Inspection on 02/08/05 for Chalfont Lodge Nursing Home

This inspection was carried out on 2nd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chalfont Lodge Nursing Home 18/07/07

Chalfont Lodge Nursing Home 21/06/06

Chalfont Lodge Nursing Home 28/02/06

Chalfont Lodge Nursing Home 21/03/05

Chalfont Lodge Nursing Home 25/11/04

Chalfont Lodge Nursing Home 06/01/04

Chalfont Lodge Nursing Home 25/09/02

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chalfont Lodge Nursing Home Denham Lane Chalfont St Peter Bucks SL9 0QQ Lead Inspector Mike Murphy Announced 2nd August 2005 9:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chalfont Lodge Nursing Home Version 1.10 Page 3 SERVICE INFORMATION Name of service Chalfont Lodge Nursing Home Address Denham Lane, Chalfont St Peter, Bucks, SL9 0QQ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01753 888002 Barchester Healthcare Plc Mrs Mary Dannfald Care Home 119 Category(ies) of Dementia (48), Old age, not falling within any registration, with number other category (43), Physical disability (28) of places Chalfont Lodge Nursing Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Chalfont Lodge is a large purpose built nursing home set in pleasant landscaped grounds adjacent to Gerrards Cross golf course and approximately two miles from the centre of Chalfont St Peter. It is operated by Barchester Healthcare PLC which according to the home’s statement of purpose owned 73 nursing and residential homes across the country. That number has now increased to 163 with the acquisition of Westminster Healthcare in October 2004. The home can accommodate 119 service users across three categories: younger physically disabled, elderly physically frail, and elderly mentally frail. The home provides for a wide range of needs and abilities. All areas of the home are accessible by wheelchair. All 93 single rooms and 13 double rooms have en-suite facilities. Room sizes exceed the minimum standards. A first level nurse is in charge of each of the three operational areas: (i) Turnberry Unit (for younger people with a physical disability), (ii) Sunningdale Unit (for physically frail older people), and, (iii) Gleneagles, Wentworth and St Andrews Units (for mentally frail older people). Prospective service users are visited at home and assessed by an experienced nurse prior to admission. This helps both parties to decide whether the home is able to meet the person’s needs. There are many communal areas in the home including a library and large conservatory which overlooks a small lake. The home’s dining room provides a pleasant ambience and good quality food is served by waiting staff. The home aims to provide good standards of care and good hotel facilities. Chalfont Lodge Nursing Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted by two inspectors over two days. The methodology included consideration of pre-inspection information provided by the manager, reading documents, talking to residents, staff and visitors, observing activity and consideration of comment cards completed by residents and healthcare professionals. The inspection took place at a time of change for the home. The previous home director (and registered manager) had been promoted to the post of regional manager. A new manager had been appointed. The head of the elderly mentally frail (‘EMI Unit’) unit had transferred to another home and that post was being filled on a temporary basis by one of the unit managers. Changes were also imminent in the organisation of staff training. Although standards relating to the premises were not assessed on this inspection (they will be assessed on the second inspection this year) it needs to be said that the home is located in very pleasant landscaped grounds in green belt countryside a short distance from Chalfont St Peter. The overall quality of the environment is high. The home is comprised of three distinct services: a service for people who are physically disabled, a service for older physically frail residents, and a service for older mentally frail residents (EMI). Although each of the three groups share common activities (such as assessment and care planning or good practice in medicines administration), each also has its own distinct activities (such as the nature and mix of multidisciplinary work or programmes to stimulate memory, identity and cognitive functioning). The implications for inspection are that it can be difficult to distil such diversity down to a single rating for each standard. The detail of the findings under each standard is summarised in the narrative. The arrangements for processing a referral are good. Prospective residents are sent information on the home and if the referral is progressed an assessment is conducted by an experienced registered nurse. A fuller assessment is carried out during the first few weeks of admission which is considered a trial period. For those who remain resident care planning is then an ongoing process. The inspection found some variation in practice between units. The home provides a varied range of activities for residents which are coordinated by two activities organisers. Activities include discussions and quizzes, varying forms of music activity – including music therapy at different levels, art therapy, presentations, outings and a specially designed range of activities under the ‘Memory Lane’ Programme. This initiative has great Chalfont Lodge Nursing Home Version 1.10 Page 6 potential to improve the quality of life of residents in the EMI units providing it is supported by an ongoing programme of staff training