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Inspection on 21/06/06 for Chalfont Lodge Nursing Home

Also see our care home review for Chalfont Lodge Nursing Home for more information

This inspection was carried out on 21st June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is located in pleasant Chiltern countryside, the grounds are landscaped and it is adjacent to a golf course which provides a pleasant environment for residents. The interior environment is spacious and most areas are well decorated. Bedrooms and communal areas are of a good size, meals are served in a pleasant dining room and facilities for residents with a physical disability are good. The home provides good quality food, which, for those residents able to go to the dining room, is served in pleasant surroundings. The home received a Chiltern District Award for Food Safety in 2005 and `Hospitality Assured` accreditation in 2006. The quality of care in the unit for residents with a physical disability is of a high standard. The unit is well equipped, there is evidence of good multidisciplinary teamwork and residents report a high level of satisfaction with standards of care. A varied range of activities under the direction of activities organisers is offered including outings, talks, discussions, art, musical events and music therapy. The `Memory Lane` programme offers potential to improve the quality of life of people with dementia, providing its introduction is supported by ongoing staff training and support.

What has improved since the last inspection?

A new manager has taken up post who has indicated that he intends to maintain greater continuity than has existed since mid 2005. Although difficult to measure objectively CSCI inspectors received some reports of a clearer sense of direction, a mood which might be described as guardedly optimistic, and a drive to deal with matters which may not have been effectively addressed for sometime.

What the care home could do better:

The home must establish strict procedures in the recruitment of staff which include that applicants complete an application form with full details of previous employment and reasons for leaving any previous care position, that photocopied or open references are verified by managers, that staff are not appointed until the appropriate level CRB certificate or `POVA first` check has been obtained, and that where staff are appointed under a `POVA first` they work to a supervision policy with a named supervisor in line with DOH (Department of Health) guidance. Staff should take a wider view when planning, providing and recording care. This is important in all care areas but particularly in a home which provides specialist care for people with dementia. Ensure full implementation of Barchester`s own memory lane programme for residents with dementia. This promises real improvements in the quality of care for such people but evidence of its implementation is not as strong as expected. This may require additional resources or the designation of a member of staff to act as a project lead and mentor to staff to ensure that it is properly incorporated into staff practice. Eliminate or effectively disguise the view from some bedrooms of waste bins and other rubbish awaiting disposal.

CARE HOMES FOR OLDER PEOPLE Chalfont Lodge Nursing Home Denham Lane Chalfont St Peter Bucks SL9 0QQ Lead Inspector Mike Murphy Unannounced Inspection 27th June 2006 09:30 X10015.doc Version 1.40 Page 1 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 Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 2 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 DS0000019191.V289737.R01.S.doc Version 5.1 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 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) 01753 888002 Barchester Healthcare Plc Mrs Gillian Marie Rocker 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 DS0000019191.V289737.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. General Nursing Care Specialist Nursing Care (Physically disabled 30 years plus) Date of last inspection 28th February 2006 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 owns over 160 nursing and residential homes across the country. The home can accommodate 119 service users across three areas of care: 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 area: (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). There are many communal areas in the home including a library and large conservatory which overlooks a small lake. The homes 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 quality hotel facilities. Fees are from £1020 per week. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Chalfont Lodge is a 119 place care home with nursing which is divided into three main care areas: physical disability, older people, and dementia. The dementia unit is divided into three further areas. Fees are from £1020 per week. This inspection was conducted over two days in June 2006. By two inspectors on the first day and one inspector on the second day. A further brief visit was made by one of the inspectors in July 2006 to examine the home’s arrangements for the storage, control and administration of medicines in one of the units. The inspection methodology included discussions with managers, staff, residents and visitors, examination of records, observation of practice, and a tour of the building. One comment card was received in advance of the inspection. The inspection took place at the end of an unsettled time for the management of the