Inspection on 16/08/05 for Chandos Lodge Nursing Home

This inspection was carried out on 16th August 2005.

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

The inspector 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 12/06/06

Chandos Lodge Nursing Home 02/03/06

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 Guy Horwood Unannounced 16 August 2005 10:00 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 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 Hayatt Mrs Hayatt Halimah Halkier Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Elderly Physically Frail 2 Elderly Mentally Frail (Organic) Date of last inspection 03 March 2005 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, and 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 will be accommodated in one of 29 single rooms or 1 shared room. 16 rooms possess en-suite 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. A team of nurses, carers, catering and housekeeping staff, supports the home’s manager and proprietor’s. A qualified nurse is to be found on the premises twenty-four hours a day. All Service Users 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 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 Home on the 16th August 2005. The lead inspector was Mr Guy Horwood. The inspection was carried out in response to concerns having been brought to the attention of the Commission for Social Care Inspection by a visiting health care professional. The inspector was met by the homes providers upon arrival at the home, and spent time with the manager during the visit. The inspector met and discussed the inspection findings with the providers before leaving. The inspection consisted of meeting with residents and staff, witnessing staff care practices, viewing records and documents pertaining to the provision of care and the running of the home. The inspector toured parts of the building, gaining permission from a number of residents to enter their bedrooms and viewing a further number from the doorway. At the time of the inspection the home was undergoing an extensive refurbishment, with significant building work taking place both internally and externally to the home. The building work will greatly improve the current building, providing increased bathing facilities, providing a number of new and en-suite rooms and significantly increasing communal space and the practicality of the building. The home was able to accommodate 15 residents at the time of the visit, and all 15 vacancies were occupied. On completion of the building work the providers are seeking to increase their registered numbers from 24 up to 31. On completion of the building work, the home will be subject to a further inspection to take into account the final changes to the environment and to review action taken to address issues raised following this inspection. The inspector found staff polite and courteous, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector would especially like to thank the residents for their time and for allowing the inspector into their home. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The manager needs to include more detail in pre-admission assessments in order to ensure that admissions are appropriate and that staff can meet the care needs of residents admitted to the home. Records required by regulation and pertaining to the provision of care and the running of the home must be better formatted, completed, reviewed, stored and monitored. This includes those records completed by staff as evidence of care provision and for the purposes of monitoring residents health and welfare, i.e., turning records and fluid / food charts. It is the manager’s responsibility to audit and monitor record keeping practices within the home, as well as to lead by example. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 7 Staff need to be aware of all residents significant health care needs through effective handovers and communication. The providers, manager and staff need to be prompt and pro-active in providing appropriate care and equipment for the prevention of pressure ulcers. Staff must be prompt in responding to advice from healthcare professionals, and trained nurses must maintain their knowledge of current best practice in relation to care issues. Staff must be vigilant in the storage of medication. At previous inspections meals have been of a good standard, well prepared and offered good choice. Unfortunately at this inspection meals were unsatisfactory and staff not suitably qualified to prepare meals. Suitably qualified staff must prepare food at all times, and meals should be nutritious and well presented. It is anticipated at the next inspection that the standard and choice of meals will have returned to that of earlier inspections. Staff recruitment procedures are not complying with regulation. This has the potential to place residents and staff at significant risk through the appointment of unsuitably qualified or unfavourable persons. Further noncompliance with recruitment regulations may lead to the Commission taking enforcement action. The providers, manager and staff need to be prompt in identifying potential hazards to the health and safety of residents, staff and visitors, and need to take prompt action in rectifying or minimising such risks, e.g., ineffective fire barriers, trip hazards, chemicals left on display and unattended. 