and support. Menus are varied and nutritionally balanced. Residents expressed a high level of satisfaction with the quality of the food. The main dining room has a particularly pleasant ambience. Complaints processes are generally satisfactory but inconsistent descriptions in different documents need to be addressed by managers. The policy on abuse had been copied from the Croner manual and, while comprehensive, has not been adapted to take account of local arrangements established by statutory agencies. It did not include details of local confidential reporting arrangements. Staff numbers and skill mix appear satisfactory (although some pressures were mentioned in the EMI units) and the home offers a varied ongoing training programme. Weaknesses in recruitment procedures persist and while the position has improved since the last inspection those relating to ‘POVA first’ checks and the status of references must be addressed and corrected without delay. The effective implementation of the ‘Memory Lane’ initiative carries good potential for improvement in the quality of life of residents with dementia providing it is supported by an ongoing programme of staff training, supervision and support. Feedback from stakeholders was generally favourable in terms of residents feeling safe and their liking living in the home and with regard to medication and satisfaction with the overall care provided in the home. However, there were also indications of communication problems which would merit further exploration by managers. The new manager had been in post for less than three months at the time of this inspection. The previous manager (registered manager) had been promoted to the post of regional manager. The home’s policies and procedures minimise the risk of residents sustaining injury. In summary this is a large home meeting a diverse and complex range of needs. While this inspection finds the overall quality of the service to be very good it also identifies some shortfalls that need to be addressed. The inspectors would like to thank the residents, staff, visitors and managers for their time and hospitality and all those who took time to complete and return comment cards. Chalfont Lodge Nursing Home Version 1.10 Page 7 What the service does well: What has improved since the last inspection? Modifications to the environment in the EMI units through the placement of objects designed to evoke memories and stimulate conversation and activity. The home has begun to train staff in the use of the ‘Memory Lane’ programme. Although the effects of this are only beginning to be seen the programme appears to have the potential to affect and modify the model of care in the EMI units and consequently improve the quality of life of residents. Chalfont Lodge Nursing Home Version 1.10 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chalfont Lodge Nursing Home Version 1.10 Page 9 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 Standards Statutory Requirements Identified During the Inspection Chalfont Lodge Nursing Home Version 1.10 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 The home has revised its statement of purpose and service users’ guide which together provide referrers and prospective residents with key information on the home. These, combined with a visit, should assist in making an informed choice in progressing an enquiry or referral. The needs of prospective residents are assessed prior to admission in order to ensure that the home is able to meet resident’s needs. A plan of care is in place for each resident. This is based on pre-admission assessment and further assessment on admission and includes the involvement of specialist or external healthcare practitioners where necessary. This aims to meet the resident’s needs. The first four weeks of admission are considered a trial period which enables both the resident and the home to decide if it can meet the resident’s needs. EVIDENCE: The service users’ guide and statement of purpose were revised and updated in June 2005. For the purposes of this inspection the documents which are in a Chalfont Lodge Nursing Home Version 1.10 Page 11 single folder were read together and as such meet all elements of this standard. The statement of purpose fully meets the requirements of Schedule 1 of Regulation 4 (a). The service users guide includes a summary of the statement of purpose, a description of the services provided, a statement of the aims and objectives of Barchester Healthcare, the residents charter, the ‘aims and philosophies’ of the home, a copy of the complaints procedure and a reference to ‘visits by persons in control’. The service users’ guide meets all elements of Regulation 5.1 with the exception of 5.1 (d) a reference to the most recent inspection report. The document also includes copies of the terms and conditions of admission and ‘resident’s admission agreement’ which together conform to most elements of standard 2 in stating the room to be occupied, overall care and services provided, fees payable, services for which additional fees are payable, terms and conditions of occupancy and period of notice. There is not an explicit statement of the rights and obligations of the registered provider although these may be implied at various points. Prospective residents are assessed by a senior member of staff who is also a registered nurse. The head of the unit to which the person may be admitted (who is also a registered nurse) may also participate in the assessment. In the case of prospective residents funded by health or social services relevant information relating