home. Between July 2005 and June 2006 the home had three general managers, the most recent of which took up post in May 2006. It would be surprising if such change and instability had not had an effect on some aspects of the home. It is expected that the position will now settle and that greater stability and continuity will be experienced for the foreseeable future. The findings of this inspection are uneven. The arrangements for conducting assessments prior to admission and assessing whether it can meet a prospective service user’s needs are good. New care plans are being introduced and it is too early to say whether they are an improvement on the previous system. There has been a marginal improvement in the content of care records but they are still heavily biased towards a healthcare model which can mean that psychological and social care needs are undervalued or overlooked. This is evident in daily records and is a particular disappointment in the units for people with dementia. The introduction of the new system needs to be accompanied by a programme of training, supervision, monitoring and audit. It also provides an opportunity to review the care model on the dementia unit, particularly in light of Barchester’s own ‘Memory Lane’ programme. The home maintains an excellent programme of activities at various levels, including activities based on music and music therapy. These contribute significantly to the well-being of residents. The environment is generally of very good quality but the Gleneagles unit for people with dementia is showing signs of wear and tear and is scheduled for refurbishment. The outlook on to waste bins from some of the windows in that unit is particularly uninspiring. It was pleasing to hear that an assisted bath is due to be installed on that Unit. Staff numbers are considered sufficient for current levels of activity. The home has yet to achieve the 50 target by the end of 2005 for NVQ qualifications Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 6 but is supporting a number of staff on NVQ programmes. Weaknesses were again found in the home’s recruitment procedures which are unacceptable. They place residents at risk through the potential appointment of staff who are unsuitable to work with vulnerable adults. These weaknesses were previously noted in the inspection reports of 2 August 2005 and 28 February 2006 and have not been effectively addressed by managers. The home has a comprehensive training programme and we understand that training is to be further reviewed by the new manager. Training on dementia seemed uneven and surprisingly the programme did not mention Barchester’s own very good ‘Memory Lane’ programme. It is suggested that the home consider training on care planning in order to optimise the benefits of the new system and widen the care planning perspective. The home now has a new manager and it is expected that there will be greater stability in this position than has existed since mid 2005. This home has very good potential but it needs good consistent management to achieve this. Residents and visitors expressed a good level of satisfaction with the home and staff reported positive experience with Barchester management. It is hoped that the weaknesses identified on this inspection will be fully addressed. What the service does well: The home is located in pleasant Chiltern countryside, the grounds are landscaped and it is adjacent to a golf course which provides a pleasant environment for residents. The interior environment is spacious and most areas are well decorated. Bedrooms and communal areas are of a good size, meals are served in a pleasant dining room and facilities for residents with a physical disability are good. The home provides good quality food, which, for those residents able to go to the dining room, is served in pleasant surroundings. The home received a Chiltern District Award for Food Safety in 2005 and ‘Hospitality Assured’ accreditation in 2006. The quality of care in the unit for residents with a physical disability is of a high standard. The unit is well equipped, there is evidence of good multidisciplinary teamwork and residents report a high level of satisfaction with standards of care. A varied range of activities under the direction of activities organisers is offered including outings, talks, discussions, art, musical events and music therapy. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 7 The ‘Memory Lane’ programme offers potential to improve the quality of life of people with dementia, providing its introduction is supported by ongoing staff training and support. What has improved since the last inspection? What they could do better: The home must establish strict procedures in the recruitment of staff which include that applicants complete an application form with full details of previous employment and reasons for leaving any previous care position, that photocopied or open references are verified by managers, that staff are not appointed until the appropriate level CRB certificate or ‘POVA first’ check has been obtained, and that where staff are appointed under a ‘POVA first’ they work to a supervision policy with a named supervisor in line with DOH (Department of Health) guidance. Staff should take a wider view when planning, providing and recording care. This is important in all care areas but particularly in a home which provides specialist care for people with dementia. Ensure full implementation of Barchester’s own memory lane programme for residents with dementia. This promises real improvements in the quality of care for such people but evidence of its implementation is not as strong as expected. This may require additional resources or the designation of a member of staff to act as a project lead and mentor to staff to ensure that it is properly incorporated into staff practice. Eliminate or effectively disguise the view from some bedrooms of waste bins and other rubbish awaiting disposal. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 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 the following standard(s): 3, 4,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed prior to admission to ensure that the home is able to meet the person’s needs. Wherever possible prospective residents visit the home to meet staff, view its facilities and have any questions or concerns answered. The visit aims to ensure that the resident is comfortable in accepting the offer of a trial admission and that the home is likely to be able to meet their needs. EVIDENCE: The home has a general brochure, statement of purpose and service user’s guide which are available to prospective referrers and residents to assist them in deciding whether the home is suitable for their needs. Enquiries are recorded on a ‘customer enquiry form’ and are considered by the general manager. Where an enquiry progresses to a referral the needs of the prospective resident are assessed either by the general manager or unit manager (both of whom are registered nurses) to ascertain whether the home is likely to be able to meet the persons needs. The assessment draws on Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 11 information provided by the prospective resident and family and that provided by other agencies (such as medical and nursing staff already involved in the care of the person). An assessment form is completed by the assessing nurse and a decision made on whether the home can meets the person’s needs. A visit to the home is then arranged. This provides an opportunity for the prospective resident (where possible - some may be too frail to undertake such a visit) and his or her family to view the facilities, meet staff and other residents, have lunch or tea, and acquire further information on the home. A date for a trial admission can be arranged at this point. Further assessments are carried out on admission, and over a four week trial period both the resident and the home can decide whether it is appropriate for the resident to continue to live in the home. The home did not offer intermediate care at the time of this inspection. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is introducing a new system of care planning and the system should support the development of a more person centred approach providing its introduction is accompanied by staff training, supervision, professional audit and management monitoring. Care plans are generally based on good assessments and contribute to meeting residents needs. However, care plan recording continues to reflect a healthcare perspective and a bias towards recording physical care given. This may lead to psychosocial needs not being fully met. EVIDENCE: A care plan is drawn up for each resident. At the time of this inspection the home was in the process of changing the format of its care plans – from the Standex system to a new Barchester one. The home aims to have completed this transition by the end of September 2006. Samples of both formats were examined on this inspection. Of those examined in the units for residents with dementia, the new format appears to fit better with the nature of the work carried out there. The introduction of the new paperwork is to be accompanied Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 13 by staff training. Care plans are drawn up by ‘named nurses’ who are responsible for co-ordinating the care of individual residents. Records had thorough assessment of needs which included tissue viability and falls risk assessments. Care plans are reviewed and updated regularly. The assessment section of the new format includes sections on communication, personal hygiene, elimination, mobility, dexterity, tissue viability, nutrition, breathing, pain, sleeping, mental state, cognition, self-harm, fears for the future, social interests/hobbies, religion and culture, and family, friend and carer involvement. It was felt that the care plans were written from the basis of a healthcare care model and did not sufficiently reflect the perspective of the resident – particularly with regard to daily living. Daily notes were more comprehensive than seen on previous inspections. However, they were still strongly biased towards physical care given and to contain insufficient information on psychosocial aspects of care. It was also felt that some care plans lacked detail on the actions required to achieve a care objective. The overall standard of record keeping varied and omissions were noted on some of those examined including incomplete sections (‘mental state/cognition’ and ‘Life story’), failure to sign and date entries, and incomplete Waterlow risk assessments for example. The new system should support the development of a more person centred and holistic approach providing its introduction is accompanied by staff training, supervision, professional audit, and management monitoring. All residents are registered with a GP. A visiting GP said that he thought the care in the dementia unit was good and that the unit worked well with primary care services. The GP felt the staff provided appropriate support and that