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 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 standard(s) 3 The pre-admission assessment viewed lacked necessary detail. Pre-admission assessments need to be detailed to enable the home to make an informed decision as to whether they can meet a residents needs and therefore admit appropriately. EVIDENCE: The pre-admission documentation for a resident who had been admitted the previous day for 2 weeks of respite care was viewed. The pre-admission assessment visit had been conducted by the manager in the resident’s own home, and a copy of a Social Services assessment had been provided to the manager. The Social Services assessment was dated from the 5th August 2004, and was therefore out of date and of questionable relevance to the residents current needs. The pre-admission assessment form was mostly in the format of a “tick box” form, and held little detail. No tissue viability assessment was evident despite the Social Services assessment stating the individual was “at risk of pressure ulcers”. No satisfactory details were recorded with regards to the resident’s Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 10 diabetes, recurrent urinary tract infections, ischaemic heart disease, and nonweight bearing status due to 2 previous strokes. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 standard(s) 7,8,9 The regular review of care plans is not consistent in all cases, and may lead to current healthcare needs not being met. Records relating to tissue viability, wound care, food and fluid intake and moving and handling are inadequate and poorly presented. These records do not provide evidence of adequate and appropriate care provision. Staff were not fully aware of a newly admitted resident’s health care needs, as a consequence the resident’s health and welfare may be at risk. The home has developed working relationships with a variety of external healthcare providers, therefore ensuring residents have access to a variety of healthcare services. Staff do not seek to employ appropriate pressure relieving equipment for use with at risk residents, and were not prompt in following the advice of clinical experts. The home possesses insufficient pressure relieving equipment. These factors place residents at risk of developing pressure ulcers. Medication is not stored securely, potentially placing residents and visitors at risk. EVIDENCE: Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 12 A selection of care plans was viewed. A combination of pre-printed and hand written care plans are used by the home. There was evidence of recent review in the majority of care plans, although there were several areas where review was long over due. Daily progress records were mostly satisfactory. The care plan relating to the resident admitted the previous day had not yet been completed. A carer was spoken with regarding the newly admitted resident. The carer gave a clear and appropriate account of the personal care he and a colleague had provided for this resident that morning, including details of appropriate moving and handling techniques. However, he was not aware that the resident was diabetic, and did not consider the resident to be at risk of developing pressure ulcers, despite the resident being unable to weight bear and given their medical history. The manager stated that she had handed over the fact that the resident was diabetic to staff, but agreed that staff were not fully aware of residents health care needs and should be. It was identified that residents have been admitted to the home, (and readmitted following a period in hospital), with hospital acquired pressure ulcers. Where this occurs records do not suggest that this issue has been raised with the relevant care manager, adult protection team or tissue viability nurse. The Commission received concerns from a visiting health care professional as to the homes lack of equipment for the purposes of pressure relief. Rooms 23 and 24 were noted to have pressure-relieving cushions on armchairs, however no other such cushions were noted at the time of the inspection. The home has 1 alternating pressure relief mattress, and all beds have Memory foam mattresses, which provide basic pressure relief. At the time of the inspection, (and despite advice from tissue viability and wound care specialist nurses on the 3rd August 2005), those residents already with pressure ulcers, and those at significant risk of developing pressure ulcers, were not provided with sufficient pressure relieving devices such as cushions and alternating pressure mattresses. It was very concerning to note that where the tissue viability and wound care specialist nurses had strongly advised a frail resident to be provided with an alternating pressure mattress on the 3rd August 2005, this mattress had still not been provided for the resident by the inspection date, (16th August). The nurse on duty on the 3rd August had assured the tissue viability and wound care specialist nurses that a suitable mattress was available within the home on the 3rd August, and had said that it would be provided to the resident on that day. Armchairs, although new and of a domestic variety, were noted to be of a standard design, with a number of similar armchairs having recently been Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 13 ordered for future delivery. The tissue viability nurse has advised that as residents are of different heights, that armchair’s of different heights be provided for pressure relief purposes. The providers have taken this in to consideration and at the time of writing this report are looking to consult with an occupational therapist for advice. All care plans viewed contained tissue viability assessments, which had been subject to monthly review. Staff