Care Home: The Chimes

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What the care home does well Staff are warm and welcoming and there is a relaxed homely atmosphere. Both staff and people using the service were keen to be involved in the inspection process providing open and helpful information about the service. The improvements made the environment since the last inspection present a pleasing and homely image. Many positive comments were made from people using the service, their relatives and staff about the care being provided at The Chimes. This included people spoken with on the day and from many who returned confidential surveys to us prior to the inspection. We observed relaxed, friendly and positive engagement between all people in the home. Staff spoke in a friendly and respectful way to people engaging positively with them. Senior staff have been at the home for several years, providing continuity of care and relationships for all people living there. We found that all the recommendations of the last inspection had been taken seriously and had been satisfactorily addressed. The service clearly acts upon recommendations and advice in wishing to improve aspects of the service and quality of care. What has improved since the last inspection? Areas of the home identified at the last inspection as needing renewals and replacements have been improved. This includes a new kitchen, re-carpeting throughout the ground floor area, upgrading of the 3 main toilet areas and redecoration of many areas. The overall presentation of the home has been considerably improved. Risk assessments are now reviewed and updated, although more person centred risk assessments would make further improvements. A fridge has been purchased as recommended, to store medication at the recommended temperatures. There is a new, improved system for recording complaints with outcomes.The ChimesDS0000008211.V376785.R01.S.docVersion 5.2There has been updated training in areas of Fire Safety, Moving & Handling, Infection Control and Safeguarding of Vulnerable Adults as recommended in the last report. People have been consulted about the programme of activities provided in the home and changes made to ensure their interests and quality of life are maximised. Resources have been made available for equipment to be provided for this purpose. Supervision of staff has commenced, as well as appraisals. This will provide greater support for staff in their work and allow them the opportunity to feedback about the service. Greater variety in choice of meals is offered for lunch and teatime after consultation with people in the home. There is a greater choice for breakfast and supper for those who want this. People asked for additional baths. A member of staff has been employed for 4 hours each day in the week to provide this. Training in End of Life Care has been provided to create greater awareness for staff of the needs of people in that situation. Training in the Mental Capacity Act and Deprivation of Liberties has been provided for staff to create awareness of the need to protect peoples interests. What the care home could do better: The pre-admission assessment tool should be revised to provide more pertinent information about people`s needs before a decision is made to offer them a place at the Chimes. It is necessary also, to inform people in writing before admission that the home can meet their assessed needs. Care planning formats should be changed and streamlined to provide good current information and a working document for staff. When people are turned in bed, turn charts should be established to record actions recommended by the nursing service. There should be a count of all medication, allowing an audit of the system and it is also necessary to review the system for administering and recording the use of creams, so that people have the correct prescribed treatment.The ChimesDS0000008211.V376785.R01.S.docVersion 5.2Creams should not be left in communal areas, always labelled and never used by more than one person. This will ensure good infection control practice. The increased range of activities provided should be recorded as evidence of the work being done in this area. The complaints procedure should be amended to provide a concise, easily understood procedure. All accidents requiring medical attention must be notified to us under Regulation 37 of the Care Home Regulations. Key inspection report CARE HOMES FOR OLDER PEOPLE The Chimes 6 St Christopher Avenue Penkhull Stoke on Trent Staffordshire ST4 5NA Lead Inspector Peter Dawson Key Unannounced Inspection 29th July 2009 08:30 DS0000008211.V376785.R01.S.do c 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 homes for older people 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. The Chimes DS0000008211.V376785.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 The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chimes Address 6 St Christopher Avenue Penkhull Stoke on Trent Staffordshire ST4 5NA 01782 744944 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) Mr William Molton Mrs Marilyn Molton Mr William Molton Care Home 28 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (28), Physical disability (3) of places The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 2 Old age, not falling within any other category (OP) 28 Physical disability (PD) 3 The maximum number of service users who can be accommodated is: 28 Age : Dementia (DE) age 55 and above. Physical disability (PD) age 55 and above. 30th July 2008 2. 3. Date of last inspection Brief Description of the Service: The Chimes is a large, extended detached property located in a residential area in Penkhull. The home provides care for a maximum of 28 service users; their needs may range from old age to dementia and/or physical disabilities. The home can accommodate 2 people with dementia and 3 with a physical disability, the staff are trained in this area, and the inspection process confirmed the home is able to meet individual needs. The building is generally adequately maintained and redecoration is ongoing. There has been recent upgrading of communal areas on the ground floor and work is underway building a new extension to the home due for completion at the end of 2009. The service users are offered easy access throughout the home by the use of stairs or a lift. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 5 Communal areas are spacious and comfortable; there are two lounges, which can be opened into one if required. The dining room is well maintained, sizeable and sited next to the kitchen. Small, quiet sitting areas are available on all floors. There are 26 single rooms, 12 with en-suite facilities and one double room with an en-suite. Bathrooms and toilets are appropriately situated. There is a garden area for service users and their visitors to use with appropriate seating facilities. Local amenities are within a short walking distance. Local towns are accessible by car or public transport. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. The last unannounced Key inspection of this service was on 30th July 2008 This Key unannounced inspection was carried out by one inspector over one day from 08:30 am – 17:00 pm. The service completed the AQAA (Annual Quality Assurance Assessment) prior to the inspection. This is a legally required self-assessment every service has to complete annually. This contains information about what the service think they do well, what progress they have made over the past year, what they think they could do better and their plans for improving the service over the next year. Some information from the AQAA is included in this report. Eight people using the service, 4 relatives and 10 members of staff sent us written feedback about their experiences of the service confidentially, prior to the inspection During the inspection most people were seen and many spoken with individually and together. It was possible to speak to a group of around 6 people in the lounge area and all gave us helpful information about the service and life at The Chimes. We inspected all the communal areas of the home and a sample of bedrooms. Records inspected included: Care plans, risk assessments, daily notes, medication records, staffing rota’s as well as other documents relating to the inspection process. There were 25 people in residence at the time of the inspection, this included 2 people who were receiving respite care. There were 3 vacancies. The Registered Manager/Provider was not present during the inspection but the Deputy Manager provided us with helpful information and good dialogue about the home. At the end of our inspection, feedback was given to the Deputy Manager outlining the overall findings and giving information about the recommendations that we would make. No requirements are being made as a result of this inspection. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 7 What the service does well: Staff are warm and welcoming and there is a relaxed homely atmosphere. Both staff and people using the service were keen to be involved in the inspection process providing open and helpful information about the service. The improvements made the environment since the last inspection present a pleasing and homely image. Many positive comments were made from people using the service, their relatives and staff about the care being provided at The Chimes. This included people spoken with on the day and from many who returned confidential surveys to us prior to the inspection. We observed relaxed, friendly and positive engagement between all people in the home. Staff spoke in a friendly and respectful way to people engaging positively with them. Senior staff have been at the home for several years, providing continuity of care and relationships for all people living there. We found that all the recommendations of the last inspection had been taken seriously and had been satisfactorily addressed. The service clearly acts upon recommendations and advice in wishing to improve aspects of the service and quality of care. What has improved since the last inspection? Areas of the home identified at the last inspection as needing renewals and replacements have been improved. This includes a new kitchen, re-carpeting throughout the ground floor area, upgrading of the 3 main toilet areas and redecoration of many areas. The overall presentation of the home has been considerably improved. Risk assessments are now reviewed and updated, although more person centred risk assessments would make further improvements. A fridge has been purchased as recommended, to store medication at the recommended temperatures. There is a new, improved system for recording complaints with outcomes. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 8 There has been updated training in areas of Fire Safety, Moving & Handling, Infection Control and Safeguarding of Vulnerable Adults as recommended in the last report. People have been consulted about the programme of activities provided in the home and changes made to ensure their interests and quality of life are maximised. Resources have been made available for equipment to be provided for this purpose. Supervision of staff has commenced, as well as appraisals. This will provide greater support for staff in their work and allow them the opportunity to feedback about the service. Greater variety in choice of meals is offered for lunch and teatime after consultation with people in the home. There is a greater choice for breakfast and supper for those who want this. People asked for additional baths. A member of staff has been employed for 4 hours each day in the week to provide this. Training in End of Life Care has been provided to create greater awareness for staff of the needs of people in that situation. Training in the Mental Capacity Act and Deprivation of Liberties has been provided for staff to create awareness of the need to protect peoples interests. What they could do better: The pre-admission assessment tool should be revised to provide more pertinent information about people’s needs before a decision is made to offer them a place at the Chimes. It is necessary also, to inform people in writing before admission that the home can meet their assessed needs. Care planning formats should be changed and streamlined to provide good current information and a working document for staff. When people are turned in bed, turn charts should be established to record actions recommended by the nursing service. There should be a count of all medication, allowing an audit of the system and it is also necessary to review the system for administering and recording the use of creams, so that people have the correct prescribed treatment. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 9 Creams should not be left in communal areas, always labelled and never used by more than one person. This will ensure good infection control practice. The increased range of activities provided should be recorded as evidence of the work being done in this area. The complaints procedure should be amended to provide a concise, easily understood procedure. All accidents requiring medical attention must be notified to us under Regulation 37 of the Care Home Regulations. 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. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): Standards 1 – 5 were inspected on this visit People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is readily available, more detailed pre-admission assessments will ensure peoples needs can be met. EVIDENCE: There is a statement of purpose and service users guide available to all in the home and to visitors. The information provides all required information for people to make a judgement about the suitability of the home. All people are given contracts. The Local Authority provide contracts for those requiring funding, the home provides a contract for people funding their own care. A random sample of a self-funding contract was seen, contained all required information was dated and signed by the person and the Manager. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 12 People are always assessed in their current setting prior to admission and are invited to visit and spend time in the home before making a decision that the home is where they want to live. Peoples needs are assessed prior to admission. The pre-admission assessment tool was seen. It provided inadequate information and did not cover the aspects of pre admission assessment as stated in Standard 3 – there was no history of falls, oral care, sight, hearing, mobility or continence assessments. These are all important factors in deciding whether the home can meet the needs of the person. The pre-admission assessment tool needs to be revised to include these aspects of care need. When a person has made a decision about admission and the assessment completed they are not informed in writing as required under Regulation 14(d). This should be done. In the records seen of people who had been recently admitted, there was a copy of the Social Workers Multi-agency assessment. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): Standards 7 – 11 were inspected on this visit People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are met. Improvements to care planning and aspects of medication will further enhance the service to people. EVIDENCE: We looked at a sample of care plans for a mixture of people with high dependency and someone admitted comparatively recently. Plans contained detailed information about the health and personal care needs of people. Diagnosed conditions were clear and there were assessments for waterlow, nutrition, continence and mobility. In some instances there was a lot of information but some was dated. The Barthel and Clifton dependency scoring tools were completed for all people, but their purpose and use was not known or clear, in one instance these had been reviewed and signed monthly The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 14 over a period of 3 years without change. One care plan seen was dated 2005 and been reviewed monthly until June 2009, recent entries recorded “no change to care plan” – presumably to the 2005 care plan. These plans need to be updated/re-written to provide a current record of the care needed to support people with their health, personal and social care needs. Information was recorded but in different places. GP visits are recorded on a separate sheet but some information was recorded in the Senior Carers daily record (for shift hand-over) and had not been recorded in the GP notes. Daily notes also completed for each shift were poor, again more information was included in the generic Senior Carers book. Information could basically be in one of several places and whilst all the information may be there somewhere, there is a need to streamline the care planning and review system. This would also reduce the amount of recording and duplication, providing a concise statement of the current care needs of people using the service. One person has pressure damage to heels and is overseen by the District Nursing Service. She has a soft form mattress, although an alternating mattress has been requested but not made available and also sits on a propad special cushion - seen whilst she was sitting in the lounge. The person requires 2 hourly turning in bed, this is apparently done but there is no turn chart. This is recommended as evidence of nursing instructions being carried out. The care plan stated that there were pressure areas on hips, elbow and heel. The heel only remains damaged, other areas had healed, but this was not clear. This person is a choking risk on a liquidised diet, has been assessed by the dietician who can be contacted directly by the home if there are any concerns. Nutritional deficits are monitored with regular weighing and food supplements. The care plan stated bed-rest after lunch, this advice had been changed by the District Nurse but the care plan not amended. Monthly reviews of care plans are shared between the Manager, Deputy and Senior Carers – some good evaluations were seen as summaries of the monthly progress being made. We spoke to a visiting District Nurse who confirmed she was currently seeing 4 people, providing wound care for 3 and blood monitoring for the other. She said that