Care Home: Chypons

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What the care home does well The building is comfortable, clean and homely. People seemed happy and well cared for. In regard to where safeguarding concerns were raised regarding pressure sore care, we were able to assess individual care records which were generally to a satisfactory standard. The registered manager told us that there are currently six people with pressure sores. This is a high number, and we needed to check that satisfactory action is being taken to prevent the cause of pressure sores, and that people are receiving appropriate treatment so their sores get better. Of the people concerned we were told three people came in with pressure sores from other care settings. In regard to the other three people we were told the people concerned were not co-operative with care or took actions which did not help the healingprocess or exacerbated the problem. We were told that there is regular liaison with the district nurses, and the tissue viability nurse has also been consulted. It is essential this always occurs so a satisfactory multi disciplinary approach can be adopted to ensure an appropriate care package for individuals is put in place. Some of the people for whom concerns were expressed have since died. We assessed their records and it seems that satisfactory care was given in regard to two of the people concerned. For example care records clearly demonstrate that the district nurses and the general practitioner regularly visited the people concerned. Care records also demonstrated where assistance with fluid intake and staff assistance where turning people, was required this was carried out. We spoke with one person who was highlighted in the concerns raised to us. The person said they were well cared for by the home. They said they had a pressure sore, but had come to the home with this after spending time in hospital. They said they felt they were receiving satisfactory treatment by staff and external professionals regarding the sore. The home confirmed there is satisfactory action taken regarding people`s diet, satisfactory equipment is provided, and suitable opportunity is available for people to exercise. These are all key actions the home needs to be focused upon to ensure pressure sores are kept to an absolute minimum. A concern was raised about the condition of a chair belonging to a former resident who moved to another home. The new home refused to take the chair as they deemed it dirty and unhygienic. The registered manager agreed this was the case, but stated the person spent day and night in the chair, and refused to have it cleaned (and because the person was ever- present in the chair staff were not presented with an opportunity to clean it). This seems a reasonable explanation. The registered manager also said the chair was the person`s personal property. Prior to the inspection, a concern was raised that a person had become much more sedentary since being prescribed medication and nothing had been done about it. The registered manager said the home had raised concerns and the person had been seen by the social worker, district nurse and another professional. Action has subsequently been taken to review the medication. Another concern was raised to us regarding the attitude of a member of staff, which was observed by an external professional. The registered manager said that the person had been given a `verbal warning` subsequently to the concern being raised with the home, and the person now does not work there. We looked at the training records in the home. These appear generally satisfactory. There is suitable information regarding pressure sore care. It is vital this is cascaded to all staff, and where possible, at the very least, senior staff attend external training courses e.g. as provided by the NHS etc. What the care home could do better: A concern was raised that when one person was discharged from the home they did not have any belongings or medication with them. The registered manager said that in regard to the medication, this was an error on behalf of the pharmacist, which the homesubsequently resolved. In regard to the person`s belongings the manager said she was not present on the day of discharge, but she understood the new care home would return for the items. It is essential that staff ensure that belongings are ready for the time of discharge. A list of belongings should be made on the persons admission, and a separate list made at the time of discharge. Effort should be made to ensure the two records tally, and that the home can account for any items which are no longer in existence e.g. items disposed of etc. A person had made allegations about staff attitudes and conduct. As the person has since passed away, it is difficult to check the detail of the allegations with them or corroborate what they said again due to the lack of detail. The registered persons have said the person made a number of allegations against staff while they lived at the home, which in their view were inaccurate and malicious. We did note that concerns were raised by staff about what was deemed a malicious allegation while the person lived there. This was written on a piece of paper, within the persons file. It is advisable that staff always record such concerns in the notes, and there is a clear record of the action taken by the registered persons to the allegations or concerns raised. We assessed staffing levels at the home. These appear to be satisfactory. However, it is essential they are kept under constant review as people`s needs change, and the numbers of people living in the home increases. Satisfactory staffing levels are vital to ensure people can have appropriate one to one care, opportunity for exercise and recreation. Random inspection report Care homes for older people Name: Address: Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU two star good service 21/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Ian Wright Date: 3 0 0 7 2 0 1 0 Information about the care home Name of care home: Address: Chypons Clifton Hill Newlyn Penzance Cornwall