were witnessed to turn 1 resident being nursed in bed on a frequent basis. However, documentation recording regular turning regimes, (“Turn Charts”), were incomplete and did not support claims of regular turning or repositioning of frail residents. A number of residents were noted to be seated in armchairs for long periods of time without repositioning / standing. Moving and handling assessment were viewed and it was noted that where hoisting equipment was utilised, limited detail was recorded as to what types and sizes of hoists and slings were to be used. A resident had been admitted to the home with pressure ulcers. Records pertaining to this resident were viewed. Advice had been sought in relation to these wounds by staff through contacting the resident’s General Practitioner and a tissue viability nurse. Insufficient records were presented with regards to the tissue viability nurse’s visit. This resident’s wound dressings were viewed at the time of the inspection with the manager. One of the dressings appeared inappropriate and to be causing trauma to the skin below. What appeared to be a pressure ulcer was noted on the resident’s ear lobe. This was highlighted to the manager who had not noted this wound before. Records pertaining to wound care, and supposedly maintained by trained nurses, were viewed. These records presented a confusing record of what condition each wound was in and what dressings were to be used. Records were difficult to interpret in areas, were poorly presented and were not orderly. The inspector has been informed that a nurse employed at Chandos Lodge has recently completed a Tissue Viability postgraduate course, and is to provide inhouse training. This will be monitored through future inspection visits. Concerns had been received by the Commission pertaining to the nutrition and hydration of residents. Records viewed included a nutritional screening tool and records of regular weights being undertaken. Evidence was seen of prompt referrals to General Practitioners and dieticians due to staff concerns as to poor intake of meals, and of admissions to hospital for investigations into swallowing difficulties. Meal supplement drinks were noted with several residents. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 14 Fluid balance charts and food intake charts were on the whole poorly completed. These records were unorganised, usually on what could be considered as “scrap” paper, and were not detailed. Concerns had been passed to the commission with regards to the home addressing resident’s continence care needs. Care records were viewed and found to contain continence assessments. Residents rooms were noted to contain individual pots of barrier creams. A visiting healthcare professional has recommended another variety of barrier cream and this information has been passed to the manager. The inspector noted the use of Incontinence pads with catheterised residents, and where residents were nursed in bed they were lying on incontinence sheets, (“Kylies”), in addition to the use of catheters and pads. The use of such incontinence sheets and pads increases the risk of pressure ulcers, especially where not monitored effectively. The medication fridge was being temporarily stored in the newly built lounge area. This area was frequented by building staff throughout the visit. The medication fridge was found to be unlocked, and held a number of prescription items. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 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 standard(s) 15 Food is not consistently prepared and presented in an acceptable manner, and does not appear to be prepared by suitably qualified and experienced staff. This means that the dietary needs of residents are not adequately catered for, and that resident’s health and welfare is potentially at risk due to food preparation by unqualified staff. EVIDENCE: Tea was seen to be provided for residents on several occasions during the visit, however biscuits were given to residents on the side of their saucer – one each – as opposed to being offered. Due to building work taking place at the time of the inspection, the home was fitted with a temporary kitchen in a porta-kabin on the driveway of the home. The Environmental Health Officer has visited the home recently to discuss this temporary measure and had advised the home accordingly with regards to health and safety in meal preparation. During the visit food was being provided by the means of a cook-chill process of reheating ready prepared meals from a catering contractor. Meal provision was discussed with residents, and a variety of comments were received with regards to meals including “very nice” to “very poor and frequently cold”. It was concerning to note that the fish in sauce served at the time of the visit Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 16 was significantly undercooked in 2 cases, and this was brought to the attention of the provider. The provider and manager were unable to provide the staff file of the cook on duty, and were unsure as to whether they had a valid food hygiene qualification. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The manager and providers are co-operative with investigation and are proactive where issues are identified. EVIDENCE: Concerns have been raised over some care issues within the home through a visiting health care professional. These concerns have been investigated with the full co-operation of the providers. Where the concerns have been substantiated, the providers and manager have taken appropriate action to address the issues in question and have sought to improve practice where needed. It is anticipated that future inspections will be able to report that these concerns have been addressed fully. The Commission has received no other concerns / complaints from residents, their representatives or other visiting health care professionals with regards to the care provision at the home. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 When completed the building work to the home will provide a pleasant and much improved home for residents. However, the current environmental standards do not provide a pleasant and pleasing environment to live in due to building work and the associated inconveniences, i.e., lack of day space, noise, and intrusion by non-care staff. Areas of risk within the environment have not been identified and as a result have not been attended to, (e.g., provision of adequate fire doors, trip hazards). This has the potential to place the health and safety of residents, staff and visitors within the home at risk. Residents are encouraged to bring personal belongings into the home, thus providing some areas of a homely and familiar environment. A call bell system operates throughout the home enabling residents to summon staff for assistance. In some cases call bells are not answered promptly potentially causing distress to residents. Staff are failing to follow the home’s and professional infection control policies and procedures, potentially placing residents health and welfare at risk. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 19 EVIDENCE: The home is currently undergoing major redevelopment with resident’s in-situ. The work is nearing completion and a full inspection of the environment will be undertaken at a future inspection. It would appear that the building work will greatly improve the existing home, as well as increasing the number of residents accommodated from 24 to 31. The new extension to the rear encloses a small courtyard garden surrounded by a wide, level path. This garden is for residents to sit in and mobilise around. A large unframed mirror was found on the path surrounding the garden, propped against a wall. This mirror presented a health and safety risk and the manager was instructed to move it immediately. At times during this visit loud building noise intruded into the home causing some disruption and annoyance to residents. Although they tried to be as unobtrusive as possible and appeared mindful of entering the residents home, building staff were present within the home and at times created noise and disturbance due to carrying out their work. Two bedrooms and a shower are situated off the main lounge. At a meeting with the providers architect in May 2005, it was required that a partition be built to separate these rooms from the lounge. This had not been done. This issue was discussed with the providers and it was required that remedial action is taken to separate the two areas. At the time of writing this report this action has been completed, and a partition with a door now separates the 2 bedrooms and shower room from the main lounge. A number of the 9 new bedrooms on the first floor were occupied. These were viewed and appeared satisfactory. 8 of these rooms share en-suite facilities and one has it’s own en-suite. The 6 bedrooms in the ground floor extension possess en-suite facilities. New furnishings have been provided for the new rooms, and height adjustable beds are already in place. Radiators are covered, fitted carpets and curtains are of a homely design and lighting is domestic in nature. Those rooms occupied were seen to contain personal belongings and reflected the interests and character of residents. A new call bell system had recently been installed throughout the home and was seen to be working during the visit. However, one resident spoken with described occasional long waits before staff answered her call bell, and even described using her personal telephone to call the homes phone number in order to tell staff she required assistance! Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 20 Tea towels and kitchen aprons were found hung over the fence in the enclosed garden of the extension. These were in full view of the residents and detracted from the homely feel sought by the providers. It was required that these items were removed. At recent inspection visits the manager was informed of staff failing to change gloves and aprons between residents when providing personal care. At this inspection staff appeared better aware of this issue. Open clinical waste bags were found on the floor in bathrooms during the tour of the premises. Visiting health care professionals have recently raised concerns with regards to staff awareness and practices in relation to infection control procedures. At the time of the visit, those completed and occupied areas of the home appeared clean. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Staff appeared caring and kind in their dealings with residents, thus providing a pleasant and caring atmosphere. Sufficient numbers of staff were on duty to meet resident’s care needs. Residents are not protected by the homes recruitment policy and practices. EVIDENCE: At the time of the visit there were 15 residents being accommodated. The manager was working from 8am until 8pm, 4 care staff were on duty between 7am and 2pm, and 3 care staff between 2pm and 7pm. One trained nurse was to be on duty from 8pm until 8am, and 1 carer was to be on duty from 7pm until 8am. The manager stated that staff handovers/reports take place between shifts, and that trained staff have sufficient time to undertake nursing duties. The manager and provider stated that staffing was currently on a regular review basis, with additional staff provided where the need was identified. This is due to the current disruption within the home and the placement of residents throughout the building. The manager and provider have stated that staffing levels within the home will be reviewed following completion of the building work and with a view to the provision of care for 31 residents. