Inspection on 27/02/07 for Challoner House

This inspection was carried out on 27th February 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 Challoner House 175 Winchester Road Chandlers Ford Eastleigh Hampshire S053 2DU Lead Inspector Jan Everitt Unannounced Inspection 27th February 2007 09:00 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 Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 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. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Challoner House Address 175 Winchester Road Chandlers Ford Eastleigh Hampshire S053 2DU 02380 266036 02380 265763 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) Barchester Healthcare Homes Ltd Lorraine Dent-Magnusson Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (10), Physical disability of places over 65 years of age (49), Terminally ill (10), Terminally ill over 65 years of age (49) Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total of no more tha 10 service users may be accommodated at any one time in the categories PD and TI between the ages of 50-65 years. 11th October 2005 Date of last inspection Brief Description of the Service: Challoner House is a care home, providing nursing for up to forty-nine service users aged 65 years and over within the categories old age, physical disability and terminal illness. Challoner House is a purpose built home surrounded by well-maintained gardens that are accessible to service users. There are forty-three single bedrooms and three shared bedrooms. All bedrooms have en-suite facilities. There is a passenger lift to the second and third floor. The home is decorated to a high standard. Challoner House is situated in a residential area in Chandlers Ford, close to local amenities. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to Challoner House Nursing Home, which was unannounced, took place over a one-day period on the 27th February 2007 and was attended by one inspector. The registered manager and deputy manager assisted the inspector throughout the day. The visit to Challoner House formed part of the process of the inspection of the service to measure the service against the key national minimum standards for the year 2006/7. The focus of this visit was to support the information gathered prior to the visit. The judgements made in this report were made from information gathered prior to the visit; pre-inspection information submitted to the commission by the registered manager, information from the previous report, the service history correspondence and contact sheets appertaining to the service were also taken into consideration. A number of comment survey cards were sent to relatives prior to the visit of which twenty-eight were returned. They were generally very positive about the care and services. Thirty-eight users comment cards were also received prior to the visit and comments made are discussed in the main body of the report. Comments and outcomes from the surveys were taken into consideration when formulating the judgements. Further evidence was gathered on the day of the site visit. The inspector toured the building and spoke with a number of the residents, relatives and staff. A sample of records was also viewed What the service does well: The home provides a pleasant well-maintained environment that is decorated and furnished to a high standard. The home has a range of activities available with activities coordinators participating in organising them. The activities are managed well, providing opportunities for residents to join in activities both inside and outside the home. Good social histories are maintained for each service user to enable the activities to be tailored accordingly. The care plans are well documented and describe how service users would prefer their needs to be met. The care plans are signed by service users or relatives and reviewed appropriately. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 6 Staff were seen interacting well with service users in general and were observed to be giving them choices. Response from the surveys received from service users were complimentary with comments such as: ‘The staff are helpful, friendly and cheerful’. ‘The home is well run and is able to provide the needs of people who are in unfortunate circumstances’. ‘Excellent attention from carers and nurses, they should be congratulated for a fine job’. ‘There is always company, books in the library and a fine garden. I go out for meals when ever friends visit’. ‘The staff are excellent in all duties’. ‘Very happy’. The organisation and the manager are committed to staff training and there is a training programme, appertaining to the client group, available to all staff, which are supported and encouraged to undertake this training. What has improved since the last inspection? What they could do better: The manager must address the large number of comments made about the response time in answering call bells. One service user commented ‘It can be frightening if no body at all is visible and there is no response to the buzzer for a long time, perhaps it should be louder”. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 7 The management of medication and the storage of medicines and medical supplies must be reviewed to ensure that the home prevents stock piling of ‘as needed’ medication and service users medicines no longer needed. The manager must be responsible in ensuring that two references are received, one being from the most recent employer, for all newly recruited staff. 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. The summary of this inspection report can be made available in other formats on request. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 8 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 Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s needs are fully assessed prior to them being admitted to the home. EVIDENCE: The inspector viewed a sample of service user’s personal care plans, which contains the pre-admission assessment document. The manager or deputy manager within service user’s homes or in the clinical area undertakes the preadmission assessment. The assessments were found to be thorough and evidenced information about the physical and psychological needs of potential service users, and were very detailed in content. The manager told the inspector that enquiries about admission to the home are usually via a relative or care manager. Comments from service users in Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 10 the survey indicate that the home provides sufficient and comprehensive information about the home to potential service users and their relatives. If possible, relatives are involved with the admission process and this was supported by one relative spoken to who said they have been very involved with choosing a home for their relative. Care plans are initially written from information in the pre-admission assessment and formalised following assessment at the time of admission. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service user’s health, personal and social care needs are set out in individual care plans and reviewed appropriately. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for management of medication. However, the procedures for ordering repeat prescriptions leads to an overstocking of medication and medical supplies. EVIDENCE: A sample of service users’ care plans were viewed. The care plans are formulated from information gathered pre-admission and at the assessment on admission. The assessments and plans are very detailed and instructions for staff are clear and are kept under regular review. Information on how to Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 12 support the service users with personal care, health and medical needs, communication, activities, social interaction, sexuality and behaviour are all covered within these plans. The care records also detail the service user’s wishes and plans following their death. The care plans contain a personal profile for each service user, which describes their social history and past hobbies and interests. Trained nurses document in the care plans the service user’s record of the activity of their daily lives. Care workers spoken with told the inspector that they use the care plans to find out the care needed for service users although many of them are familiar with the needs of the service users. The care workers response from the surveys indicated that they receive clear instructions and are told about particular care needs of the service user and told how to understand and use care plans to inform their practice. Twenty eight service users returned the survey to the inspector. Most were complimentary about the trained staff and care workers, although there were comments made about the difficulties in communicating with some of the foreign staff. This was discussed with the manager who stated that all staff from abroad have to undergo an English test. Albeit that some are able to understand the written and spoken work better than speaking the language but this is overcome by her assisting them in attending English classes. The inspector observed that care plans were being reviewed monthly. The home has the services of a number of local GPs and the primary health team who, the manager reported, are prepared to give advise on specialist needs such as tissue viability. Service users spoken with told the inspector that they see a GP promptly if they are unwell. The responses from the surveys returned generally reported that the service users consider their health care needs are met. One service user commenting ‘the home is very good at obtaining help from outside services such as hospitals and appointments’. The manager reported that they are admitting an increasing number of service users from the hospice for end of life care. She told the inspector that the staff have received training in this and that the home is introducing a care pathway for end of life care that is used in hospice care. She reports that the home receives excellent support from the GP and the hospice team. The inspector did not receive any responses from the survey for the visiting professionals. Visiting professionals do document in the appropriate care plan and the home has a physiotherapist that visits the home weekly to assess service users mobility and moving and handling profiles. The manager reported that the primary care trust team assess the service users for their continence aids and that three of the trained nurses have Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 13 undertaken the training to enable them to review assessments at appropriate intervals or when the service user’s needs change. The home has medication policies and procedures in place. One service user was choosing to self-medicate and the inspector viewed the assessment and risk assessment undertaken to enable this to take place. Lockable storage areas are available in each room. The deputy manager told the inspector that she organises the ordering receiving, safe storage and disposal of medication The inspector visited the clinical room that houses the medicine trolleys and medical supplies. Oxygen was also being stored in the room in a safe way. Notices identifying that oxygen was in use were displayed on two of the resident’s doors. The room was disorganised and untidy. There was medication that had been used in a drug trial, and no longer being used, left on the top surface with no indication what was to happen to it and the deputy manager was unaware of why it had been left there. The medication is delivered in blister packs and stored in the medicine trolleys. The deputy manager described her role in the ordering and management of the medication. The manager reported that the photocopies of the prescriptions are kept in