Random inspection report
Care homes for older people
Name: Address: Chalk Leys London Road Great Missenden Bucks HP16 0BB three star excellent service 10/03/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Chris Schwarz Date: 0 8 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Chalk Leys London Road Great Missenden Bucks HP16 0BB 01494863051 01494890224 manager.chalkleys@fremantletrust.org www.fremantletrust.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): The Fremantle Trust The registered provider is responsible for running the service care home 36 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age- not falling within any other category (OP) Date of last inspection Brief description of the care home Chalk Leys is located in Great Missenden, next to the fire station, and is within walking distance of the village centre. There are rail and bus services nearby and a few shops, churches, pubs and other amenities close to the service. The service provides care for
Care Homes for Older People Page 2 of 8 1 0 0 3 2 0 0 9 Brief description of the care home up to thirty seven older people in single rooms, none of which have ensuite facilities. The building is divided into four groups, each with a lounge and kitchen/diner and a shared garden. People using the service have access to doctors surgeries and other community health facilities as required. Care Homes for Older People Page 3 of 8 What we found:
This visit was arranged following feedback we received from a health and social care professional when we carried out the services Annual Service Review in February this year. The feedback raised concern about some aspects of how the service was managing peoples health and personal care, such as communication with community nursing staff, managing peoples medication and implementing preventative measures such as filling out fluid charts and blood glucose monitoring records. The feedback also mentioned that there are occasional lapses in hygiene standards at the service such as dirty commodes and soiled pads left in view in peoples rooms. An unannounced visit was made to Chalk Leys on 8 March 2010 to review this information. The visit included discussion with the registered manager and conversations with other staff, a look at a sample of peoples care plans, medication storage and records in two lounges were looked at plus medication audit records, and a sample of bedrooms and bathrooms were viewed. The Annual Service Review report had been sent out to the service about a fortnight before this visit took place and included the feedback we had received about health and personal care. It was impressive to see that the manager had implemented measures since receiving the report to address the concerns, such as meeting with senior staff on 1 March to discuss the issues raised and organising a meeting with a health care professional to look at where the service needed to improve. Care plan files were now being stored in the duty office so that seniors had ready access to them when health care professionals visit or call the service and archiving was taking place of office files. Five care plans were read. All gave an outline of peoples health and personal care needs and contained accompanying assessments. One file was for a person with diabetes whose blood glucose levels need to be monitored and there were records to show that staff had been consistently monitoring and recording the readings. Another file contained records of food and fluid intake which the services staff had initiated in response to the service user losing weight. Records on health care interventions such as visits from doctors and district nurses were recorded. Two of the files needed attention to make sure that assessments and identified risks were being appropriately monitored. For example, both contained pressure risk assessments with scores which indicated monthly re-assessment; one had last been reviewed in May 2009 and the other in February 2009. Both also contained nutritional assessments with scores which also showed that needs should be monitored regularly but the assessments had not been updated since February 2009 for one service user and January 2008 for the other. Moving and handling assessments for these two service users had not been reviewed since 2008. A requirement is made to ensure that assessments are regularly reviewed, to make sure that peoples health and personal care needs are appropriately being met. Medication practice in two of the four lounges was looked at. In both lounges the cabinets were secure and the keys kept with staff. Samples of staff initials and signatures were contained in the files and copies of the corporate medication policy. There was guidance on the use of as required medicines and lists of new medicines or changes to medicines
Care Homes for Older People Page 4 of 8 to alert staff to amendments in medication regimes. Photographs of service users were in place to readily identify people. Storage of medication was satisfactory in both lounges. In one lounge lactulose suspension was prescribed to be administered three times a day for a service user, which was clearly printed on the record sheet and the pharmacy label. Staff had not administered it at lunchtime since the record sheet commenced; this had not been observed during the new daily medication audits that have been taking place. A requirement is made to ensure that medication is administered according to the prescribers instructions. In the second lounge one person was prescribed Movicol sachets as directed and five sachets had been supplied by the pharmacy on 17 February 2010. None of the sachets had been administered and the carer in the lounge was unable to advise when these should be given or why. We would advise that this be followed up with the doctor. Another person was prescribed promazine syrup to be given twice a day as a regular dose and at lunchtime as an additional as required dose. The current medication administration records showed that the lunchtime dose was being given each day and the carer on duty confirmed that generally staff do give it at this time to pre-empt agitation in the afternoon. We would advise that the use of the medicine on a regular basis at lunchtime be reviewed with the doctor. A sample of bedrooms were viewed to see if there were any hygiene or infection control risks. No risks were apparent; four commodes were also checked and these were clean. Bathrooms and toilets that were seen were also in a hygienic condition. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 8 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 8 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 8 12 Assessment tools to monitor and improve peoples health and personal care are to be regularly reviewed. This is to ensure that peoples needs are identified and can be met by staff. 01/05/2010 2 9 13 Medication is to be administered according to the prescribers instructions. This is to ensure that people receive their medicines in a safe and consistent manner. 01/05/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 7 of 8 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 8 of 8 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