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 22 A selection of staff files were viewed: • • Staff 1. Carer. File contained a Criminal Record Bureau check dated after the employment start date. Only 1 reference, which was entitled “To whom it may concern” and was from a foreign country. Staff 2. Cook. The provider and manager were unable to present the staff file for the cook on duty, and could not confirm that they had received a Criminal Record Bureau and PoVA check, satisfactory references or evidence of a suitable food hygiene qualification. Staff 3. Cook. The provider wished to commence a cook for whom some required records had been obtained and were on file. However, they had no references for this person and the Criminal Record Bureau check was from a previous employer. No Criminal Record Bureau and PoVA check had been applied for. Staff 4. Housekeeper. A housekeepers post had been recruited to but not yet started. Only 1 reference held and no Criminal Record Bureau and PoVA check obtained. • • Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,37,38 Individual records and home records are not stored securely potentially leading to a breach of confidentiality. Documentation recording staffing levels within the home is disorganised and unclear, potentially leading to insufficient staffing levels at the home affecting care provision. The home has not been proactive in ensuring that potentially harmful items are stored appropriately, e.g., chemical cleaning products, clinical waste. Risks to the health and safety of residents, visitors and staff were identified, (e.g., ineffective fire doors, trip hazards, uncovered electrical wiring), and action had not been taken to reduce or remove these risks. These failings place residents, staff and visitors at risk of significant harm. EVIDENCE: Until the manager’s office is completed in the new building, the manager’s desk and filing cabinets are placed in the newly built lounge area. Building Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 24 staff frequented this area at the time of the visit. Resident’s care plans and staff recruitment files, as well as other documentation pertaining to the running of the home and in some cases of a confidential nature, were noted on and around the manager’s desk. The manager was not using these records at the time of the visit. Records were requested for the daily staffing levels. The manager provided rotas, which she described as being in a temporary format. This temporary format consisted of a sheet of paper per day, which listed staff working, times of their allocated breaks and which residents they were caring for. These records were disorganised, unclear and not in an orderly fashion. Copies of past rotas had not been kept and archived. The manager was reminded that these records are legally required documents and must be better managed. The manager stated that with the completion of the homes building work order would be returned to the home and records and record keeping would improve. This issue will be followed up at future inspections. At the time of the visit carpeting had not yet been fitted in the new lounge. There was a carpet “runner” through the new lounge area for the passage of resident’s from their rooms to the temporary communal area. This runner had a number of ridges and raised edges, and presented a significant trip hazard. This issue was raised with the providers who took immediate action to address the hazard. At the time of writing this report the lounge area has been fitted with permanent carpeting throughout and the above hazard no longer exists. Chemicals were seen to be left unattended by the homes housekeeping staff during the visit. Due to the category of some resident’s accommodated by the home; it is a significant risk for such items to be left unattended. The home is visited on a frequent basis by young children, further reason for housekeeping staff to be vigilant with regards to leaving cleaning products unattended. It had been previously agreed that residents could use the corridor of the new extension as temporary day space. At the time of the visit 10 residents were seated in this area. It was noted that doors between the new extension where these 10 residents were seated, and the new lounge area where building work was continuing, were fire doors. However, these fire doors were incomplete and would therefore be ineffective in the event of a fire. The doors were not fitted with smoke seals or windows, had no closure devices, and no handles or locks. This was also the case with the door leading from the new lounge to the front reception area of the home. The local Fire Safety Officer was immediately consulted with regards to this issue. This issue was discussed with the providers and they were required to take immediate action to provide adequate fire safety measures within the home. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 25 Before leaving the home the work to make these effective fire doors had been completed to a satisfactory standard. The provider stated that following recent consultation with the local Fire Safety Officer, the buildings project manager was in the process of fitting screens and doors in other areas of the home to comply with fire safety requirements. At the time of writing this report this work had been completed and a certificate for the fire alarm system has been issued. Electrical wiring was found protruding from the wall in a corridor used by staff and residents. It was unclear as to whether these wires were Live. This was brought to the attention of the providers and action to remedy this was required immediately. The providers attended to this issue promptly with an electrician working at the home. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 26 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 2 1 2 1 2 2 2 2 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 2 x x x x 1 1 Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14(1) Requirement Pre-admission assessments must be detailed and thorough. Where Social Services assessments or care plans are utilised, these must be up to date and pertinent to current care needs. Social Services assessments are to be used to support the managers own preadmission assessment and are not to be used instead of the managers assessment. Immediate Requirement served 16.08.05: The manager must contact the dietician and tissue viability nurse for advice regarding the care of the resident identified at the time of the inspection. Immediate Requirement served 16.08.05: The resident identified at the time of the inspection is to be provided with an alternating pressure mattress, and the use of the Kylie incontinence sheet is to be discontinued. Medication must be stored securely within the home. The medication fridge must be locked at all times. . Timescale for action 01.11.05 2. 8 12(1), 13(4) and 13(6) 20.08.05 3. 8 12(1), 13(4) and 13(6) 16.08.05 4. 9 10(1) 13(2) 16.08.05 Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 28 5. 15 13(3), 16(2)(i) 6. 26 12(4)(a) 23(2)(o) 7. 22 8. 27 10(1), 12(1), 13(1)(b), 13(4)(c) and 13(6) 13(3), 18(1), 19 and Schedule 2 19 and Schedule 2 9. 29 10. 37 10(1) 17 11. 37 10(1), 17 Immediate Requirement served 16.08.05: Food prepared for residents must be nutritious, wholesome and properly prepared. Laundry is not to be hung out for drying in areas intended for residents use, e.g., the garden. Drying facilities for the homes laundry are to be serarate from residents communal areas. Immediate Requirement served 16.08.05: The providers are to acquire 10 pressure relief cushions by the 01.09.05, and a further 10 by the 01.12.05 Immediate Requirement served 16.08.05: All staff involved in food handling and preparation must have relevant and up to date training pertaining to food hygiene and handling. Immediate Requirement served 16.08.05: Staff cannot commence employment within the home until all of the checks required under Regulation 19 and schedule 2 of the Care Homes Regulations 2001 have been undertaken. This includes that the home must have obtained a satisfactory CRB and PoVA check, 2 relevant and favourable references and proof of identity. . The manager must ensure records are stored securely at all times when not in use, and must take every reasonable precaution to ensure confidentiality is maintained where appropriate. The manager is to ensure that records relating to care and the running of the home are up to date, well maintained, subject to review, and are orderly. The manager must ensure that 16.08.05 01.11.05 01.09.05 16.08.05 16.08.05 01.11.05 01.12.05 Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 29 12. 37 17(2), 17(4) and Schedule 4 23(4) 13. 38 14. 38 10(1), 13(3) 15. 7, 38 15, 38 16. 38 10(1), 13(4) records support the provision of care to residents and the actions of staff. Records relating to the staffing of the home, (Rota), are to be well presented and organised, are to be up to date and must be a true reflection of staffing within the home. The manager and providers are to ensure that at all times adequate precautions are taken against the risk of fire and that adequate arrangements are made to detect, contain and extinguish fires. The manager is to make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. Details as to types and sizes of hoists and slings to be used for moving and handling purposes must be entered into individuals care plans. Chemicals, (e.g., cleaning products), must not to be left unattended when in use, and must be stored securely when not in use. 01.11.05 16.08.05 01.11.05 01.01.06 16.08.05 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 8, 18 Good Practice Recommendations If the home admits a resident from hospital, (or readmits following a spell in hospital), and that resident has a hospital acquired pressure ulcer, it is recommended that trained nurses at the home liase with the tissue viability nurse and residents care manager to disclose this information. It is strongly recommended that a separate wound care 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 30 2. 7, 8 Chandos Lodge Nursing Home 3. 4. 5. 6. 7. 8. 9. 22 26, 38 chart be used to record details pertaining to each individual wound. It is strongly recommended that the specific residents identified at the inspection be provided with an alternating pressure mattress and pressure-relieving cushion. It is recommended that alcohol hand rub is provided for staff use. Chandos Lodge Nursing Home 20050816_Chandos Lodge_UI_Stage 4_S19192_V244781_H53_GH_ces.doc Version 1.40 Page 31 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, 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. 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