TR18 5BU 01736362492 01736360399 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Donna Louise Norton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Geoffrey Walden Knights care home 27 Number of places (if applicable): Under 65 Over 65 3 3 27 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 0 0 0 The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care neds on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) maximum 27 places Dementia aged 65 years and over on admission (Code DE(E)) maximum 3 places Mental disorder, excluding learning disability or dementia, aged 65 years and over (Code MD(E)) maximum 3 places Care Homes for Older People Page 2 of 11 Date of last inspection Brief description of the care home 2 1 0 4 2 0 1 0 Chypons provides accommodation and personal care for up to 27 older people, three of who may have dementia and a further three who may have a mental illness upon admission. The home is situated in the village of Newlyn, near to Penzance and is easily accessible by road. All the amenities of the village and town of Penzance are close by, although there is quite a steep hill leading up to the home. There is ample car parking space for visitors in the homes grounds. The home consists of two inter-linked wings. Most of the bedrooms are for single occupancy and have en suite bathrooms. The main lounge and several of the bedrooms have spectacular sea views. There is a large lounge/ dining room and hairdressing/beauty salon. There is a small, paved terrace area on the upper floor to enable people who use the service to sit outside if they wish. The home has a lift to enable people who use the service to access the upper floor. The entrance to the building has suitable access for people with physical disabilities. The home has equipment and grab rails at strategic points to assist people with physical disabilities. The home is privately owned. A registered manager is employed to manage the home on a day to day basis. A team of care staff, including senior carers and ancillary staff provide care and support to people who use the service. At the time of the last key inspection in April 2010, fees range from £395-£575 per week. Additional charges are made for hairdressing, newspapers and personal items. A copy of this inspection report is available via the homes management or free of charge from the Care Quality Commission (see back of the report for contact details). Care Homes for Older People Page 3 of 11 What we found: This unannounced random inspection was completed to: * Check pressure sore care is appropriate following concerns raised as part of a safeguarding alert.Other professionals are also looking at this matter and will report back to the safeguarding case conference. * Look at other issues raised via the safeguarding alert.Other professionals are also looking at this matter and will report back to the safeguarding case conference. * Check there are sufficient staff, and they are satisfactorily trained to provide care for the people living in the home. * Check peoples care is maintained to a satisfactory standard, and we are happy with care standards in the home. The methodology to complete this inspection was as follows: * We carried out a joint visit with the Service Improvement Officer of Cornwall Council. * We inspected the building. * We met with the registered manager regarding the safeguarding concerns, how these had been managed, and any improvements which have occurred in the home. *We inspected relevant documentation held in the home; for example care and staff training records. We did not look at action taken regarding the requirements set at the previous key inspection. The requirements are repeated at the back of this report, but it may be the case that satisfactory action has now been taken. The reader should check with the registered persons for further information. What the care home does well: The building is comfortable, clean and homely. People seemed happy and well cared for. In regard to where safeguarding concerns were raised regarding pressure sore care, we were able to assess individual care records which were generally to a satisfactory standard. The registered manager told us that there are currently six people with pressure sores. This is a high number, and we needed to check that satisfactory action is being taken to prevent the cause of pressure sores, and that people are receiving appropriate treatment so their sores get better. Of the people concerned we were told three people came in with pressure sores from other care settings. In regard to the other three people we were told the people concerned were not co-operative with care or took actions which did not help the healing Care Homes for Older People Page 4 of 11 process or exacerbated the problem. We were told that there is regular liaison with the district nurses, and the tissue viability nurse has also been consulted. It is essential this always occurs so a satisfactory multi disciplinary approach can be adopted to ensure an appropriate care package for individuals is put in place. Some of the people for whom concerns were expressed have since died. We assessed their records and it seems that satisfactory care was given in regard to two of the people concerned. For example care records clearly demonstrate that the district nurses and the general practitioner regularly visited the people concerned. Care records also demonstrated where assistance with fluid intake and staff assistance where turning people, was required this was carried out. We spoke with one person who was highlighted in the concerns raised to us. The person said they were well cared for by the home. They said they had a pressure sore, but had come to the home with this after spending time in hospital. They said they felt they were receiving satisfactory treatment by staff and external professionals regarding the sore. The home confirmed there is satisfactory action taken regarding peoples diet, satisfactory equipment is provided, and suitable opportunity is available for people to exercise. These are all key actions the home needs to be focused upon to ensure