CARE HOMES FOR OLDER PEOPLE
Chandos Lodge Nursing Home Blackpond Lane Farnham Common Bucks SL2 3ED Lead Inspector
Kate Harrison Unannounced Inspection 4th June 2007 13:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chandos Lodge Nursing Home DS0000019192.V337289.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.V337289.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 01753 646332 hay41@aol.com Mr Hayatt Mrs H Hayatt Mrs H Hayatt Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th June 2006 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 been refurbished to improve facilities and to increase the numbers of people accommodated from 24 to 31. People at the home live in their own single rooms, 29 altogether, or in the one shared room. 16 rooms have en-suite washbasin and toilet facilities, and there are additional communal bathrooms and shower rooms on both levels of the home. The communal bathrooms and shower rooms are suitable for people with disabilities, and grabrails are fitted throughout. There is a lift to the first floor of the home, and hoists are provided to help staff members move people safely. 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 support the homes proprietor to run the home. A registered nurse is available on the premises 24 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 GP referral. The fees currently charged by the home range between £540 and £650 per week. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 1.00pm, and was in the service for 5.5 hours. This inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the service, and any information that the Commission has received about the home since the last inspection. The inspector saw most areas of the home, observed staff interactions with the individuals living at the home, spoke to staff members and looked at records and documents relating to the care of the individuals. Staff recruitment records were also seen. The registered manager was available on the day, as was the deputy manager, who is a nurse. As the registered manager is not a nurse, two senior nurses share the clinical management at the home, and one is the deputy manager. The inspector asked the views of relatives and health care professionals, as well as the views of people living at the home, through questionnaires that the Commission sent out. Altogether eight responses were received, and these views are reflected in this report. The inspector spoke to several residents at the home during the day, and to three visitors. There were 30 people living at the home at the time of the inspection visit. Most of the comments about the care at the home were very positive, especially comments about the staff. One individual living at the home commented about the service, ‘I couldn’t wish for better’. The home has improved on several levels since the last inspection, and all the requirements and recommendations made at that time have been met. What the service does well:
Chandos Lodge provides a caring, homely environment for people to live in. One relative said that the home provided a ‘family friendly home-from-home atmosphere’. Visitors are very welcome, and say that they are offered refreshments at any time. The home’s management is sensitive to cultural and religious needs and efforts are made to meet the needs of people living at the home from a variety of cultural and religious backgrounds. One relative said that her relative’s Christian faith was appreciated and supported at the home. Good assessments are carried out before individuals are admitted to the home, and a ‘Welcome’ pack with all the information about the home is given to individuals on arrival. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 6 Healthcare needs are recognised and plans are in place to meet the needs identified. People at the home said that the food is good, and that it is easy to make a complaint if necessary. The staff team is vetted and trained and there are sufficient carers available to help the people at the home with their needs. Relatives said that the home is ‘well run, with polite and caring staff’, and that people’s needs are attended to ‘quickly and efficiently’. What has improved since the last inspection? What they could do better:
To improve the care given to people living at the home, information gained from the risk assessments should be used consistently in the care plans. This will mean better direction for the staff members so that they will know what to do to care better for the individuals. The home’s management is considering how to make all aspects of life at the home more centred on the wishes of the people living at the home. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chandos Lodge Nursing Home DS0000019192.V337289.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.V337289.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each individual has their care needs fully assessed by a senior nurse before admission to the home, to make sure that the home can meet the individual’s care needs. EVIDENCE: The home has a clear policy about admitting people to live at the home. The records about the recent admission of one individual from hospital showed that a pre-admission assessment had been carried out at the hospital. Only senior nurses carry out the pre-admission assessments, and only if it is clear that the home can meet the individual’s needs will a place be offered. If a care manager makes a referral to the home, then information is acquired from the care manager before the pre-admission assessment is carried out. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 10 The individual and relatives are encouraged to visit the home at least once before coming to stay. The home’s ‘Welcome’ pack, including a guide to the home and the complaints procedure, is given to all individuals on admission, and the first six weeks at the home are seen as a trial period. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Skilled and caring staff members make sure that the health and personal care needs of people living at the home are met. EVIDENCE: The keyworker system is in place, and this helps people living at the home and their relatives to know who to approach about care issues. Each person living at the home has care plans setting out all their care needs, and some of the care records were assessed in detail during the inspection visit. Staff members monitor the changing needs of the individuals and arrange access to health care professionals as required. Risk assessments are carried out for all important care topics such as moving and handling, nutrition and falls, although this information is used inconsistently in the care plans. As staff may not refer to the risk assessments, the information from the risk assessments should be consistently used in the care plans. Plans are in hand to replace the existing nutrition risk assessment tool with a nationally evidenced one. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 12 Staff members are encouraged to take up any training offered, and weekly learning workshops have recently started so that the care staff members can better understand the needs of the individuals. Most of the care staff who are not nurses hold a National Vocational Qualification in Care. Relatives say that the care staff know how to meet their relatives’ personal care needs, and one general practitioner expressed satisfaction with the home’s management of the health needs of the people living at the home. Care staff members were seen to be respectful to the people living at the home, and individuals said that the staff members were kind and caring. Medication is prescribed individually by the general practitioner, and supplied by a local pharmacy. Good systems are in place to make sure that the medication is properly stored, recorded and disposed of. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are helped to keep control over their lives and to exercise choice whenever possible. EVIDENCE: Individuals said that the routines of the home suit them, and the care plans show that individual choice is considered. Activities are provided, usually twice everyday, by groups of staff members trained on the subject, and a schedule is available for the people living at the home. Trips out are organized, and individuals enjoy the garden activities provided. Feedback from relatives say that some individuals would welcome more one to one conversations, and the manager said that with more staff now available, this will be incorporated into the daily activities. The management of the home is working to involve the people living at the home more in planning daily life at the home, so that they are able to live more as they want to. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 14 Some individuals from South East Asia live at the home, and the staff team are very well able to provide for their cultural needs. Their food preferences are catered for, and the daily routines are individually organised so that each is able to live according to their wishes. Individuals are able to see films in the language of preference, and listen to preferred radio stations. Visitors said that there are no restrictions on when they can come to the home, and that they are always welcomed and offered refreshments. Food is an important part of life at the home, and menus are available and alternatives are offered. Dedicated staff members are available in the kitchen at mealtimes, and fresh fruit ‘smoothies’ are offered in the morning, and freshly made soup is on the menu at suppertime. Individuals said that the food is good, especially the fish and chips and rice pudding on Fridays. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home are protected from harm and know that their concerns will be listened to and addressed. EVIDENCE: People who live at the home and their relatives know who to complain to, and have confidence that their concerns will be listened to and addressed. The home’s complaints procedure is visible in the home, and a copy is in each individual’s room. The Commission has not received any substantiated information concerning the home since the last inspection. The home has a copy of the local interagency codes of practice on safeguarding vulnerable adults. Training on safeguarding vulnerable people is part of the home’s induction procedures, and further training is provided on a regular basis so that staff members are confident in reporting any signs of abuse. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, clean and well maintained. EVIDENCE: Visitors said that the home is always fresh and clean, and provides a homely atmosphere for the people living there. A named individual is responsible for keeping the home safe and well maintained, and records of routine maintenance are kept. The laundry area is well managed, and good systems are in place to minimise the spread of infection, including the training of staff. The lounge and dining areas are part of one large room, and efforts are made to make small areas for people to sit and socialise together. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have their needs met by trained, caring and safe staff members. EVIDENCE: The staff rota shows that there is always a registered nurse available at the home, and enough carers are on duty to meet the different needs of the people living at the home. As the registered manager is not a nurse, two senior nurses share the clinical management at the home, and one is the deputy manager. The home has reached the national minimum standard of 50 trained staff at National Vocational Qualification (NVQ) Level 2, and most of the care staff are registered on an NVQ programme. The home uses the local university training service to deliver induction training for new staff members and additional training on care topics is provided on an ongoing basis. Some individuals at the home have developed dementia, and training for staff on caring for people with dementia is included in the training programme. Relatives and people at the home said that the staff members are ‘good’ and ‘very caring’. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 18 The recruitment procedure was checked through the documentation for three staff files. One reference was not on a file, but this was quickly found, and all the other necessary information was available. The home sees it as very important to find the right person for the job, and the staff team work together to fill any gaps in the staffing rota so that familiar staff are available. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are protected by the home’s quality systems and the registered manager’s drive to improve the service. EVIDENCE: The registered manager is co-owner of the home, has completed the NVQ Level 4 in Care Management, and has over 20 years experience of managing a care home. She has clear vision about how to improve the service and provides strong leadership at the home. A condition of her recent registration by the Commission as the registered manager at the home was that a clinical lead be identified, so that people living at the home know who to contact about health matters. This information is included in the home’s documents. The deputy manager and another senior nurse share the responsibility, and one of them is usually on duty to manage clinical issues and to be available for individuals at the home and their relatives.
Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 20 The home has a system for regular supervision meetings for staff, including for the clinical lead nurses regarding the running of the home. All staff members attend an annual appraisal focussing on the needs of the home. The views of people living at the home and their relatives are sought on a quarterly basis about the service, and the results are used to improve the home. The manager has plans to broaden the scope of the quality assurance surveys by asking detailed views about certain aspects of the service, and by inviting health and other professionals for their views. The home does not manage petty cash for residents, and invoices are sent for outgoings incurred, such as for chiropody and hairdressing services. A trained named person is responsible for health and safety at the home, and the home has a policy statement about its health and safety responsibilities. A fire risk assessment and evacuation plan is in place, and monitoring of the fire prevention system takes place. Fire safety training takes place regularly. Maintenance contracts are in place for services and facilities, to make sure that safety risks are minimised. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Information from the risk assessments should be consistently used in the care plans, so that staff members know how to care properly for the individuals. Chandos Lodge Nursing Home DS0000019192.V337289.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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