to the needs of the person is made available to home staff. A full assessment of needs is carried out on admission and forms the basis of the plan of care. The home either employs or facilitates access to other services including general practitioners, specialist nurses (including tissue viability, continence or multiple sclerosis nurses), physiotherapists, opticians, music therapist, art therapist and others. Staff recruitment and training programmes are aimed at ensuring that staff have the relevant skills to meet residents needs. Prospective residents may visit the home to view the facilities and talk to staff and the contract includes a condition that the first four weeks of residence is regarded as a trial period. The home does not offer intermediate care at present. Chalfont Lodge Nursing Home Version 1.10 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9.10 The care plans in the units for younger people with physical disabilities and physically frail older people give carers the information they need to meet resident’s physical needs. They do not contain sufficient information to assist carers to help residents fulfil their emotional and psychological needs. An in depth falls risk assessment would help minimise the risk to residents from falling. The care plans in Wentworth Unit were based on comprehensive assessments but entries in the daily record were very limited and did not reflect the ‘person centred’ approach espoused in the statement of purpose for this service. They did not contain sufficient information to assist carers fulfil psychological and social needs and did not reflect implementation of the home’s ‘memory lane’ programme. Residents healthcare needs are met with good evidence of multidisciplinary team working. Medication is managed well and residents receive their medication in a safe and timely way. Staff treat residents with courtesy and respect and uphold residents right to their privacy and dignity. Chalfont Lodge Nursing Home Version 1.10 Page 13 EVIDENCE: The home uses a system for recording care planning which has different pages for different activities. A comprehensive ‘long term assessment’ forms the basis for the care plan. Needs are identified from this (and from information obtained through pre-admission assessments) and a plan of care constructed. Care plans were examined in all three areas of care. Turnberry Unit (Younger people with a physical disability). Four residents were selected at random and their care tracked. All had had their needs assessed prior to their admission and had care plans in place. There was good evidence of multidisciplinary team input in the care plans. There were plans for daily living and a range of risk assessments including Waterlow assessments and nutritional assessments. The daily entries and monthly evaluations had been signed and dated. One resident had signed his own care plan and one family member had signed the care plan of a resident who was unable to sign his own. The care plans did not contain detail of residents emotional and psychological care needs. One gentleman’s condition had improved since the last inspection although his improved cognitive ability was not recorded in the care plans. The activities that are undertaken by residents are now recorded on their care plan. Sunningdale Unit (Physically frail older people). Four residents selected at random and care tracked. All had pre-assessments and care plans in place. There was evidence of multidisciplinary team input. The care plans had been updated monthly. There were some gaps in the daily entries. Not all care plans had life histories or sufficient detail about emotional and psychological needs. There was evidence of activities in the plans. The accident book held records of residents falls. One gentleman was recorded as having a number of falls. His care plan noted this and there was a limited risk assessment. Care would be enhanced by developing an in depth falls assessment in line with good practice in NHS and guidance in The National service framework for Older people. Wentworth Unit (Elderly mentally frail). Four resident care plans were selected at random. All had comprehensive assessments of need covering physical and mental health, pressure sore risk, nutrition, moving & handling, and overall dependency. One of the four plans examined had a more detailed falls assessment. Registered nurses and care workers recorded care in different sections. Medical input is recorded in a separate sheet. Participation in social activities is recorded using codes for different activities. Daily records were limited to brief descriptions of care provided and in one case the worker had recorded the same entry, apparently for two different residents since two Chalfont Lodge Nursing Home Version 1.10 Page 14 names were used, twice in a single care plan. The statement of purpose says that ‘The care provided has a Person Centred focus highlighting the uniqueness of the individual aiming to maintain the concept of personhood and wellbeing’ (page 23 of copy supplied for inspection refers). A ‘person centred’ focus was not reflected in the daily record section of care plans examined. There may be many reasons for this. From observation of interactions between staff and residents it is possible to speculate that records may not reflect the range of activities in which residents participate or the overall range of care provided. This may reflect some limitation of this method of care planning for people with dementia. It may also reflect a need for staff training or audit of care plan practice