there was not an over reliance on medication to manage behaviour problems. A dietician advises on nutritional needs as required. The home is in touch with tissue viability nurses who advise on tissue viability and tissue management matters, provide information to staff, and prescribe dressing for residents as required. The inspection coincided with the visit of a tissue viability nurse which provided an opportunity to discuss staff practice, knowledge and skills and developments in the home. A chiropodist visits regularly. An optician was due to do a routine visit in December 2006 but also visits individual residents on request. Dental services are provided on referral. Residents generally expressed satisfaction with the care provided and reported that the environment and the care met their expectations. Residents reported that their privacy and dignity is respected and staff were observed to do so over the course of the inspection. Comments included “I like it here, know how to complain but don’t have anything to complain about – the food is good, the carers are nice – make sure things are done for me in privacy”. “Staff are friendly and understand needs. Privacy is maintained, doors shut as needed. I have no issues of concern and am very happy with the care”. One resident who was generally happy with the care expressed a wish for a bigger bed. One of the inspectors raised this with the unit manager who was unaware of the wish Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 14 and agreed immediately to provide a larger bed. A very positive response from this manager. The service has a policy for medication which was last reviewed in 2005 and is scheduled for review again in 2007. It has a contract with Vantage pharmacy in Chalfont St Peter. GPs prescribe medicines. The prescription is sent to Vantage. Medicines are supplied in pre-dispensed packs. Two deliveries a day take place. The home’s arrangements are checked periodically by a pharmacist. A report goes to the clinical manager. Medicines are stored in cupboards fixed to the wall in a drugs room in each unit, a drugs trolley and a drugs fridge. References available for staff include A BNF (British National Formulary) 2006, the organisation’s own policy and the Royal Pharmaceutical Society of Great Britain guidelines. Only registered nurses administer medicines. No resident was self-medicating at the time of this inspection. The clinical manager said that this is because the residents are considered too ill or disabled to manage their own medication. This assumption needs to be reviewed by managers from time to time. New staff are familiarised with the home’s arrangements by working under the supervision of the unit managers during their orientation. Competence should be assessed at the end of this period but this system was not working in 100 of cases at the time of this inspection i.e. not all new nurses had had a drug assessment. The subject was included in the training programme for 2006. New care plans list medicines on admission. MARS sheets are the true record of current medication. Mars charts have the photograph of the resident and a record of diet, essential care needs and other essential information is included in the drugs record – a very good practice. Verbal directions from doctors are confirmed by fax. The homely remedies policy is displayed on the door of a medicines cupboard and includes maximum doses to be administered. Arrangements for the storage and control of Controlled Drugs are satisfactory. A separate record is maintained for each drug. The balance for one resident was checked and found to be correct. Medication is retained for seven days after the death of a resident. Overall, satisfactory practice. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home maintains a lively and diverse programme of activities for residents. Residents may have visitors at any time. This supports the emotional and social well-being of residents and helps maintain contact with family and friends. Residents may bring personal possessions in to the home which both personalises their room, and increases a sense of comfort and well-being, but also maintains associations with family, friends and life events. EVIDENCE: The home provide a varied range of social and cultural activities. Activity organisers arrange group and individual activities in all areas of the home. A weekly programme is advertised throughout the home. Interests and activities are recorded in care records. Games, videos and DVDs are available for residents use at all times. Group quizzes, crosswords, discussion on current affairs and games are organised for those wish to participate each day. Music at varying levels is a key feature of the service and the home employs a fulltime music therapist. This can vary from individual music therapy to small group musical events to larger entertainment events. In one week in April Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 16 2006 group musical events included a production of ‘Easter Bonnet’ by Partytime (a company which performs plays in schools, care homes and day centres) fun with musical instruments, singing in the lounge and a recital by a pianist. Events may also include gentle ‘keep fit’ sessions to support the maintenance of physical activity. The grounds are pleasantly landscaped and residents, with the support of staff and visitors as required, make use of them. Residents have a choice on when they get up or go to bed. Visitors may visit at any time and residents may see their visitors in