Inspection on 12/06/06 for Chandos Lodge Nursing Home

This inspection was carried out on 12th June 2006.

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

The inspector 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

Chandos Lodge Nursing Home 04/06/07

Chandos Lodge Nursing Home 02/03/06

Chandos Lodge Nursing Home 16/08/05

Chandos Lodge Nursing Home 03/03/05

Chandos Lodge Nursing Home 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Chandos Lodge Nursing Home Blackpond Lane Farnham Common Bucks SL2 3ED Lead Inspector Mr Guy Horwood Unannounced Inspection 12th June 2006 09:40 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 Chandos Lodge Nursing Home DS0000019192.V295441.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. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chandos Lodge Nursing Home Address Blackpond Lane Farnham Common Bucks SL2 3ED 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 643224 Mr Hayat Mrs Hayat Care Home providing Nursing. 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Categories: That Chandos Lodge Nursing Home is registered to accommodate up to 31 residents requiring Nursing (N) and within the category of Old Age (OP), not falling within any other category. 2nd March 2006 Date of last inspection Brief Description of the Service: Chandos Lodge Nursing Home is located in a quiet residential area of Farnham Common. The village centre is a short distance away, and has a small selection of shops. The towns of Slough and High Wycombe are a short distance away and possess a larger selection of shops and other amenities. These towns are well served by public transport networks. The home has recently undergone extensive refurbishment to improve facilities and to increase the number accommodated from 24 to 31. Residents are accommodated in one of 29 single or 1 shared room. 16 rooms possess ensuite washbasin and toilet facilities, and there are additional bathrooms and shower rooms on both levels of the home. Bathrooms and shower rooms facilitate disabled bathing, and grab rails are fitted throughout. A through floor lift enables access to the first floor of the home, and hoists are provided to facilitate safe moving and handling practice. The home has a large dayroom, which provides space for meals, activities, receiving visitors and relaxing. The fees currently charged by the home range between £540 and £600, and accommodation is provided for both privately funded and social services sponsored residents. A team of nurses, carers, catering and housekeeping staff, supports the homes proprietor. A qualified nurse is to be found on the premises twenty-four hours a day. All residents are registered with a local General Practitioner, who attends as requested, and other healthcare professionals can be contacted either directly or by G.P referral. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced inspection carried out at Chandos Lodge Nursing Care Home on the 12th June 2006, commenced at 9.40am. The lead inspector was Mr Guy Horwood who was accompanied by Mrs Caroline Roberts (Regulation Inspector). The inspection consisted of touring the premises, meeting with residents and staff and viewing records and documents pertaining to the provision of care and the running of the home. The home’s proprietor, Mrs Hayat, has decided to take on the position of manager, and due to not possessing a nursing qualification herself, is looking to appoint a senior nurse to manage clinical /nursing issues. Mrs Hayat has recently submitted her application to be registered as the homes manager, as required under the Care Standards Act 2000. Mrs Hayat was present throughout the inspection, and along with her husband received feedback at the conclusion of the visit as to the inspector’s findings. From this inspection it was apparent that Mr and Mrs Hayat and the homes entire staff team, with support from external agencies, have continued to work hard to address issues identified through the previous 12 months inspections. They are to be commended on continuing their hard work since the inspection of the 2nd March 2006, and it is anticipated that their desire to provide a caring and homely service will continue. Throughout the inspection the inspectors found staff polite and helpful and would like to thank them for their hospitality, co-operation and assistance during the inspection. The inspectors would especially like to thank the residents for their time and for allowing the inspectors into their home. What the service does well: The inspectors spoke with visitors to the home. One commented that Chandos Lodge was an “absolutely gorgeous home”, and all complimented staff and the care provided. Visiting relatives were offered drinks and meals at the time of the inspection, and from evidence gathered on the day, and at previous inspections, this welcoming manner is usual. The ethos of the home is to provide a caring, safe and homely environment for residents. The providers and staff appear caring and kind, and residents appear well cared for. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 6 Pre-admission assessments are conducted to ensure residents care needs can be met prior to their admission to the home. Service Users health care needs are documented in care plans. These care plans are orderly, working documents, are up to date and subject to review and auditing. This ensures residents current identified needs are known to staff to enable them to provide the appropriate care. Residents have access to healthcare professionals external to the home to ensure that their healthcare needs are met. In the majority of cases, medication is received, recorded, stored, and administered safely, and residents receive their medication as prescribed. Through working with the General Practitioner, the home seeks to avoid using sedatory medicines. Residents are treated with privacy, dignity and respect. Residents are presented with choice within everyday routines and are able to maintain relationships with families and friends. Residents are provided with wholesome, nourishing and varied menus, which incorporate appealing drinks and meals, individual choice and cater for religious and special dietary needs. Staff are sensitive, polite and unhurried where assisting residents with meals. The complaints procedure is satisfactory and accessible. Residents are protected through staff training and robust recruitment procedures. The improvements and refurbishment of the premises within the past 12 months, along with the standards of cleanliness apparent at the time of inspection, provide a safe, pleasant and homely environment for residents to live in. Suitably trained staff are employed in sufficient numbers to meet residents care needs. Where residents money is handled by the provider, this is done appropriately with good records kept. The health, safety and welfare of residents and staff is protected and promoted through a robust programme of maintenance, servicing and adherence to health and safety guidelines. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: 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. Chandos Lodge Nursing Home DS0000019192.V295441.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 Chandos Lodge Nursing Home DS0000019192.V295441.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments of potential residents are conducted, and this allows the home to make an informed decision as to whether they can meet a residents needs, and as a consequence, residents appear to be placed appropriately. Intermediate care is not provided at this service. EVIDENCE: The home has a pre admission checklist which is used for all admissions to ensure they can meet the needs of potential residents. It is usual practice that a senior nurse undertakes the initial assessment accompanied by a junior nurse. In one instance the pre-admission assessment visit had been undertaken by an acquantance of the provider not employed to work at the home. The provider was advised that pre-admission assessments must only be conducted by persons employed to work at the home. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 10 Evidence was available to show that where pre-admission visits are not possible due to distance, the home gathers the necessary information required to enable them to make a decision as to whether they can meet the individuals needs prior to agreeing to admission. Evidence was available of the home declining to admitt people due to the home being unable to manage their care needs. Some of the beds in this home are part of a block contract with social services so assessments are conducted in conjunction with the receipt of a care service order/care plan from the allocated care manager. The inspectors viewed three pre-admission assessments, the majority of which were satisfactory. However, in some instances more detail was required to identify specific moving and handling needs. A discussion took place with the provider about the pre-admission assessment needing to be more holistic with the need to include details pertaining to social care needs. Some assessments were not dated or signed, and did not convey the place of the assessment. The provider needs to ensure that all assessments are consistently dated, signed and provide details of where the assessment took place. Intemediate care is not provided at this home. Chandos Lodge Nursing Home DS0000019192.V295441.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement also takes into account the views and experiences of people using the service. Service Users health care needs are documented in care plans. These care plans are orderly, working documents, are up to date and subject to review and auditing. This ensures residents current identified needs are known to staff to enable them to provide the appropriate care. Staff appear to be caring and residents appear to be well cared for. Residents have access to healthcare professionals external to the home to ensure that their healthcare needs are met. In the majority of cases, medication is received, recorded, stored, and administered safely, and residents receive their medication as prescribed. However, improvements are required in the consistency of recording why medications are omitted and in the disposal of wasted medicines. Observation and comments made at the time of the inspection provide evidence that residents are afforded with privacy, dignity and respect. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 12 EVIDENCE: A random selection of care plans was viewed. These were found to be orderly, user friendly and generated from information gathered through pre-admission assessments. The care plans viewed provided a good level of information, which would enable the resident to be cared for by a staff member unfamiliar with their care needs. Care plans were subject to maintenance, review and alteration where required. The monitoring of specific healthcare needs on a regular basis was evident within these care plans, (weights, vital signs, nutritional status, blood sugar levels), from the point of admission to the date of inspection. Care plans included reference and monitoring of social interests and activities undertaken, and referred to specific cultural needs including religious preferences and diet. The home accommodates residents from a variety of cultural backgrounds, and