the clinical room and are checked against the incoming medications as per the policy of the organisation to ensure unnecessary orders are not received. This system must be failing in some areas as the home demonstrated a large stockpile of ‘as needed medication’. The cupboards were over-flowing with liquid and tablet medication that had been ordered and received unnecessarily. The inspector observed a bag of medication that the deputy could give no explanation as to why they had been stored in this cupboard. The medical supply cupboards were also disorganised and stored a variety of dressings and equipment that indicated trained staff were not auditing stocks and ordering only what was needed and had not returned or destroyed unwanted stocks. The inspector discussed her findings with the manager who agreed that the monitoring of quality assurance in the management of medication and medical supplies must be improved. The inspector observed a medication round for the ground floor and this was being undertaken as per safe procedures. Service users spoken to reported they receive their medication appropriately. One service user commented that she sometimes ‘chooses to refuse medication’. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 14 The inspector viewed the MAR sheets and these had been recorded appropriately. The inspector observed the practices throughout the day and staff were observed to be interacting well with service users and giving them choices. The inspector could not detect any difficulties in communication and staff were speaking and treating service users with respect. Because the majority of accommodation in the home is single en-suite rooms, service users are able to retain their privacy in their rooms is they wish to do so. One service user reported that she ‘enjoys socialising in the day and going to her room after supper to watch the television’. Another reported that ‘ she enjoyed staying in her room to read quietly’. Staff were observed to be knocking on doors before entering. The inspector had one comment from a relative that ‘staff never knock and wait to be invited in’. This was discussed with the relative. During the conversation a member of staff did knock on the door, albeit, quietly and came in to offer tea. This issue was discussed with relative who was advised to speak to the manager about this if it was distressing her parent. Another relative survey response comment was that ‘nurses and carers are gentle and sympathetic and show respect to both the resident and family’. A staff member response from the survey stated that she considered the home ‘respects the resident’s wishes, interests, special needs and making them feel at home’. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 14, & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users find the lifestyle in the home matches their expectations and meets their social, religious and recreational needs. Service users are supported to continue to have contact with their families and friends who are welcome at the home. Service users are supported to make choices in their activities of daily living. The home provides service users with a wholesome balanced diet with meals being taken in pleasant surroundings of their choice. EVIDENCE: The home has an activities programme displayed on the notice board that detailed a good variety of activities taking place throughout the week both morning and afternoons. The morning of the site visit the inspector observed one group of people playing cards. The inspector was promptly excused from one lady’s room because she ‘could not miss her game of cards’. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 16 The home employs an activities organiser, who has been in post for a considerable time. She reported that the organisation as a whole is developing new person centred activity paperwork for recording activities undertaken by each service user. The care plans capture excellent social histories and recreational preferences of service users. The activities records were well documented and details whom and to what extent service users participate in the social activities. The home has big social events at festive times of the year and the manager told the inspector that they had put on a special lunch for a number of couples on Valentines Day which was well attended. Photographs are displayed on walls of past events during the year. The home can demonstrate that social activities are planned around the recreational and social needs of the residents, taking into consideration their social history and recreational preferences. Service users response from the survey indicated a mix of feelings towards the activities programme and whether they choose to participate. ‘There are plenty of activities although I choose not to participate because of my deafness’. ‘Very helpful in getting me to and from activities. I am not put under pressure to go to any activity I do not wish to attend. The activities staff are friendly and helpful’. ‘There is usually activities going on, however I choose to not take part in most of them’. ‘Talks by interesting people’. ‘Plenty of activities on offer and many treats too. Sometimes though the effort to take part can be really too much when one is very old’. The inspector observed the visitor’s book that demonstrated the home has a number of visitors each day. A service user told the inspector that she goes out to lunch with her son occasionally. Another resident attends a local club weekly, which he told the inspector, is an important aspect of his life. Twenty six of the twenty eight responses from the relative’s survey reported that they were always made welcome to the home. The remaining two comments on the responses were: ‘Depends who is on duty’. ‘Not always’. The inspector observed throughout the visit that service users were being offered choices about their daily activities of living. Preferences of how service users wish to spend their days are recorded in care plans. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 17 Service users who spoke with the inspector confirmed that they do as they wish and can choose how they spend their days. The inspector visited the kitchen and spoke to the chef. The kitchen was observed to be clean and well organised, although the inspector did not look at this in detail. Copies of the menus were submitted with the pre-inspection information and these demonstrated a wholesome varied diet provided for the residents. The responses received from the thirty eight CSCI surveys returned were mixed. The majority commented that they usually like the meals they receive. The comments written by service users were of mixed opinion such as: ‘Main meals very poor, certainly room for improvement’. ‘A choice at each course is always provided. Attention to detail is excellent such as nicely presented tables with linen napkins’. ‘Portion size too large despite asking for smaller portions’. ‘Serve the meals nicely. They are always tasty’. ‘The meals are excellent and both in presentation and service’. ‘Meals always appear to arrive late’. ‘ I am rather a picky eater and staff try hard to find a good meal for me’. ‘If I don’t like them, I leave them’. ‘Efforts are made to counter one’s poor appetite and digestion and they provide very good cakes’. ‘Plates are sometimes cold and portions too large’. Variable but some are very good. Would like more fresh fruit particularly apples and bananas’. These comments were discussed with the manager who agreed that of late there had been problems with the food that was being provided. This had also been highlighted in the ‘suggestion/comment book’ that is housed in the front reception area, resident’s meetings and the service user satisfaction surveys that had been undertaken by the home. The manager reported that the organisation had acted upon this feedback and the chef had been replaced and a large package of training is being introduced that the newly appointed chef and his staff will undertake. The inspector observed the lunchtime meal. The dining room is very pleasant and the tables looked attractive. The service user’s lunches were being presented well and the meal looked appetising. The menu was displayed and it demonstrated choices at each mealtime. The inspector observed nutritional assessments were in the service user’s care plans and weights were recorded regularly, if a risk was identified. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 18 A relative spoke to the inspector about her parent who had been seen by the dietician and had been put on a fat free diet. She considered this was not always adhered to and that her parent did not receive an appropriate diet. Advice was given that she should talk to the manager or deputy or even speak to the chef. Alternatively she could view the care plans to see if the dietician had documented this direction. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and their families are confident that their complaints are listened to and acted upon. Service users are protected from abuse. EVIDENCE: The complaints policy is displayed on the reception area wall. It also forms part of the information that service users and relatives received about the home. The pre-inspection information reported that fourteen complaints had been received since the last inspection. This was discussed with the manager and she had accounted for the comments made in the suggestion book informally, and when analysed there have been no formal complaints received. The service users responses to the survey identified that generally they would know who to go to if they wished to complain or discuss an issue and when asked they said to ‘Lorraine’ or the manager. Other service users comments were: ‘My family’. ‘No I do not know how to make a complaint. I have not needed to make one’. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 20 ‘I do not hesitate to say what I think, which is passed to whom it refers’. Relative’s responses to the surveys identified that the majority of relatives would know how to complain and to whom to go to. However, four of the twenty-eight responses said they have made a complaint, one stating ‘that it was done at ‘floor level and was dealt with without having to put it in officially’. Another relative spoken with for a considerable time had many valid issues she wished to discuss with the inspector. The inspector enquired if this had been put officially in writing to the manager as the procedure states. She had not done so and commented that the manager and deputy were not always ‘approachable’. I advised her that there was a management structure within the organisation that included an operational manager she could alternatively communicate with. This was discreetly discussed with the manager who told the inspector that she had no idea of this level of discontent and had received no communication from the family. Survey responses from the staff indicated that they would know to go to the manager or deputy should a resident/relative wish to complain. The home has in place an adult protection policy and procedure. The staff receive training about this during the induction programme and also attend yearly updates that are mandatory and provided and funded by the organisation. Staff surveys returned and staff spoken with were aware of the procedures and their responsibilities with regard to reporting or identifying incidences of abuse. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean well maintained home that provides a homely comfortable environment. EVIDENCE: The inspector toured the home and visited most rooms. It was observed that rooms are personalised and equipped to meet resident’s needs whilst providing a homely environment for them. There is a mixture of beds supplied to meet needs and assist staff in their caring. Where bed rails or extra mattresses are needed for those that have fallen in the past a risk assessment has been done. The inspector observed that there were adequate assisted baths and showers. The manager identified that one bath has been moved around to give optimum space for residents. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 22 The home has had a large conservatory built which has been fully furnished to a good standard and looks out over the well maintained surrounding gardens with easy access for all residents. The home has five areas that offer communal space with a quiet area for residents to entertain visitors. The service users gave praise for the cleanliness of the home and included in their responses to the survey comments such as: ‘Flowers are in vases in passages’. ‘’Daily room cleaning is provided’. ‘No one can fault the cleanliness’. There were no negative comments about the environment received from the service user and relative’s surveys. The inspector observed that there were numerous hand-washing facilities around the home. Gloves and aprons were being worn. One comment from a care workers survey response was that thin plastic gloves were supplied and were ‘useless’. This was discussed with the manager and she reported that she buys a mix of gloves to prevent the rubber gloves being used indiscriminately and inappropriately when working with service users. Infection control training is provided to staff and this was evidenced on the training matrix. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The level of staffing and training programme would seem to meet the needs of the residents. Service users are protected by the home’s recruitment policies and procedures. However, this is not consistently followed when taking up checks on newly appointed staff. EVIDENCE: The manager submitted staff rotas with the pre-inspection information and demonstrated that between 9 and 10 carers were on duty in the morning and between 8-9 in the afternoon. 2 trained staff and two carers cover night shifts. These rota figures also indicated that the manager, deputy manager and student nurses are supernumerary to these number. A separate housekeeping staff are also employed. At the time of this visit the home was accommodating forty-one residents. Of the twenty-eight relative responses from the CSCI survey ten reported that they did not think there was sufficient staff on duty. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 24 In the service user’s survey responses, when asked if staff were available when they were needed, twenty nine indicated ‘always’ or ‘usually’ the other nine making comment reported: ‘Sometimes the staff take a long time to come if I am uncomfortable and I may need a drink’. ‘Some staff exceed their duties and are able to accompany residents to the shop’. ‘They always seem busy with someone else’. ‘Shortage of staff sometimes’. ‘Staff will always let me know if I will have to wait for one of them to attend to me. At busy times I have to wait longer than expected for someone to come’. ‘The home appears to need more staff both day and night. Bells are not always answered promptly.’ ‘While one is conscious of being only one of many needing attention, it is irritating and frightening if nobody at all is visible and there is no response from the bleeper for a long time’. The inspector concluded from these responses that because call bells are not responded to as promptly as anticipated, this then gave the perception that there was not enough staff on duty. This was discussed with the manager and staff rotas were viewed by the inspector. The geography of the building and the individual rooms would give an impression that there were not many staff about. This together with the call bell system being of a type that if one person uses the call bell alarm in any part of the home, and then another, the calls bank up and the alarm bells appear to be ringing continuously. Individual floors cannot be isolated on the system to enable the call to sound on that floor only. The manager told the inspector she has no way of monitoring the call bell system and the length of time it takes for each call to be responded to. It is recommended that the manager discuss this with the operational manager and that the system is reviewed and the response time to call bells be made part of the quality assurance. This is obviously an issue with a number of service users and relatives and results in them having the opinion that not sufficient staff are on duty. The pre-inspection information indicated that 52 of the care staff have achieved NVQ level 2 training. The manager told the inspector the home assists staff in applying for an NVQ qualification with the Barchester’s training forum, which is suitable for them and offers support in the home with three internal verifiers and two about to complete their training. There is a fluid staffing group at the home with new staff either having the qualification already or willing to study an NVQ. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 25 The inspector viewed a sample of three recruitment files. The information expected and required to be recorded in staff personnel files was present. However, there was evidence of only one reference in the file of a recently employed nurse. This was discussed with the manager. She admitted responsibility for the missing reference and instructed the administrator to rerequest the second reference. She added that the nurse is working under supervision as she is still undertaking her induction. Staff files viewed contained a terms and contract signed by the member of staff. Staff spoken to at the time of the inspection reported they were happy with the recruitment process and felt supported during the recruitment process. The organisation has a comprehensive training programme in place. The training matrix was submitted to the CSCI with the pre-inspection information and this demonstrated