pressure sores are kept to an absolute minimum. A concern was raised about the condition of a chair belonging to a former resident who moved to another home. The new home refused to take the chair as they deemed it dirty and unhygienic. The registered manager agreed this was the case, but stated the person spent day and night in the chair, and refused to have it cleaned (and because the person was ever- present in the chair staff were not presented with an opportunity to clean it). This seems a reasonable explanation. The registered manager also said the chair was the persons personal property. Prior to the inspection, a concern was raised that a person had become much more sedentary since being prescribed medication and nothing had been done about it. The registered manager said the home had raised concerns and the person had been seen by the social worker, district nurse and another professional. Action has subsequently been taken to review the medication. Another concern was raised to us regarding the attitude of a member of staff, which was observed by an external professional. The registered manager said that the person had been given a verbal warning subsequently to the concern being raised with the home, and the person now does not work there. We looked at the training records in the home. These appear generally satisfactory. There is suitable information regarding pressure sore care. It is vital this is cascaded to all staff, and where possible, at the very least, senior staff attend external training courses e.g. as provided by the NHS etc. What they could do better: A concern was raised that when one person was discharged from the home they did not have any belongings or medication with them. The registered manager said that in regard to the medication, this was an error on behalf of the pharmacist, which the home Care Homes for Older People Page 5 of 11 subsequently resolved. In regard to the persons belongings the manager said she was not present on the day of discharge, but she understood the new care home would return for the items. It is essential that staff ensure that belongings are ready for the time of discharge. A list of belongings should be made on the persons admission, and a separate list made at the time of discharge. Effort should be made to ensure the two records tally, and that the home can account for any items which are no longer in existence e.g. items disposed of etc. A person had made allegations about staff attitudes and conduct. As the person has since passed away, it is difficult to check the detail of the allegations with them or corroborate what they said again due to the lack of detail. The registered persons have said the person made a number of allegations against staff while they lived at the home, which in their view were inaccurate and malicious. We did note that concerns were raised by staff about what was deemed a malicious allegation while the person lived there. This was written on a piece of paper, within the persons file. It is advisable that staff always record such concerns in the notes, and there is a clear record of the action taken by the registered persons to the allegations or concerns raised. We assessed staffing levels at the home. These appear to be satisfactory. However, it is essential they are kept under constant review as peoples needs change, and the numbers of people living in the home increases. Satisfactory staffing levels are vital to ensure people can have appropriate one to one care, opportunity for exercise and recreation. 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 set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 17 Ensure care plans and daily records are completed fully This will ensure records to deliver care are maintained to a higher standard which should improve consistency of the delivery of care. 01/07/2010 2 18 13 The adult safeguarding procedure needs to be amended to reflect agreed multi disciplinary safeguarding procedures People using the service will subsequently be more assured that correct procedures are followed if they have an allegation of neglect or abuse. 01/08/2010 3 19 23 Window restrictors must be 01/07/2010 fitted to all windows where this is necessary. The registered persons should seek advice from the Environmental Health Department about this matter. The Commission requires the registered persons to confirm in writing when this work is completed. (Timescale of 01/07/2009 not met. Second Notification) Care Homes for Older People Page 7 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This will help to minimise the risk of falls 4 19 23 Window restrictors need to be fitted where this is necessary. This will help to minimise the risk of falls and/or intruders entering the building. 5 29 19 Obtain two written references for all staff. This will help to ensure that people employed to work with the residents at Chypons are deemed suitable to work with vulnerable elderly people. 6 29 19 Satisfactory pre employment 01/06/2010 checks must be completed on all care staff employed from the date of this report. The issues outlined in this report must be appropriately addressed. (Previous timescale of 01/06/2009 not met Second Notification) Action regarding the matters of concern will ensure people using the service, and other stakeholders will be more assured that staff employed are deemed as fit to work with vulnerable people and within a care setting 7 30 18 Staff must have satisfactory training as is required by law. The registered persons must: (a) Complete the 01/09/2010 01/06/2009 01/07/2009 Care Homes for Older People Page 8 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action current training programme being undertaken. (b) Ensure there are satisfactory levels of first aid cover, to an appropriate level, at all times. This will give people using the service assurance that staff are trained to meet their needs and deal appropriately with any incident where first aid is required. Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: 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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