safety, health & Safety, moving & handling, infection control, safeguarding vulnerable adults, epilepsy awareness. Staff are monitored through supervision with regards to their competence and skills to perform their job. where skills gaps are identified we source appropriate training.” Additionally it states “We have close links with numerous training organisations and staff continue to embark on relevant courses in the work place to keep the staff up to date with current legislation.” This inspection highlighted whilst each staff member has a list of training attended and there is a rolling programme of routine training, this is not directly linked to the individual needs of carers and the tasks they have to perform. A more formalised approach was discussed previously with the proprietor and a training matrix has been formulated but this is not fully operational yet. The initial induction for new carers is an in-house design and now does meet the induction standards set out by Skills for Care 12 week induction programme. One staff member spoken with did identify the fundamental parts of their initial induction and evidence of inductions were found on some staff files reviewed. Comments from relative surveys said ‘staff are quick to attend to my relatives needs’, ‘I think the team does its best for the residents and the carers are very good.’ Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 25 At the last inspection the formal supervision of staff had only recently commenced and it was not possible to determine if the frequency of supervision met with levels set out in National Minimum Standards. We are advised in the home’s AQAA “Staff are monitored through supervision with regards to their competence and skills to perform their job. where skill gaps are identified we source appropriate training.” Evidence was available to show the home is formalising supervision to a ratio of 6 supervisions, 1 appraisal and 2 documented observations annually. Staff spoken with confirmed they did have regular supervision and one commented “This helps with identifying areas we wish to develop in” In discussion with staff and from observation of their practice, all went about their tasks in a friendly and supportive manner. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that all aspects of the home are managed appropriately. They can expect that quality systems be based upon appropriate consultation and that they safeguard their health and welfare. EVIDENCE: The Proprietor and Manager both have good experience of managing the service and have both completed the Registered Managers Award NVQ Level 4. The inspection highlighted that the overall ethos and leadership of the service is positive. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 27 The Manager has shown that she continues to foster positive and supportive teamwork. Staff spoken with described the manager as “fair and open” and “approachable if you have a concern”. The quality assurance system has improved since the last inspection and has been addressed in a planned and systematic way. Evidence of pictorial resident survey responses were seen. These were sent out last in July 2009 and a report is still to be formulated from the same. The Proprietor has also integrated an interactive quality assurance system, this is not fully operational yet though. The home’s AQAA states under their plans for the next 12 months that they intend to “Fully implement the quality assurance and monitoring system. Review our Annual development plan and to take action as appropriate.” We feel this could have been enlarged upon to provide clarity of the same. The approach to quality did however evidence a clear format and methodology that is operational and meets with satisfactory principles of quality monitoring. Feedback from resident’s and relatives regarding their experience of the homes arrangements to safeguard health and welfare was mainly positive and comments included. “Chrislyn House provides a safe and warm environment for the service users” and “They put all service users first” Additionally the Manager in the AQAA states “The home is managed to run alongside all new legislation. Staff are informed of all changes regarding the service user and training is given to ensure that they receive the highest level of care. Having completed my RMA I am confident that the home is well managed in all aspects of leadership, staff development , promoting independence and individuality for service users. My approach is one of inclusion where all service users and staff participate in the decision making processes in all aspects of the running of the home and this is reflected in the homes philosophy. Health and safety is paramount in all aspects of our work, we risk assess each activity and task undertaken by both S/U and staff to enable us to manage any identified risks. These risk assessments are recorded and can be found in the office. All policies are reviewed and updated regularly and random policies are posted on the staff notice board for staff to read and sign Chrislyn has an open door approach which positively reflects on the general atmosphere promoted within the home.” The health and safety arrangements were generally satisfactory in that the home has monitoring systems for fire detection, hazardous substances, emergency lighting, gas safety and electrical safety, including portable appliance testing. All of these systems were sample checked to identify when the last review and test dates had been undertaken and all were satisfactory. Qualified contractors undertake some of the checks. Aspects to health and safety requiring attention at the last inspection including the lack of window restrictors had been addressed to ensure service users were kept safe. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 3 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 3 x Version 5.2 Page 29 Chrislyn House DS0000017793.V376669.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The home should refrain from pureeing food so it is all mixed in together and serve it in individually pureed portions so it looks appetising and ensuring the service user can choose whether they wish to eat it. An audit system to check the signing, omissions of medication and transcribing of medication on MARS sheets must be in place so that other possible medication issues can be monitored and good practice is always adhered to. It is recommended that the premises be assessed by a competent person who has specialist knowledge of older people to ascertain the appropriateness of use by older people with a learning disability. The home must have an effective staff team with sufficient numbers and complimentary skills to support residents needs at all times. This must be reviewed in line with any increase in residents or any changes in dependency levels. The workforce must be regularly updated with training to ensure they are skilled and knowledgeable as to how to DS0000017793.V376669.R01.S.doc Version 5.2 Page 30 2. YA20 3. YA24 4. YA33 5. YA35 Chrislyn House deliver appropriate support to residents. Chrislyn House DS0000017793.V376669.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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