staff were cooperative and keen to following instructions given. There has been a recent change in the oversight of care homes by the Nursing Service, meaning that staff on both sides had to establish new working relationships. The District Nurse felt that all were working together to resolve some outstanding issues. A recommendation of the last report to review and update risk assessments within care plans has been addressed, at least in part. It was noted that many risk assessments were generic (pre-populated assessments with names added) The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 15 An example seen was a risk assessment for Hot Water that was in all plans seen. More individualised risk assessments are needed. We looked at the medication system in use in the home. A new version of the Monitored Dose System has been introduced to replace the former cassette system. Staff feel this is better and medication is more secure. No one self-medicates at this time, although this sometimes happens when people have respite care. The last dose of medication given to a person 5 times per day is decanted for night staff to administer after the medication is locked away. This is not satisfactory and it was agreed that a dosette box could be provided by the pharmacy for this medication. The person presently signing the Medication Record is not the person administering the medication. This will be changed too. In relation to the same person, records showed that analgesic medication (for moderate/severe pain) was out of stock for 4 days. This was due to pharmacy error and provided after 4 days. Aqueous cream without prescription or label was seen in a toilet area and removed for destruction immediately by the Deputy Manager. Multi-use of creams should not be used because of potential cross-infection. MAR (Medication Administration Records) sheets did not have a count of all medication. It is important that all medication received is recorded and medication brought forward from the previous period added, so that an ongoing count/audit of medication can be carried out at any time. A recommendation to provide a fridge for medication requiring storage at required temperatures has been purchased and is in use. Prescribed creams on MAR sheets presented some confusion. There is a separate list of creams for carers to sign when administered. These records were poor, the cream type not stated and there were no instructions about when and where the cream should be applied. These records did not match MAR sheets - for example, the MAR sheet had been consistently signed but there were gaps on the carer’s signature list. It is important to establish a clear process for the administration of creams so that treatment prescribed can be evidenced. Care plans should contain information about the treatment required– we saw daily records stating “all care given – cream applied” The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): 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 using the service can make choices about their daily lives and benefit from an improved range of activities available to them. EVIDENCE: This outcome area was rated poor at the time of the last inspection. The reasons were that views of the garden were restricted and people unable to access it due to pending building works. There were few activities and it was recommended that people should be consulted about the activities arranged for them. There was no recording/evidence of activities. Surveys from people indicated more activities were needed at that time. Progress has been made in this area. The building work, previously on hold, has commenced. Willow screening has been erected to screen the building works and the patio in use with tables and seating enhanced by flower pots. Although a temporary arrangement, people The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 17 are using this area to enjoy the summer months until the building work is completed. During the past year people have been consulted about the type of activities they would like and the results summarised in the AQAA are as follows: ‘ We have regular short story readings, which are popular with residents. Contacts with the local Pentecostal Church made and group have visited to entertain residents with music and singing. Two people go out weekly in a mini-bus to the local church. Two people go to the pub weekly for lunch. There are photographs of outings and activities. A range of resources made available for activities including a Wii, and projector to facilitate word searches, and crosswords. We have made our own themed song sheets that residents enjoy’ These changes were confirmed in discussions with people using the service who also said that reminiscence boxes were used too that they enjoy. Unfortunately activities are still not recorded and it was suggested that, for ease, they could be included in the daily notes for each person. When asked what activity was provided for the most dependent person who has high physical dependency and communication needs due to dementia, staff said that she is given hand massage, they read to her regularly and she ‘flicks’ though old magazines she remembers. She has specific allocated time one to one. In the surveys we received from people using the service 7 people said that activities were provided ‘always’ and 4 people said they were provided ‘usually’. This is a vast improvement on the views expressed at the time of the last inspection. Views expressed by people during the inspection and from written surveys received were: “The home does most things well, the staff are very good and Bill (Manager) is very good to me” “People are friendly, I enjoy the company. I go to the pub once a week. I enjoy the meals, I’m quire happy with things as they are” “The staff are good, I feel safe here” “Food is good, all staff are lovely we get checked on at night by the excellent night staff. We came here in an emergency, we didn’t know where we were going or where The Chimes was, but we have settled well” Comments from relatives included: “They take care of my dad’s needs, keep him clean and well looked after, they do a good job” “Staff are kind and patient, my mother always appears cared for. Staff always find time to talk about any aspect of my mother care with me”. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 18 There was evidence of chosen lifestyles – few people were up at 8.30 am, rising later, some having breakfast in their rooms. People were seen accessing their bedrooms during the day, someone who prefers to spend all her time in her room and has all meals served there made very positive comments about the home and staff and the good service she has received in the last five years. All people spoken with said that food choice and quality was good, there were no complaints. The dining room is located at the front of and central to the building. It is bright, attractive with well-laid and well presented tables and seating. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 – 18 were inspected on this visit. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Amendments to the complaints procedure will ensue people are clear about how to make a complaint. People are protected from abuse and their rights are protected. EVIDENCE: The complaints procedure is available in the reception area of the home for visitors and all people using the service have been given a copy. The procedure is not satisfactory. It implies that complaints can only be made in writing and tells people to “ask for the complaints book”. The procedure needs to be amended and made more user-friendly and relevant. A recommendation of the last report to provide a more robust system of documenting and recording complaints, with outcomes has been addressed. The new format is much improved. The home have not received any complaints since the last report and we have not received any. There is a suggestions box in the hallway that allows anonymous comments/complaint from people. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 20 It was a recommendation of the last report that staff are given training in Safeguarding Vulnerable Adults. All staff, with the exception of one, attended a training course in November 2008. No referrals have been made under the Safeguarding Vulnerable Adults procedures since the last inspection. The AQAA states: “Staff are trained to recognise possible signs of abuse and know the correct action to take. Zero tolerance of any form of abuse towards residents” Two senior staff attended a training course relating the Mental Capacity Act and Deprivation of Liberties in March this year. This training is being cascaded to staff. No applications have been made to date under the Deprivation of Liberties legislation. The AQAA states: “The home operates an opinion that each resident has capacity to make all their own decisions unless proven otherwise. Staff are aware that a persons capacity may change daily and will assess each individual decision”. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): Standards 19 – 26 were inspected on this visit 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. Improvements to the environment mean that people live in a safe, well maintained, comfortable and homely setting. EVIDENCE: Some areas of the environment were poor at the time of the last inspection and recommendations made to re-carpet the lounge and corridor areas and to upgrade the 3 main toilet areas on the ground floor. This work has all been completed. The lounge, dining and corridor areas on the ground floor have all been re-carpeted with quality carpeting and this has made a vast improvement to the presentation of all those areas. The three The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 22 toilet areas have been upgraded and provide much improved presentation and facilities. There was concern at the last inspection that people were unable to access the garden and there were restricted views due to the building works. As stated earlier in this report the building work is underway after a delay, the area has been screened and people can use the patio area created. This has resolved the concerns raised previously. A new fitted kitchen has been installed and soap/paper towel dispensers installed in the bathroom/toilet areas, improving infection control in those areas. There has been redecoration of many areas. The fire risk assessment for the building is reviewed monthly. We saw individual fire risk assessments for each person with care plans. Accommodation is on 3 floors with bathing facilities on each floor. There are two assisted baths and a shower room. About half the bedrooms have ensuite facilities. The building works have continued as stated. Work for completion of the new extension expected to be completed by December 2009. People using the service said that the builders were “very friendly” and they look with interest at the progress being made. It was noted that the external windows at the front of the building require painting, many have bare wood exposed. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): Standards 27, 28 and 30 were inspected on this visit. 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 can be sure that their needs are met by the numbers and skill mix of staff that are adequately trained. EVIDENCE: Two areas of concern in relation to staffing were expressed in recommendations in the last report. They were that staff should receive training in the Mental Capacity Act 2005 and updated training was required in relation to Fire, Moving & Handling, Infection Control, Abuse and Protection. As stated earlier in this report two senior members of staff have undertaken training in the Mental Capacity Act and Deprivation of Liberties Safeguarding and this has been cascaded to staff. The staff training matrix was not available on the day of inspection but e-mailed to us as promised the following day. This showed that all staff had Moving & Handling training in January 2009, all staff with the exception of one had training in Safeguarding in November 2008, all staff have now had training in Infection Control over the period April 2008 to May 2009. Fire training has also been provided. The recommendations