compared to standards drawn from the person centred approach. In the younger physically disabled and older physically frail units the residents whose care was tracked were well groomed and carers had assisted them with their personal hygiene needs. All had Waterlow assessments and plans of care to prevent pressure damage. They had the appropriate mattresses to minimise the risk of pressure damage. They had had nutritional assessments and had been weighed regularly. The home has the services of a dietician. Residents continence needs are assessed against criteria issued by the Buckinghamshire Continence Service and the Primary Care Trust provides the appropriate aids. There was evidence in the care plans that residents had access to a physiotherapist. Residents are registered with a local General Practitioner who visits weekly. There was evidence in the care plans that residents are referred to secondary health care services when necessary. There was also evidence in the care plans that residents have had access to chiropody and sight tests on a regular basis. A number of residents suffer from multiple sclerosis and the local Multiple Sclerosis Specialist nurse attends the multidisciplinary team meeting on a monthly basis. Residents have recently received vaccination against influenza. Residents in the elderly mentally frail unit were seen by a GP as required and medicines were reviewed twice a year or more often if required. A psychiatrist from Wexham Park or High Wycombe hospitals visited twice a year to review specialist medical care. Some residents had been seen by a neurologist from Amersham hospital. Psychologists are accessed through the GP. Physiotherapists are available for advice or to carry out treatment for individual residents. Notes on nutrition were on file. The unit was beginning to implement the ‘memory lane’ programme and objects to evoke memories and discussion were on display in places. ‘Conversation Starters’ prompt cards were available to staff to develop interest and explore resident’s reactions to the objects. The music therapist does two sessions a week. Birthdays are celebrated and on the afternoon of inspection the home provided a cake and hats to celebrate a resident’s birthday. The occasion had a warm feel to it, residents participated in varying degrees and it seemed to be a very positive experience for those involved. Chalfont Lodge Nursing Home Version 1.10 Page 15 There are medication policies in place. A dosette system is in place. Controlled drugs are stored correctly. There are three books for recording controlled drugs on each unit. These were completed correctly. The medication administration records were completed accurately. There are drugs refrigerators on each unit. The temperatures are monitored and within the expected range. No drugs were found to beyond their expiry date. Drugs were labelled with their date of opening. The home has recently established a contract with Vantage chemists. There was evidence that the pharmacist audits the medication records regularly although with the new contract it will be necessary to ensure that these audits are continued. There was evidence in the care plans that the general practitioner reviews residents medication needs. The temperature of the medicines room and the drugs fridge are recorded daily. Copies of guidance from the Nursing and Midwifery Council (NMC) and Royal Pharmaceutical Society are available for reference. Overall, good practice in relation to this standard. Residents privacy and dignity is respected. Staff knock before entering bedrooms. Residents are addressed by their preferred names. Personal care, examination or treatments are carried out in the privacy of resident’s bedrooms. Chalfont Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Overall the range and amount of organised activities in the home has improved since the last inspection and provide residents with interest and variety in the day. There is a need to ensure that residents are given the opportunity to go out more and to remain in contact with their local community where they wish to do so. The ‘Memory Lane’ programme is an excellent initiative with good potential to improve the quality of life for residents with dementia. Its successful implementation however will depend not just on effective utilisation of the resource package but on an ongoing programme of staff training and support. Residents are able to maintain contact with friend and family where they wish to do so. The dining room is attractive and the meals are of a high standard providing residents with a well balanced diet in a pleasant ambience. Presenting pureed foods in a more attractive manner and for carers to assist residents more discretely would enhance the mealtime experience of frail residents EVIDENCE: There are two activities coordinators. Both undertake group and individual activity. In addition residents have the opportunity to pay for the additional service of a ‘buddy’ who works with them alone for a designated time. The Chalfont Lodge Nursing Home Version 1.10 Page 17 amount and frequency of organised activity has improved since the last inspection. The activities coordinators now record their work in residents individual care plans and are treated as part of the multidisciplinary team. There are group activities in the lounge in the morning as well as individual activities. The home has a minibus which is used for trips to the local shops. There are three drivers in the home although they have permanent roles and therefore their time is limited. Some residents go out with their