a wide range of training subjects that appertain to the client groups that are accommodated in the home. The training subjects on offer are the mandatory health and safety, communication, COSSH, Peg Feeding, Infection control, Syringe drivers and others. The home has a training room in which a computer is contained and staff undertake courses and training via a computer programme. The programme are designed so that students have to go through it systematically and if they answer questions incorrectly this prevents them from going on to the next level. This was reported to be more popular with some staff than others. The staff personnel files contain the certificates of training the staff have undertaken. Staff surveys indicate that staff are satisfied with their training, they consider they have a lot of opportunities to do training and that the manager encourages them to continually update their skills. Staff also confirmed that they received regular supervision and the manager is in the process of creating an appraisal programme to replace the ‘job chat’ system. The inspector evidenced records of the ‘job chats’. The home has an induction programme in place based on the Skills for Care Council standards. The inspector evidenced a nearly completed programme for a staff member who has been with the company for a short time. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run and managed by a person who it fit to be in charge and is able to discharge her responsibilities fully. The home has a quality control system to ensure the home is run in the best interests of the service users. There was evidence that health and safety is attended to protecting the well being of all at the home. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager, who has been registered for a year, has gained her Registered Managers Award. She previously held the post of deputy for a number of years and therefore staff and service users know her and are familiar with her being about the home. The manager has recently appointed a deputy manager to support her in her role. The manager told the inspector that during her year as manager there has been a big turnover of staff and also the home has lost a number of residents. She reports that she is fully staffed and has plans for the coming year. The inspector discussed the issue of a relative commenting that she was finding the manager and her deputy ‘unapproachable’. The manager told the inspector that she is in the home for five days and week and is always around the floor and has an ‘open door’ policy by which staff and relatives may speak to her at any time and was always willing to listen to any issues. There is clear leadership and staff spoken to support the manager in her role. The evidence from speaking with staff and relatives and responses from the surveys would support that staff and service users know they can speak out and offer their own ideas for the home. The organisation has a quality control system that each home undertakes on a monthly auditing programme. This is set out from an organisational directive and the manager enclosed a copy of the programme in the pre-inspection information. The audit programme covers health and safety, nutrition, infection control, medication. activities, documentation, personal care and professional practices. The manager returns the results monthly to head office. Service users and relative surveys are also dispatched annually. The results of the recently completed survey, along with a letter to the manager from head office, stated that an action plan must be agreed and follow-up letters sent to all people who returned the questionnaires with any actions she has taken to address issues identified. From this quality assurance information gathering, the organisation produce a report that is published and dispatched to all homes for display and distribution. The home does not look after any monies for residents; families or representatives such as a solicitor do this. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 28 Where necessary the inspector has received regular notification of incidents at the home. The inspector viewed the accident book. The organisation has produced a recording form and the information has to be put onto a computer so that the information is collected centrally. Risk assessments for service users and the environment are in place. The inspector viewed a sample of servicing certificates for equipment and systems and they were found to be current. Health and safety training is provided for staff and staff confirmed that they do attend this training. The fire log was viewed and found to be in order. The manager reported that the fire policy is in the process of being reviewed. All kitchen staff have received training in Food Handling Hygiene. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 29 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation Reg 13(2) Requirement The registered manager must ensure that the storage of medication is safe and that all unwanted or unnecessary stocks of medications accumulated in the cupboards be destroyed as per policy. A more robust stock control system must be put in place. The registered person must ensure that two references are received by the home before the commencement of any staff employment. Timescale for action 30/04/07 2. OP29 Reg 19(1)(b) Sch 2. 30/04/07 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 OP33 Good Practice Recommendations It is recommended that a call bell system devise be fitted to enable the response time to call bells to be monitored and recorded to address the issues raised by the service users and relatives with regards to the time they have to DS0000069281.V331805.R01.S.doc Version 5.2 Page 31 Challoner House wait to be responded to. Challoner House DS0000069281.V331805.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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