have all been met. Additionally 3 staff have had training in The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 24 End of Life Care, 5 in Mental Health Needs and all in managing MRSA infections. At this time 82 of care staff have completed NVQ training. Two domestic staff have achieved NVQ2 in Housekeeping and the cook NVQ2 in Hospitality and Catering. There has been other training that some people using the service have also been involved in they include: Diabetes, Optical care and First Aid. It was not possible to access and inspect staff files on this visit due to the Provider/Manager being away for the day and holding keys for access to the records. There were no concerns about recruitment practices at the time of the last inspection and staff files will be inspected on the next visit. Staffing levels were reviewed: On the day of this unannounced inspection there were 3 Carers on duty (one is always a Senior Carer) plus the Deputy Manager. Domestic and catering staff were also working in the home and an additional carer who works 8 – 12 on five days exclusively to bath people - this is provided as a result of people asking for more baths and in the mornings. It also caters for some people having respite care who want daily baths. Staff were all pleasant and helpful and keen to be involved in the inspection process. There appeared good relationships and positive engagement between staff and people they were caring for. We received written feedback from 10 members of staff, there were no negative comments and many positive ones including: “We do our best to ensure the residents are happy and their needs are met. I feel as a carer that the whole team support each other” “There is good communication amongst staff, I enjoy coming to work each day. If there is a problem it’s reported and dealt with straightaway”. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): Standards 31 – 33 and 36 – 38 were inspected on this visit. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home should review some areas of recording and medication and also improve the quality assurance system to make sure that best practice is available to all who use the service. EVIDENCE: The Registered Manager has 9 years management experience in the home and has completed the Registered Managers Award (RMA). The Deputy Manager has 8 years experience in the home and has also completed the RMA. A Senior Carer has completed NVQ4 in Management. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 26 At the time of the last inspection care staff were not receiving supervision 6 times a year as stated in the National Minimum Standards. Supervision was commenced following the inspection and efforts have been made to provide this on a regular basis, there have been some shortfalls but this is being “pulled back”. The Deputy Manager focuses on providing supervision for all, but perhaps this should be shared with other senior staff. Annual appraisals have commenced. The AQAA states that plans for the next 12 months include “Improving upon current appraisals and supervision sessions” There are meetings for people using the service but no meetings for relatives. Quality Assurance feedback is obtained from people using the service and their relatives by annual surveys, but there is a poor response. It was suggested that the Quality Assurance assessment is extended to GP’s, Health Professionals, Social Workers and other visitors. The AQAA states: “We plan to review our resident satisfaction survey questionnaire and to use this frequently throughout the year so that we can increase the amount of information available to us”. Discussions and inspection of records revealed that the service were not notifying us of all accidents where injury was involved. This must be done under Regulation 37 of the Care Home Regulations. In relation to records the care planning system needs to be reviewed and streamlined to provide a current working document for care staff. The pre-admission assessment tool is inadequate and should be replaced. The complaints procedure should be re-written. Activities provided for people should be recorded/evidenced. Turn charts should be provided as evidence of nursing instructions followed. Some practice issues could be improved around areas of medication in relation to the use of creams and count of medication for audit purposes. Progress has been made in many areas since the last inspection and the home can continue to make progress in the areas mentioned. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 2 3 The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 28 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 2 3 Refer to Standard OP3 OP7 OP8 Good Practice Recommendations Review the pre-admission assessment tool and inform people in writing before admission that their needs can be met. This will provide clarity for assessments. Care planning formats should be reviewed and streamlined to provide a current working document to meet people’s needs. Provide written charts that record when people are turned in bed. This will ensure compliance with nursing instructions. There should be a count of all medication available in MAR sheets. This will enable an audit of the system at any time. Review the system for administering and recording the use of creams. This will ensure people have the correct treatment prescribed DS0000008211.V376785.R01.S.doc Version 5.2 Page 29 4 OP9 5 OP9 The Chimes 6 7 8 9 OP9 OP12 OP16 OP38 All creams must be labelled and not left in communal areas for multi-person use. All activities should be recorded as evidence of the level of service being provided for people. Amend the complaints procedure to provide a clearer and more user-friendly document All accidents requiring medical attention must be notified to us as required under Regulation 37 of the Regulations. The Chimes DS0000008211.V376785.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission West Midlands Region 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. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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