private. In discussion with the manager towards the end of the first day inspectors wondered if some of the younger residents in the physically disabled unit might not benefit from participating in informal outings and participation in everyday activities around the local area such as shopping, cinemas, cafes or pubs. Arrangements for meals are of a good standard. Residents have a choice of dishes. A large number of residents have meals in the main restaurant on the ground floor where they are served by waiting staff. Other residents have meals in the dining area of their unit or in their own room, whichever they prefer. Assistance is provided where needed (however, in one unit a care assistant was observed to be sitting on a coffee table while assisting a resident with her lunch). A dietician advises on meals as required. The new manager intends to improve the quality further by using fresh ingredients as much as manager intends to improve the quality further by using fresh ingredients as much as possible and by increasing support in the units for people with dementia by employing additional waitresses or hostesses and other changes to improve the meals service in those areas. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s policies and practice on complaints and on the protection of vulnerable adults provides comprehensive guidance to managers and staff and protection to residents. However, some details are incorrect and can be misleading thus failing to conform to joint agency procedures and to proper investigation of suspected abuse. EVIDENCE: The home has a complaints procedure which is available to residents, is on display in the home, and is summarised in the statement of purpose. The summary in the statement of purpose is not entirely consistent with the standard when it fails to make clear that a complainant may refer a complaint to CSCI at any stage. However, the copy on display does include this. This inconsistency should be easy to resolve. The home is responsive to complaints and records are maintained. Both residents and relatives said that they knew how to make a complaint and were confident that the home would take the matter seriously. The policy on the protection of vulnerable adults is misleading where it states that where abuse is witnessed ‘….if appropriate CSCI, the police and POVA team…’ should be informed. There is no discretion here, where abuse occurs the statutory agencies must be informed – in CSCI’s case under Regulation 37. Further comments on this were made in the inspection report of 28 February 2006 and the manager then in post informed CSCI that she was seeking further advice. That advice was still awaited at the time of this inspection. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 18 While this could be misleading and ought to be corrected, the Aylesbury office of CSCI has found that in practice managers have informed CSCI and Social services when they have had concerns about POVA. The new manager undertook to obtain a copy of the latest joint agency POVA guidance in Buckinghamshire (published in January 2006). It is noted that the training programme has eight sessions on ‘Abuse/Neglect/POVA’ planned between July and November 2006, each session of approximately two hours duration. Staff spoken to understood the home’s procedures but had no knowledge of the Buckinghamshire joint agency arrangements. The home’s staff recruitment procedures (see under staffing below) potentially exposes residents to risk through the appointment of persons who are unsuitable to work with vulnerable adults. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 19 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 the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good quality and well maintained environment which provides residents with a comfortable and safe place to live. The outlook from at least two of the bedrooms in an upstairs bedroom could be improved and measures should be taken to modify this and provide a more pleasant view for those residents. EVIDENCE: The home is located in very pleasant grounds adjacent to a golf course, about two miles from Chalfont St Peter. The interior environment is generally of a high standard and is well maintained. The home has 119 registered places of which 93 are in single bedrooms. All bedrooms have en-suite facilities, a telephone and television. The accommodation is over three floors. The top floor has a training room, therapy room and staff accommodation. The middle floor accommodates two of the three dementia units and the physical disability unit. The ground floor has the third of the dementia units and the unit for older Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 20 people. There is lift access to all floors. Each care unit has a living and dining area. There is a restaurant and larger living areas, including a very pleasant conservatory, on the ground floor. The three dementia units have pictures and objects of times past which are linked to the organisation’s ‘memory lane’ programme. The dementia unit on the ground floor, St Andrews, and one of the units on the first floor, Wentworth, were well decorated, tidy and clean. Gleneagles is showing signs of wear and tear and would benefit from redecoration. The manager said that it will be refurbished in the near future. A new assisted bath (as recommended on the last inspection) is to be installed. At least two of the bedrooms have a fairly uninspiring view of waste bins (including clinical waste bins, one of which was full and open on the day of