staff were seen to be enabling residents to continue to follow these religious and cultural choices. There was evidence in care plans that residents are registered with a G.P and have access to specialist health services, as recorded on their medical record sheets. The provider stated that communication was good with the local General Practitioner, and previous meetings with the General Practitioner by the inspector would support this statement. Visits by healthcare professionals and their advice / intervention was seen to be recorded within the care plans. One resident, who was part of the case tracking process, is diabetic. The records pertaining to this resident were viewed and found to be well documented and up to date, with a process of regular review apparent. One resident is receiving palliative care and records evidenced regular visits and reviews by the General Practitioner and local palliative care specialist nurses. At the time of the inspection, only 1 resident had chosen to stay in their bedroom, all others had moved to the lounge. All residents appeared well cared for and comfortable. At the time of the inspectors arrival all residents had at least 1 drink to hand, (most had 2, comprising of a choice of fruit juice, squash, fruit smoothies, water, hot drinks, milk and supplementary drinks), and interaction between residents, visitors and staff appeared friendly and good-natured. Fluid / food intake charts were being maintained for 3 residents, and these appeared to have been completed to a satisfactory standard. Pressure relieving mattresses were seen in use on beds, and pressure-relieving cushions were noted in use for several residents in the lounge. Evidence of discussion with tissue viability specialist nurses was apparent, as was the use of skin integrity assessment tools and the provision of supplementary drinks. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 13 However, a comment card returned from a visiting healthcare professional expressed some concerns as to staff practice with regard to moving and handling and the level of staff awareness with regard to infection control and pressure area care. This healthcare professional expressed mixed feelings as to the overall provision of care at the home. The homes procedures pertaining to the receipt, storage, handling, administration and recording of medication within the home was reviewed. The home uses a pharmaceutical company to provide residents medication, and as a result the homes medication systems were found to have improved significantly at the inspection of March 2006. These improvements appeared to have been maintained at this inspection in that: Medication was stored securely; Medication Administration Records, (MAR charts), were up to date with no gaps noted. MAR charts were well maintained, although some inconsistencies were noted pertaining to reasons for the omission of medication. Where staff entered instructions on charts, supporting documentation of the original prescription was available. Wasted medication was noted as being disposed of inappropriately, and a requirement is served that suitable containers for the disposal of medicines are obtained. The senior nurse stated that the home has been working with the General Practitioner to reduce the use of sedating medicines as far as possible at the home, and it was apparent that very few residents received such medicines. Where sedating medicines were prescribed for use “as needed”, these were noted to be rarely used. The senior nurse described how one resident frequently refuses to take medication as prescribed, and it was recommended that the General Practitioner be contacted to discuss this issue. Staff were noted to speak to residents politely; to knock at doors before entering rooms; to discuss procedures with residents before undertaking them, (e.g., hoisting and assisting with meals). Visitors spoken with stated that staff were polite, welcoming and always offered drinks, and on occasion meals, to them when they visited. One residents comment card received by the Commission stated that their privacy is respected. Evidence was found in some care plans of discussion that had taken place with some residents and / or their relatives with regard to the care they wished to receive in the event of their death. The staff group are from a variety of cultural backgrounds, and as such were aware of different religious practices to be followed in the event of the death of a resident. Palliative care can be provided at the home, and evidence was seen of General Practitioner’s and palliative care specialist nurses communication with the home where this care was being provided. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 14 Chandos Lodge Nursing Home DS0000019192.V295441.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 at least once during a 12 month period. 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 from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. Residents are able to receive visitors at times of their choosing; receive a choice of meals and where to dine; are able to follow religious observance; are provided with some entertainments and activities. Residents are therefore presented with choice within everyday routines and are able to maintain relationships with families and friends. However, further improvements need to be made to provide a more varied activities programme in order to stimulate and entertain residents. Meals and drinks are provided in sufficient amounts; are of a good standard; incorporate relevant dietary needs, likes and requests; and therefore provide residents with appealing meals and meal choices. EVIDENCE: Mr Hayat possesses a licence enabling him to drive a bus. This enables residents to go out on trips throughout the year. In previous years, and in recent months, residents have been on day trips to the seaside and to see the Christmas lights in London. The inspectors were informed that further outings are being discussed for the coming year. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 16 On the day of the inspection staff were seen to engage residents in reading newspapers and doing armchair exercises. One resident was celebrating their birthday and the providers had bought a large birthday cake. Staff gathered with visiting relatives to sing happy birthday, and the resident and relatives were complimentary as to staff efforts to make the day special. Visiting relatives were seen to bring an impromptu “Thank you” card and box of chocolates for staff, and complimentary comments were noted from the visiting relatives of a recently deceased resident. Visitors to the home were spoken with, and commented that they could visit at any convenient time of the day. They also confirmed that they were contacted when their relative became unwell. One residents comment card returned to the Commission stated that the home provided suitable activities, whilst another relative commented that they felt boredom was a problem within the home, and that the prime entertainment was the television in the lounge. The inspectors did pass comment to the providers with regard to a period when the radio and television were on in the lounge, whist at the same time a member of staff encouraged a group of residents to participate in armchair exercises. Care plans were found to record the times residents like to get up and go to bed, as well as religious preferences. Care plans were found to record the provision of activities, although the variation of activities appeared somewhat limited. The home provides a small separate area within the lounge where they are able to screen Asian films for residents of that ethnic origin whose first language is not English. A new chef was appointed to the home earlier this year, and the provider stated that a review of menus has taken place. Menus are available for viewing within the home, and these incorporate a variety of seasonal and cultural meals. At the time of the inspection the main chef was on annual leave, and a replacement cook was preparing the days meal. The inspectors sampled the day’s lunch, which was found to be tasty, although improvements need to be made to the overall appearance and presentation of the meal. Throughout the inspectors visit, residents were provided with a variety of regular hot and cold drinks, and in an attempt to introduce a wholesome and nourishing diet, residents were offered fruit “smoothies” as a mid-morning drink. These were seen to be very popular with residents, as were the bowls of snacks and crisps distributed throughout the lounge. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 17 Due to the home accommodating residents from a variety of cultural backgrounds, the homes menu incorporates a variety of dishes. Lunch at the time of the visit gave good examples of the menu’s provision of choice, with residents able to choose from mince and vegetables, a halal meal and a vegetarian dish. Meals were served in the main lounge from a heated trolley, with staff seen to exhibit due regard to relevant health and safety guidelines in relation to the serving of food, i.e., hand washing, wearing aprons. The inspectors expressed concerns as to the trolley itself being located in the lounge and heated up prior to lunch being served, given the fact that it was extremely hot to the touch and presented a risk to passing residents. It is strongly recommended that an alternative location be sought for the trolley to heat up prior to the serving of food. Residents were offered a choice as to where they received their meal, and were subsequently served either at dining tables or in armchairs with lap tables. Two resident chose to sit in the garden to receive their meals. Given that the day of inspection was particularly hot and sunny, parasols provided by staff shaded these two residents. All residents received drinks with their meals. It was noted that staff, where required, assisted residents with their meals in a kind, considerate and unhurried manner. Staff were seen to sit next to residents when assisting with their meals, and to engage in conversation whilst providing this assistance. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The home has a complaints procedure for residents and their representatives, which enables them to express their concerns and expect a structured response. Care staff have received training with regards to the Protection of Vulnerable Adults and the identification and reporting of abuse. The homes recruitment procedures are satisfactory. These measures safeguard residents. EVIDENCE: One complaint has been received directly by the Commission for Social Care Inspection with regard to this service. One complaint has been received by the home in the period under review (3 months). Complaints are logged by the home and investigated fully, with records maintained as was evidenced in viewing the one complaint received. The Complaints policy is available to residents and relatives, and is displayed within residents bedrooms. The home has adult protection polices in place, which are available to staff. However, it was advised that the home obtain a copy of the Buckinghamshire inter-agency protocols in relation to dealing with allegations of abuse. A requirement was served at the last inspection that all care staff should receive abuse awareness training, and it was confirmed that this has been provided, with certificates available as evidence. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 19 A recommendation was made at the last inspection that housekeeping staff should also receive abuse awareness training. This has not been undertaken, although Mrs Hayat stated that it is intended for this training to be provided in the near future. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 20 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 & 26. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The improvements and refurbishment of the premises within the past 12 months, along with the standards of cleanliness apparent at the time of inspection, provide a safe, pleasant and homely environment for residents to live in. EVIDENCE: The home is situated in a quiet, pleasant residential area, and has parking for several cars. The home was found to be secure at the time of the visit, and entry to the home by the front door is monitored through the use of CCTV. The home was found to be in excellent decorative order throughout, with high standards of cleanliness and no unpleasant odours detected. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 21 The home is furnished with lighting, carpets and curtains of good quality and that are domestic in design. Resident’s personal belongings were seen to be included in their bedrooms, and appeared to reflect the character and interests of the occupant. All rooms have adjustable nursing beds, which possess fulllength integrated cot-sides. A number of pressure relieving mattresses and chair cushions were noted in bedrooms. Windows open to provide ventilation, with windows above ground level fitted with restrictors. However, 2 windows were noted to have defective window restrictors, enabling them to open fully. The home possesses hoists for the safe manual handling of residents. All rooms are fitted with a nurse call bell system, and this was in working order at the time of the visit. Call bells can be detached from the wall and are therefore able to be placed within reach of the resident wherever they sit. Clinical waste bins and electric hand dryers were noted throughout the home. Plastic apron dispensers are fixed at numerous locations. At the time of the visit, staff were seen to work with due regards to infection control measures – e.g., the use and disposal of gloves and aprons, hand washing. The home has washing machines and a tumble dryer. The washing machine has a sluicing facility. The door to the laundry was locked when unstaffed to prevent access to any chemicals. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 & 30. Quality in this outcome area is good. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. At the time of the inspection the home was staffed with a sufficient number of care staff to meet personal and healthcare needs. The homes recruitment policies and procedures are robust and protect residents. Staff are provided with appropriate training in order to meet resident’s personal, health and social care needs. EVIDENCE: At the time of the visit the home appeared sufficiently staffed to meet residents needs. Usual staffing numbers equate to 2 trained nurses and 4 carers on an early shift, 2 nurses and 3 carers on a late shift, and 1 nurse and 2 carers on at night. Between the hours of 8am and 3pm, a carer is based in the lounge to assist, monitor and interact with residents. The provider stated that 3 staff possess a Level 2 NVQ in care, that 2 staff had commenced on this qualification, and that 2 more are planning to undertake it. The provider holds the Registered Managers Award (Level 4). Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 23 Staff recruitment files pertaining to 2 carers, 1 nurse and 1 domestic, all recently recruited, were viewed. These files were found to be stored securely and to hold the required information - including up to date Criminal Record Bureau and PoVA checks. Some of the files were a little disorderly and improvements in the management of these records are anticipated by the next inspection. Records were present pertaining to staff training and courses undertaken. Records and certificates evidenced that a good level of training has been provided for the first 5 months of 2006, including abuse awareness, care planning, moving and handling, team working, dementia care, equality and diversity, and overseas staff receiving training to ensure that they have appropriate communication skills. The inspectors recommend that a spreadsheet be developed to identify when staff require updates in mandatory training. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 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, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The ethos of the home is to provide a caring and homely environment for residents. However, the provider has limited experience and qualifications with regards to the provision of nursing care, which may lead to inadequacies in the provision of specialist clinical care. A quality assurance tool is in place but has not been utilised fully. As a result this service has not been scrutinised by the provider in order to ensure that the home is run in the best interests of the residents. Systems are in place for the handling of money on the behalf of residents, and although these systems appear satisfactory, the providers are looking to provide a more secure system to further safeguard resident’s finances. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 25 The health, safety and welfare of residents and staff is protected and promoted through a robust programme of maintenance, servicing and adherence to health and safety guidelines. EVIDENCE: Since the departure of the previous manager, Mrs Hayat has decided to apply to become the registered manager of Chandos Lodge Nursing Home. As she is not a qualified nurse, Mrs Hayat intends to recruit a qualified nurse to work with her to provide clinical leadership within the home. Given that some concerns have been expressed in relation to the provision of nursing care over the last 12 months, it is required that this position be filled as a matter of urgency. It is anticipated that this will ensure that the improvements shown in the last 6 months are maintained and further improved upon. Mrs Hayat was seen to interact well with residents, staff and visitors, and was co-operative and polite throughout the inspection. Within the last 6 months, Mrs Hayat has rescinded the homes registration category permitting the home to accommodate residents with a dementia type illness. The home has a quality assurance tool in place, however, this has not been fully utilised to date. A requirement is made that this process of monitoring the quality of the service provided is to be completed within 6 months of the date of this inspection. The provider handles monies for 2 residents. This money is banked, and records viewed appeared up to date and well maintained, with receipts held. However this money is held in the homes account and the provider stated that she is currently in liaison with a bank to organise separate accounts for these residents. It is anticipated that this undertaking will be have been completed and applied to any new residents by the next inspection. Records pertaining to hot water temperatures in bathrooms were noted; these were up to date and well maintained. The homes fire logbook hold’s details as to the testing of alarm systems, staff fire drills and emergency lighting tests. Staff training records relating to fire safety were seen and appeared satisfactory. The home employs a full time maintenance man. Up to date certificates were seen pertaining to the servicing of fire alarm systems, gas safety, nurse call alarms, lifts, hoists, and portable electrical appliance testing. These records are held in an orderly and easily accessible manner, and were easy to locate for the purposes of inspection. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 26 Up to date certificates for insurance were displayed within the home. An Environmental Health inspection has taken place within the last 3 months. Chemicals were stored securely and appropriately throughout the home. Infection control measures and practices appeared satisfactory during the inspection. Thermostatic valves are fitted to sinks and, where tested, hot water was running at suitable temperatures. Window restrictors are fitted to windows above the ground floor, but at the time of the inspection two 2 were found to have been disengaged. This was discussed with the providers and a programme of regular review and repair of window restrictors is required. Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X X 2 Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Pre-admission assessments must only be undertaken by persons employed at Chandos Lodge Care Home, and who have been subject to all of the required employment checks. Timescale for action 01/07/06 2 OP9 13(2) Staff must record reasons for the 01/08/06 omission of prescribed medicines at all times. Wasted medicines must be disposed of in an appropriate manner and through a registered agent. The providers are to appoint a suitably qualified person to provide clinical leadership and oversee the provision of nursing care, as a matter of urgency. The providers are to undertake a process of reviewing the provision of care at the home, and make improvements as required, on a regular and ongoing basis. 01/08/06 3 OP9 13(2) 4 OP31 7 and 8 01/09/06 5 OP33 24 01/01/07 Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 Page 29 6 OP38 13(4) Window restrictors must be in good working order at all times, and a programme of assessing and maintaining window restrictors must be in place, with records of this practice kept. 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP3 OP12 OP15 OP15 OP18 OP30 Good Practice Recommendations It is recommended that pre-admission assessments be audited on a regular basis to ensure staff consistency in the level of detail included. It is recommended that the providers review the activities provided with a view to increasing the variety and choice available. The providers are recommended to audit the provision of meals to residents in order to ensure they are presented in an appealing manner on a consistent basis. It is recommended that the chef undertake training specific to the dietary needs of elderly people and provision of special therapeutic diets. The providers are recommended to obtain a copy of the local interagency policy pertaining to the identification and reporting of abuse. It is strongly recommended that all catering and housekeeping staff are included in training pertaining to the Protection of Vulnerable Adults and the identification and reporting of abuse. It is recommended that the providers develop a spreadsheet to record the training provided to staff in order to identify when training updates are required. It is strongly recommended that measures are taken to prevent residents being injured through coming into contact with the heated serving trolley. 7 8 OP30 OP38 Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 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 Chandos Lodge Nursing Home DS0000019192.V295441.R01.S.doc Version 5.2 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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