Inspection on 14/04/08 for Chantry House Residential And Nursing Home

This inspection was carried out on 14th April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chantry House Residential And... 12/06/07

Chantry House Residential And... 12/06/06

Chantry House Residential And... 25/01/06

Chantry House Residential And... 24/08/05

Chantry House Residential And... 03/02/05

Chantry House Residential And... 19/07/04

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Chesham House

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

CARE HOMES FOR OLDER PEOPLE Chantry House Residential And Nursing Home Chantry Road Saxmundham Suffolk IP17 1DJ Lead Inspector Julie Small Unannounced Inspection 14th April 2008 09:20 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 Chantry House Residential And Nursing Home DS0000024354.V362355.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. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chantry House Residential And Nursing Home Address Chantry Road Saxmundham Suffolk IP17 1DJ 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) 01728 603377 01728 605645 kats.sheldrake@anchor.org.uk Anchor.org.uk Anchor Trust Vacant post Care Home 24 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Learning disability over 65 years of age of places (1), Mental disorder, excluding learning disability or dementia (8), Mental Disorder, excluding learning disability or dementia - over 65 years of age (8) Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Chantry House may also care for one service user (as named in the letter from the Commission for Social Care Inspection to Mr John Ellis dated 11th May 2005) who is elderly and who has both a learning disability and dementia, falling in the registration categories of LD E, DE, E. 12th June 2007 Date of last inspection Brief Description of the Service: Chantry House is a registered care home, which provides nursing and residential care for up to 24 older people with mental health needs. The home is owned by Anchor Homes, a non profit making organisation, who provide care, support and housing to older people throughout the country. Chantry House is situated in the market town of Saxmundham and is close to all local amenities. Saxmundham is served by a local bus and train service and is a short distance from the main A12. The town is surrounded by open countryside and is a short drive from the Suffolk Coast. Chantry House opened in 1993 and is a purpose built resource, which is set back from the road and is surrounded by landscaped gardens. There is a large car parking area to the front of the building. Placement to the home is via the Social Care Services and Health Authority on completion of a Community Care and STARS assessment. The accommodation is in three units, two on the ground floor and one on the first floor. Rooms are all single occupancy and have en suite facilities. Each unit has a lounge/dining room with a kitchenette used to serve meals brought from the main kitchen. At this inspection the fees for the home were received from the manager and from the Statement of Purpose and were £870 week per week. They do not cover the cost of items such as toiletries, hairdressing and newspapers. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced inspection took place on Monday 14th April 2008 from 09.20 to 17.50. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The manager was present during the inspection and the manager and staff spoken with provided the requested information promptly and in an open manner. Since the last inspection a new manager had been employed at the home, at the time of the inspection they were waiting for their CRB (Criminal Records Bureau) check as part of the CSCI (Commission for Social Care Inspection) registered manager application process. During the inspection five staff recruitment records, training records, the care plans of three people who lived at the home and accident records were viewed. Further records viewed are detailed in the main body of this report. Six staff members and one person who lived at the home were spoken with. A short observation was completed in one unit of the home where five people lived, the observation was undertaken over a period of two hours at five minute timescales. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home and at the time of writing this report had not been returned to CSCI, due to it initially being sent to the wrong e-mail address by us. Surveys were sent to the home to provide people with an opportunity to share their views about the service. Two service user, seven relative and six staff surveys were returned to us. What the service does well: Staff were observed to be attentive to people who lived at the home and offered clear choices, for example what they wanted for breakfast and to drink and what channel they wanted to watch on the television. Staff were observed to follow infection control procedures, such as washing their hands and putting on clean aprons before they handled food. The quality of the food and choices provided to those living at the home was noted to be very good. It was noted that efforts were made by staff to ensure that the dining experience of people who lived at the home was enjoyable. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 6 During lunch staff were observed to remain with people when they were being assisted to eat. The home was clean and well maintained, providing people with a pleasant environment to live in. 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. The summary of this inspection report can be made available in other formats on request. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 7 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 Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 8 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): 1, 3, 4, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be provided with the information they need to make an informed choice about where to live, that their needs to be assessed prior to moving into the home and be assured that their needs will be met. The home does not provide an intermediate care service. EVIDENCE: People were provided with detailed information about the home in the Statement of Purpose and Service User’s Guide, which explained the services that they could expect to enable them to make decisions about if the home was appropriate to meet their needs. The Statement of Purpose was viewed and included details about the structure of the home, fees, summary of the terms and conditions of the home and the Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 9 health and safety policy. The document included a colour pamphlet, which included a photograph of the home and a map of the local area and explained what people could expect regarding accommodation, dining, leisure and facilities provided by the home and in the local area. The pamphlet included a quote from a family member stating that they were confident that the home was the best place for their relative to live. The Service User’s Guide was viewed and included details about admission to the home, values, philosophy, abuse, harassment, fire, care plans, visitors, complaints, CSCI details, services and facilities, provider details, staffing and the manager’s experience and qualifications. The records of three people who lived at the home were viewed, which held detailed needs assessments that identified the support that each person needed on a daily basis. The assessments included details of lifestyle choices, support and daily care needs, continence, dietary needs, communication and understanding and emotional and physical well being. The records included care plans, which identified how the assessed needs were met, which were updated regularly with the people’s changing needs. The manager was spoken with and said they or staff from the home undertook assessments of people before they moved into the home and identified if the home was appropriate to meet their needs. The manager said that they had asked family members to provide information regarding the person’s history, which would support staff in discussions with the people and in meeting their needs. The relative/visitor survey asked if they got enough information about the home to help them to make decisions. Two answered always, three answered usually and two answered sometimes. One survey commented ‘before (the person who lives at the home) was admitted we were shown around the care home and then left to talk with any residents or staff when we visited. All our questions were openly and freely answered’. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect their needs to be set out in an individual plan of care, to have their health needs met and to be treated with respect. They cannot expect to be protected by the home’s recording procedures for the safe handling of medicines. EVIDENCE: The care plans of three people who lived at the home were viewed, which included details of the support that they required to meet their needs. The records identified the care needs, expected outcomes, significant areas of risk and actions required. They included details of the person’s religion, life and family history, interests, communication, personal care and dietary needs. The care plans were regularly updated to reflect people’s changing needs and changes were recorded on progress and evaluation sheets. The care plans included the details of people’s end of life decisions and funeral arrangements. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 11 The records included risk assessments such as in areas of mobility and falls and methods of minimising the risks. Records of personal evacuation plans were viewed, which identified the support that should be provided to the person in case of an emergency that required evacuation from the home. Daily records were maintained and records of significant events, which informed staff of issues that they should be aware of when supporting people, such as areas of behaviour changes or if a relative had died. Quality assurance records were viewed, which included the auditing of care plans, to ensure that they were completed in line with the home’s procedures and identified how people’s needs were met. The relative survey asked if they felt that the home met the needs of their relative, four answered always and three answered usually. The survey asked if they were kept up to date with important issues that affected their relative, six answered always and one answered usually. Five surveys said that the home always gave the support or care to their relative that they had expected or agreed and two said that the home usually did. The staff survey asked if they were given up to date information about the needs of the people that they supported. One answered always, four answered usually and one answered sometimes. The care plans viewed evidenced that people who lived at the care home had their health needs met. There were details of when each person had received health care treatment, such as visits from the chiropodist and doctor. The care plans viewed contained a record of falls and actions taken to prevent falls, dietary and nutritional requirements, their continence management and weight checks. It was noted during the inspection that people’s privacy was respected. All bedrooms in the home were of single occupancy and staff were observed knocking on bedroom and bathroom doors and waiting to be invited in, before entering them. A person was asked for their permission for their bedroom to be viewed during the inspection. Staff were observed to be attentive to people’s needs and they were observed asking them if they would like drinks and if they were comfortable. A person who lived at the home was spoken with and said that staff ‘treat me very well’. Two service user surveys said that staff listened an acted upon what they said. Medication was stored in a safe way, ensuring that people who lived at the home were protected. The pharmacy provided medication to the home in MDS (monitored dosage system) blister packs. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 12 The medication record keeping did not safeguard people with regards to the administration of medication. A requirement from the previous inspection report was that MAR (medication administration records) must be completed with signatures or codes if medication is not given for any reason to ensure that accurate records are kept of people’s medicines. It was noted at this inspection that there were still gaps in the MAR sheets and it was not possible to confirm that people had received their medication and as a result they may be placed at risk. The MAR sheets viewed were from 31st March 2008 to the date of the inspection, and gaps were noted on the sheets for eleven people and there was a total of twenty two gaps on different dates, nine gaps were from 11th April 2008. A staff member was spoken with regarding the medication procedures in the home. They stated that audits were regularly undertaken and individual staff members were advised of issues where medication had not been signed for, by placing a note on the MAR sheets for their information and in one to one supervision meetings. They stated that the MDS blister packs were checked to identify if the medication was still in the packs or not, to ensure that people had been provided with their prescribed medication. They reported that people had been provided with their medication, but staff had not signed the MAR sheets. Since the last inspection there had been efforts to improve the issue, which were monthly and six monthly medication audits, which were viewed. The records of the audits that were viewed did pick up the gaps in medication. However, at the time of the inspection the audits did not ensure that the issues were eliminated. The manager stated that they would undertake daily audits to ensure that the issue was resolved. Minutes of staff meetings were viewed and evidenced that staff had been advised on the importance of recording on MAR sheets appropriately. Medication records viewed included a record of staff who were responsible for administering medication, their signatures and training that they had been provided with was included. The records contained details of people who lived at the home, including a photograph, their preferred name, accent and physical description, which ensured that the prescribed medication was administered to the correct person. Training records were viewed and evidenced that staff who were responsible for administering medication were provided with medication training. Chantry House Residential And Nursing Home DS0000024354.V362355.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, 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 can expect to be provided with the opportunity to participate in activities that are of interest to them, to be supported to maintain contacts, to be supported to exercise choice and control in their lives and to be provided with an appealing and balanced diet. EVIDENCE: Three people’s care plans were viewed, which included a record of what activities that they had participated in. The activities included watching a historical DVD film, having their nails manicured, watching songs of praise on television and memory and reminiscence activities. The care plans detailed people’s individual interests and their preferred religious worship. During the inspection people were observed to be undertaking various activities, such as watching television, reading magazines, listening to music and singing along to music, such as songs by Vera Lynn. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 14 The manager stated that there was an activities co-ordinator that was employed at the home, however, they had recently been on leave and were soon to return to work. The manager said that they had encouraged staff to take responsibility in ensuring that people were provided with regular activities that they were interested in. People were provided with the opportunity to enjoy therapies such as reflexology and aromatherapy. A person who lived at the home was spoken with and said that they had plenty to do and that they could choose what they wanted to do on a daily basis. Comments in the relatives surveys included ‘I am always impressed by the willingness of the care staff to “go the extra mile” e.g. coping with an outing which we organise e.g. taking (the person) to the phone’ and ‘the general level of care is very good. My (relative) needs more stimulation that (relative) gets. Too much time watching TV or doing nothing at all. Could (relative) be encouraged to do some small exercises?’ Care plans included information of contacts with family members and friends that people maintained. During the inspection a person’s family member was observed to visit them. They were welcomed into the home and staff explained to the person who had came to visit them. The person had dementia and the staff member spoke to them in a gentle and calming manner. The minutes of a recent cheese and wine evening were viewed, which was attended by people who lived at the home and their relatives. They were provided with information about changes in the home and an opportunity to share their experiences of the home. The relative/visitor survey asked if the home supported people to live the life they chose. Two answered always, three answered usually and one did not answer. One commented ‘residents have a wide range of abilities and disabilities. There is wide support ranging from outings, parties and games to give everyone a chance to make the best they can of their life. Residents are free to watch televisions, welcome friends and take meals at times which suit them’. Care plans included details of people’s preferences and their life histories, which ensured that their