the inspection) and other rubbish for disposal. This was discussed with the previous manager at the last inspection. It was discussed again with the new manager who informed us that he has plans to deal with it. Turnberry unit was clean and tidy but again is also showing signs of wear and tear and would benefit from some redecoration. Some pressure on storage was evident in places e.g. hoists stored in a bathroom and a carpet shampooer left in a corridor. Bedrooms are comfortable, well furnished and have personal items brought in by residents. All areas were tidy and clean and free from offensive odours. The laundry is well equipped and washing machines have programmes to cope with a range of washing requirements. Arrangements for the control of infection appear satisfactory. A new infection control policy was introduced in March 2006. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has sufficient numbers of staff to meet the needs of residents. Weaknesses in recruitment as reflected in the content of staff files continues to put residents at risk by increasing the potential for the recruitment of staff who are unsuitable to work with vulnerable adults. Staff induction and training programmes provide staff with the basic knowledge and skills to care for residents, but on the subject of dementia do not appear to draw sufficiently on the resources of the organisation. Addressing this would improve the quality of care to residents with dementia. EVIDENCE: In terms of the staff establishment staffing numbers have not changed. The home reports that at the time of the inspection it had 19 registered nurses, 123 care staff and 56 ancillary staff. It reports that four staff had left since the CSCI inspection in February 2006. Barchester has its own NVQ training department which offers training at NVQ levels 2 and 3. It is estimated that about 30 of the care staff (this figure excludes registered nurses) have acquired NVQ 2 and 3. The home employs about ten staff who are registered as nurses in Bulgaria but who are not eligible for registration with the Nursing and Midwifery Council (NMC) in the UK. It is considered that because of their skills they should be considered equivalent to Health and Social Care NVQ3. However, CSCI and Skills for Care consider that only Scottish NVQs (SVQs) are equivalent to English NVQs and a nursing qualification obtained abroad does not qualify. This is not to say however, that managers of care homes should Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 22 not recognise the skills and experience of such staff. An NVQ awarding body might give credit for such experience if such care workers decide to work towards an NVQ 3. The home aims to correct the shortfall from the 50 target (set in standards 28 (homes for older people) and 32 (homes for adults 18 to 65 years)) by the end of 2006. Four staff were due to complete their NVQ training by the end of July 2006 and at the same time another nine were due to start. The manager is supported in the recruitment of new staff by human resource staff based in Chipping Norton in Oxfordshire. The files of four staff who have been appointed since the last CSCI inspection were examined. From the clerical point of view files were in good order. However, the contents failed to conform to the standard and to Schedule 2 of Regulations 7, 9 and 19. Open references (i.e. not addressed to the home in connection with a particular position) had not been verified, the reason why one applicant had left a previous care position was not recorded (this is now required under POVA procedures), the status and dates of CRBs could not be checked because only the top section of the disclosure was on file, this in turn meant that the interval between an employee starting work on a POVA first certificate (when they are required to work under strict supervision as outlined in DOH (Department of Health) guidance) and the date the CRB was received could not be checked. There was no record of a nurses registration having been checked with the NMC at the time of recruitment (although a full list of nurses registrations confirmed with the NMC was supplied with the inspection papers), a gap of two years in the case of one applicant was not explained, and a copy of an NHS hospital contract was noted on one file without explanation. It was noted that all staff, including a part-time worker, had signed an exemption to the European Working Time Directive. The clinical manager is responsible for organising staff training. The home has a training room on the top floor. Training is provided by the clinical manager, through on-line interactive training, by a practice development nurse employed by Barchester, through Barchester’s own NVQ training scheme, at outside institutions (such as Thames Valley University (TVU)), and on occasions by external trainers such as specialist nurses. Training may considered at four levels: induction, ‘mandatory’, foundation, and periodic updates (which for registered nurses would include continuing professional development (CPD)). The induction programme is one week. This used to be followed by a further period of approximately two months during which the new member of staff worked through what was then the TOPSS (the organisation which preceded ‘Skills for Care’) induction booklet. Staff now work through competence forms covering a wide range of subjects. Some of these are straightforward tasks such as ‘Carry out urinanalysis’, while others are much more complex such as ‘Able to encourage social care and well being of