families. The range and frequency of activities has increased since the last inspection although the size and location of the home does mean that residents cannot go out unless on an organised trip or at time convenient to the limited number of drivers. There is a music therapist who works with residents and uses music to meet therapeutic and social needs. He runs a choir which one resident spoken to said that she particularly enjoyed. The home has recently begun to implement Barchester Healthcare’s ‘Memory Lane’ programme in its units for people with dementia. According to the organisation’s publicity the programme aims to maintain ‘personhood’ (‘identity, dignity and feelings of worth’), independence, provide specialist activities and therapies and to involve relatives. Implementation of the programme is supported by an excellent resource package. The acting head of the EMI unit was involved in implementing the programme. Evidence of its development included a cascade training programme for staff, availability of resources (such as the ‘conversation starter’ prompt cards referred to above), and most visibly, areas of the unit in which objects designed to evoke memories or stimulate activity are set out. It is reported that the programme is leading to more activities and consequently more interactions between staff and residents. Its implementation is to be audited over the latter half of the year. The Gleneagles Unit has an activities programme for residents who are unable to attend main activities sessions. To quote, the programme ‘suggests activities which carers can lead, with the help and advice of the Activities Department). Activities include: music, TV, music & movement, walks, individual activities and aromatherapy (to be used by staff who have received training). Residents can see their relatives in their rooms. The visitors spoken to said that they were welcome at any time. One resident on the young disabled unit has installed a doorbell to her room which reinforces the fact that her room is her home. There do not appear to be restrictions on when friends and families can visit nor on times when residents, with the exception of those in the elderly mentally frail unit, can go out or return. The location of the home, whilst beautiful, does not allow for easy access to the local community groups. Chalfont Lodge Nursing Home Version 1.10 Page 18 Menus are varied and nutritionally balanced. The residents spoken to all said that they enjoyed the food and that they had a choice. The meals tasted on the day of the inspection were of a high standard and the dining room was attractively laid out. The pureed foods were served using an ice cream scoop. The home’s own audit tool had shown that moulds were not in use. These should be considered. One carer was seen to be standing to assist two ladies at a time with their meal. This is not acceptable. Residents must be assisted one at a time and carers should sit alongside the resident. Chalfont Lodge Nursing Home Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home’s complaints procedures aim to ensure that complaints by residents will be promptly investigated. However, different versions appear in the service users’ guide and in the statement of purpose which is not be helpful. The policy on adult protection and abuse is copied from the Croner manual and has not been adapted to ensure that it fits with local joint agency reporting and investigation procedures. As such it fails to fully protect residents by failing to comply with those procedures. EVIDENCE: The complaints procedure is outlined in the service users’ guide and the statement of purpose. In the former it consists of two paragraphs and is not specific either to the home or to the local office of CSCI (described in the procedure as ‘…or the Registering National Commission for Care Standards.’). In the latter the procedure is very specific to the home, to the director responsible for quality and care and to the local office of CSCI. The home should have one procedure and should amend the reference to CSCI by stating that a complainant may refer the complaint at any stage to CSCI in order to fully conform to this standard. In practice however the home responds promptly to complaints and maintains records in the administration office. The policy on abuse was being reviewed at the time of this inspection. The document supplied was a copy of the policy on ‘Adult Abuse and Protection’ from Croner’s Home Management (Issue 31). This is a comprehensive document but is expressed in general terms and as such does not take account of local joint statutory agency arrangements, nor does it include local agencies Chalfont Lodge Nursing Home Version 1.10 Page 20 to which abuse may be reported (including for example the local office of CSCI or the confidential Social Services funded ‘Careline’ telephone line). The home holds minimal amounts of cash for residents. The system was briefly examined and weaknesses in recording were found. These were discussed with administrative staff and the manager. Chalfont Lodge Nursing Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards in this section were not examined on this inspection but the home presents and maintains a high quality environment. EVIDENCE: Chalfont Lodge Nursing Home Version 1.10 Page 22 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The staff establishment appears sufficient both in numbers and skill mix to meet resident’s needs. Weaknesses in staff recruitment processes pose a risk to residents. The home maintains a good training programme to provide staff with