residents’. Competence is assessed through three stages: demonstration by the trainer, practice by the trainee observed by the trainer, and finally, assessment of the trainee’s Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 23 competence. The week’s induction includes fire safety, health and safety, abuse/POVA, and moving and handling. A copy of the training programme for the period June to December 2006 was provided for the inspection. The induction programme was incorporated in to this. The programme listed dates, times, duration, subject and the staff for whom the training was intended. No training on the use of the new care planning system was noted in the copy of the programme provided for the inspection. This seemed at variance with the expectations of some staff who were under the impression that the introduction of the new system would be supported by training in its use. It did not indicate the level of training or the trainer or training agency. It is a comprehensive programme covering a wide range of subjects. The duration of training varied from 30 minutes (an interactive on-line session) to a whole day (moving and handling). It is noted that in June 2006 ‘Challenging behaviour Dementia Care’ covers two sessions in two full days. Between July and December 2006 ‘Dementia Care’ covers four sessions each of one hour’s duration. The programme does not include reference to Barchester’s ‘Memory Lane’ programme for people with dementia. This is surprising given the proportion of residents with dementia in the home (48 places out of 119 (40 )) and the existence of a very good programme for dementia within the organisation. The new manager was reviewing training needs and it is expected that further training and staff development events will take place later in 2006. Staff spoken to during the course of the inspection seemed happy working for Barchester and at Chalfont Lodge. They felt that they were fairly treated by managers and that their decision to accept a post in the home was a good one. Staff from overseas said that they received a lot of support while dealing with the complexities of visa arrangements and professional registration as well as their application for the job and induction into the home. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has come through a very unsettled year from the management point of view and this has led to a failure to fully address weakness identified in earlier CSCI inspections and uneven standards of service to residents. This inspection has heard that matters are improving and that this may be attributable to a stronger management and supervisory presence. However, serious weaknesses in staff recruitment need to be addressed as a matter of urgency because a failure to do so places residents at risk through the potential to appoint staff who are unsuited to work with vulnerable adults. EVIDENCE: The home has experienced a degree of instability at general manager level. Between July 2005 and June 2006 three managers have occupied that position. The new general manager, who was appointed in May 2006, expects to achieve stability and to maintain continuity in the position for the foreseeable future. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 25 The general manager is a registered nurse and has extensive experience of managing care services, both with Barchester Healthcare and other organisations. The manager is not responsible for any other registered service. It is acknowledged that the turnover of managers over the past year potentially undermines the quality of the service and the new manager now intends to address this. Monthly meetings are held with heads of department and the manager says there is a standing agenda, which, among other matters, includes health & safety, matters raised in CSCI inspections, and service development. Heads of departments are expected to cascade information from that meeting to their own unit or team meetings. Systematic self-monitoring is partly achieved through an audit of an area of activity each month. This may include medication, ‘customer service’, infection control, health & safety or documentation (e.g. care plans). In 2006 the home acquired ‘Hospitality Assured’ accreditation (‘Hospitality Assured’ is an organisation which promotes standards of service excellence for organisations in the hospitality industry). The manager intends to hold regular informal meetings (over wine and buffet perhaps) with residents and relatives and said that he is in regular touch with some relatives. The home has not conducted a stakeholder survey since the last inspection in February 2006 but the views of residents, relatives, staff and of some visiting professionals have either been sought or been communicated to the manager. Inspectors were informed that improvements in the quality of some aspects of care were noted and this appeared attributable to a stronger management and supervisory presence. Staff reported signs of a clearer sense of direction and it is hoped that this will continue and be built on after a very unsettled year. The home has not been fully responsive to CSCI inspections by failing to fully address all the requirements of recent inspections. CSCI received one comment card in advance of this inspection. The respondent expressed overall satisfaction with the care provided, felt welcome in the home at any time, was kept informed of important matters relating to the resident, and could visit the resident in private. While the respondent did not have knowledge of the home’s complaints procedure he or she had not had reason to make a complaint to date. The home does not routinely manage money on behalf of residents but does have facilities for holding small amounts of cash which is managed through sundry accounts. A full time administrator manages this and other financial matters. Weaknesses in record keeping identified in the last two inspections have now been fully addressed. The structure for supervision was outlined by the clinical manager. All nursing and care staff have access to a supervisor. The clinical manager supervises the three unit managers who in turn supervise the staff under their control. Senior staff acting as supervisors of care staff are prepared for the role by professional development nurses within the organisation and by an external Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 26 training agency based in Amersham. Other staff are trained “on the job”. Supervision should take place at least every two months, records are maintained and are signed and dated by the supervisor and supervisee. Due to a problem in extracting the information in the time available it was not possible to check a representative sample of supervision records on this inspection. Three records were seen. Entries were brief. Two of the three records showed that the individuals concerned had received supervision in the month prior to the inspection. The third had not received supervision since January 2006.From the records seen it was not possible to assess whether supervision is addressing all aspects of standard 36.3 (all aspects of practice, philosophy of care, and career development). Periodic audit of supervision records would enable managers to monitor the frequency and quality of supervision more closely. Staff receive training in food hygiene, moving & handling, health & safety, fire safety and infection control. The most recent visit of the fire authority is recorded as having taken place in 2004. According to the maintenance representative no work is outstanding from that visit. Records of a fire risk assessment having been carried out over the past year were not available. The emergency lighting was checked in April 2006. Fire equipment was checked in August 2005. A fire drill was held in February 2006. Fire alarms are tested weekly. An environmental health officer visited in April 2005. The home’s electrical wiring was checked in April 2006. The maintenance department undertake ongoing PAT testing of electrical equipment and label if satisfactory. Visual checks of electrical items are carried out every six months. Gas checks were carried out in September 2005 (hot water boilers), January 2006 (kitchen) and February 2006 (laundry). Water samples for Legionella are taken and analysed monthly. Hot water outlets are regulated and maintained by the maintenance department. Hoists were checked in January 2006. The lift was checked by a maintenance engineer in March 2006. The home has a contract with PHS for the removal of clinical waste. Accidents are recorded. There was not a development plan in place at the time of this inspection. However, the new general manager had identified a number of matters which need attention and action was being taken to address weaknesses across a number of areas. At a different level Barchester had submitted plans for a significant capital development on the site. Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 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 X X 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 X 3 Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP18 Regulation 13 (6) Requirement The manager is required to review the homes policy and procedure on abuse and ensure that it takes account of the procedures of local statutory agencies.(Previous timescale of 30/04/06 not met). Timescale for action 31/07/07 2 OP29 19 (1) (c ) The manager is required to ensure that staff recruitment procedures include verification of references and that the content of staff records retained in the home conform to Schedule 2 (as amended after the introduction of POVA in July 2004) (Previous timescale of 28/02/06 not met) 23(4) The manager is required to ensure that a fire risk assessment is carried out to ensure compliance with fire regulations. 27/06/06 3 OP38 31/07/07 Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 29 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 OP7 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, 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 establish a programme of training, supervision and audit for care staff in the use of the new care plan format to ensure effective use of the documentation and the development of a more holistic care perspective by staff. It is recommended that the manager establish a programme of training and supervision for staff in the dementia unit which supports incorporation of the ‘Memory Lane’ programme (or similar good practice approach to the care of people with dementia) into care practice. It is recommended that the manager remove or disguise the waste bins and other material awaiting disposal so that the residents of some rooms on Gleneagles Unit have a more pleasant view from their rooms. 2 OP27 3 OP7 4 OP30 5 OP19 Chalfont Lodge Nursing Home DS0000019191.V289737.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury 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 DS0000019191.V289737.R01.S.doc Version 5.1 Page 31 - 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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