the skills to deliver the care required. EVIDENCE: The nursing and care staff establishment has not changed since the last inspection. Section D2 of the pre-inspection questionnaire (‘staffing levels and service user dependency’) was not completed. A printout of the ‘Employee Selection Form’ (listing names of individuals but not position or hours) and daily staffing of Turnberry, Sunningdale and Gleneagles Units was supplied. These are as follows: Turnberry Unit (25 places: ‘Young Disabled’). Early: 10 staff (including 2 RGNs). Late: 7 staff (inc. 1 RGN). Night: 3 staff (inc. 1 RGN). Sunningdale Unit (43 places: ‘Elderly Frail’). Early: 11 staff (including 2 RGNs). Late: 9 staff (inc. 2 RGNs). Night: 4 staff (inc. 1 RGN). Early and late shifts are supplemented by 1 waitress. Gleneagles Unit (48 places: ‘Mentally Frail’). Early: 10 staff (inc. 2 RGNs). Late: 9 staff (inc. 2 RGNs). Night: 5 staff (inc. 1 RGN). In addition to nursing and care staff the home employs a managerial staff, a physiotherapist, a music therapist, activities organisers, catering, administrative, domestic, and maintenance staff. Chalfont Lodge Nursing Home Version 1.10 Page 23 According to information supplied by the home, at the time of this inspection seven care staff had already acquired NVQ2 in care. Of those seven four were pursuing NVQ3 and another thirteen were pursuing NVQ 2. The percentage of carers holding NVQ2 at the time of the inspection was not provided but if all of those currently pursuing NVQs are successful then the home might be on track to achieve 50 by the end of 2005. The home manages recruitment of staff in conjunction with the organisation’s human resources department in Oxfordshire. Applicants are required to complete an application form, attend interview, provide two referees, have an enhanced CRB certificate and a ‘POVA first’ check if starting employment before the enhanced CRB certificate has been obtained. Staff files should contain the information currently required under Schedule 2 (Regulations 7,9 and 19). There should be a policy setting out the supervision arrangements of staff employed with a POVA first check. Staff should receive a copy of the GSCC codes of practice. Four staff files were examined. The position had improved since the last inspection and files were in good order. However, some irregularities were noted. One employee had started work two days before a POVA first check had been received. Another started employment ten days before a POVA first had been obtained. A policy governing the supervision of ‘POVA first’ employed staff was not in place (as outlined in annex C to DOH POVA guidance in July 2004). The status of references was not always clear i.e. the status of the referee, their relationship to the employee or, in the case of open or photocopied references, evidence that the reference had been verified by Barchester Healthcare managers. One file had neither a POVA first or CRB certificate. Systems for verifying RGN qualifications were in order. All staff had been issued with a copy of the GSCC codes of practice. Staff gave positive accounts of the home, of managers and appreciation of opportunities for training. However, staff in the EMI units expressed a wish to be able to spend more time with residents. It was said that there are always basic tasks to do and that additional staff time at peak periods would enable staff to give more time to individual residents. To date staff have benefited from a well organised training department. The structure was changing at the time of this inspection and it was unclear what the new arrangements will be. This may be a consequence of organisational restructuring following the recent takeover of Westminster Healthcare by Barchester Healthcare. The training manager was transferring to another home and the training assistant had moved on to another post within the organisation in the spring of 2004 and was not to be replaced. The training programme for 2005 was supplied to the inspection. An induction programme is run at the beginning of each month. The NVQ programme is Chalfont Lodge Nursing Home Version 1.10 Page 24 ongoing and has been referred to above. Two administrative staff have completed NVQs 2 and 3 in customer service and administration respectively. According to information supplied four RGNs are trained as NVQ assessors. The programme for night staff is run twice a month and staff are required to attend in order to meet the mandatory requirement. The transport schedule is changed accordingly so that staff without their own transport can attend. Training sessions are run on a wide range of subjects throughout each month. A particular subject for training this year will be dementia care. The organisation is aiming to develop NVQs in dementia care. Chalfont Lodge Nursing Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 & 38 The manager has over two years experience in a care home with nursing and is in overall charge. Lines of accountability within the home are clear. This maintains an organisational structure which supports efficient provision of care to residents. Overall the homes policies and procedures minimise the risk of service users sustaining an injury. There is a need to ensure that fire safety records are maintained to prevent the risk to service users should there be a fire. The grounds are attractive but service users access to them is limited by the lack of accessible paths EVIDENCE: A new manager has been appointed following the promotion of the previous post holder. She is a registered general nurse (RGN), a qualified assessor and had recently successfully completed a law degree. The manager had been in post for two and a half months at the time of this inspection. The manager had Chalfont Lodge Nursing Home Version 1.10 Page 26 previously been the registered manager for another care home with nursing in Buckinghamshire and is therefore familiar with conditions associated with old age. The manager is accountable to the regional manager. Lines of accountability within the home seem clear - four staff are directly accountable to the manager; the clinical manager, home affairs manager, chef and the maintenance man. Care staff are accountable to the manager through the clinical manager. Ten comment cards were received in advance of this inspection. Respondents communicated a mixed account of the home. All resident respondents liked living at Chalfont Lodge and felt safe there but added the understandable comment that they would prefer to live in their own home. There were mixed reports on whether residents felt well cared for and were well treated by staff. One respondent added ‘All the staff have changed – I do not know who the manager is – language difficulties with foreign staff’. The majority of residents expressed a wish to be more involved in decision making within the home. The majority of residents knew who to talk to if they were unhappy with their care. Professional respondents seemed ambivalent about the extent to which the home communicated and works in partnership with them. Similar views were expressed about the staff understanding of residents care needs and of incorporating specialist advice into the residents care plan. There were no concerns about medication, about staff taking appropriate decisions when unable to manage the care needs of residents and all expressed satisfaction with the overall care provided in the home. None had received complaints about the home. There is a Health and Safety policy and procedures in place. The annual maintenance checks had been completed. A new fire safety logbook has been introduced by the organisation and the handymen were in the process of implementing its guidance. There is a need to undertake a fire risk assessment and to agree the local evacuation procedure. There is a need to ensure that the required monitoring of alarm systems and fire drills is maintained during the transition from the old logbooks to the new Fire Safety logs. The home was awarded the Chiltern District Award for Food safety in 2005 and last inspected by the Environmental Health officer in April 2005. There is a manual handling policy and the staff spoken to say that they had received manual handling training. Generic risk assessments are in place and were last updated in November 2004 Chalfont Lodge Nursing Home Version 1.10 Page 27 There is a low railing bordering the patio, which leads to a steep slope. This should be risk assessed and the risk to wheelchair bound and other mobile service users assessed and suitable changes made if necessary. There are also limited safe walking and disabled pathways for service users or families to walk along. There is no pavement alongside the main drive. Further disabled walkways would give service users greater opportunity to go into the attractive gardens Chalfont Lodge Nursing Home Version 1.10 Page 28 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 x x x x x x 3 Chalfont Lodge Nursing Home Version 1.10 Page 29 Yes Are there any outstanding requirements from the last inspection? 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. 1. Standard 1 Regulation Schedule 1 Requirement Timescale for action January 31 2006 January 31 2006 2. 1 3. 18 4. 29 The manager is required to compile a statement of purpose which contains the information required under Schedule 1 5 The manager is required to produce a service users guide which includes the information listed in section (1) (a) to (f) of this Regulation and that required under standard 1.2 13 (6) The manager is required to review the homes policy and procedure on abuse and to ensure that there is one procedure which takes into account the arrangements and procedures of local statutory agencies. 19 (1) (c ) The registered manager is required to ensure that staff recruitment procedures include verification of references and that the content of staff recrords retained in the home conform to Schedule 2 December 31 2005 September 30 2005 Chalfont Lodge Nursing Home Version 1.10 Page 30 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 7 Good Practice Recommendations It is recommended that the manager review current practice in recording care given in the EMI unit so that care records include a fuller account of the residents day and reflect a person centred ethos. It is recommended that the manager review references to the complaints procedure in the homes documentation so that one single procedure, conforming fully to this standard, is stated in all documents. It is recommended that, together with staff, the manager review staffing, work activities and workflow in the EMI units and ensure that care staff have sufficient time to spend with residents individually as well as completing essential tasks. It is recommended that the manager address potential weaknesses in financial procedures and ensure that all financial transactions involving residents monies are recorded. 2. 16 3. 27 4. 18 Chalfont Lodge Nursing Home Version 1.10 Page 31 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chalfont Lodge Nursing Home Version 1.10 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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