preferences were respected, even when people could not communicate them. During the inspection it was noted that people were provided with choices such as what they wanted for breakfast and to drink and if they wanted to watch television and what channel they wanted to watch. People who lived at the home were provided with a diet which was appealing and nutritious. The menu was viewed and it was noted that the planned meals were balanced and imaginative. A staff member was spoken with and explained that if people did not want what was on the menu they could choose an alternative, for example if they chose an alternative of fish, there were ten varieties of fish that they could choose from on a daily basis. They said that Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 15 people were asked what their meal choices were each morning. On the day of the inspection, lunch was turkey and bacon pie, lyonnaise potatoes and buttered French beans and fresh fruit sorbet and coconut crunch, which looked and smelled delicious. Alternative meals provided for people were egg and chips and fish and chips. It was noted that soft diets for people were not all softened together, but the potatoes, beans and pie were all provided separately, which gave people the different tastes of the food and choice of what they wanted to eat and in what order. Lunch was observed to be calm and well organised. Before lunch, tables were laid with paper napkins, cutlery, a choice of cold drinks and salt and pepper. People were observed to sit where they chose to and staff checked that they were happy with their choice of meal. People who required assistance with eating their meal, were supported by staff who remained with them throughout the meal and asked them what they wanted to eat, such as which item they wanted from their plate. People were provided with their choice of breakfast and drinks at a time that suited them. People’s dietary needs were met, care plans included details of people needs and preferences and there were records maintained by the kitchen staff, which identified what people liked and disliked, allergies, foods that people could and could not have due their medication or health and if people required a softer diet. A staff member reported that the records were checked daily and that changes to diet could only be made by nursing staff and that changes were recorded in their care plan. An example of meeting people’s diverse needs was explained by a staff member, a person had been admitted to the home who had originated from overseas, the staff member said that they had researched their cultural diet on the internet to seek ideas to ensure that their needs were met. The chef that worked at the home made preserves, bacon and wine. It was noted that as well as the homemade preserves there were choices of named brand preserves that people could choose from. There were a good range of fresh vegetables and it was noted that there was fresh fruit in bowls in the home that people could help themselves to. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect that their complaints will be listened to and to be protected from abuse. EVIDENCE: The home had a detailed complaints procedure, which provided contact details of CSCI and what people could expect when they made a complaint. The complaints, compliments and comments book was viewed. There were compliments received from individuals such as visitors to the home and family members, regarding the support that had been provided to individuals. The records of complaints and concerns included clear details of how the issues were resolved and the support that had been provided to the complainant. All complaints had been resolved in a timely manner. Six staff surveys said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. The service user survey asked if they knew how to make a complaint, one answered yes and one answered no. The relative survey asked if they knew how to make a complaint, five answered yes, one answered no and one did not answer. One relative survey had the comment ‘information about complaints procedures are usually Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 17 on display’. The relative/visitor survey asked if the home had responded appropriately if they had raised concerns about the home, three answered always, two answered usually and two did not answer. A comment on one survey was ‘on the one or two occasions when I expressed concerns that my (relative) appeared to be suffering pain or discomfort there was immediate and practical response’. Staff were informed of their responsibilities in safeguarding adults who lived at the home. Training records viewed evidenced that staff were provided with adult safeguarding training. Staff spoken with were aware of their responsibilities in the protection of people who lived at the home. The home had the local authority guidance for safeguarding adults. There were notices posted in the home explaining ‘No Secrets’, for the attention of staff, people who lived at the home and visitors. There had been a safeguarding referral made by the home to social care since the last inspection, following concerns raised by staff at the home about a number of colleague’s work practice. It was noted that the organisation had responded appropriately to the issues and kept CSCI informed of the outcomes. Minutes from staff meetings were viewed, which evidenced that staff were provided with the opportunity to discuss issues, which ensured that concerns were aired and help to encourage an environment where people could be protected. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a safe, clean, hygienic and well maintained environment. EVIDENCE: People were provided with a clean, attractive and safe environment to live in. A tour of the building was undertaken and it was noted that the home was clean and well maintained. The communal areas were clean and attractively furnished. There were no offensive odours in the home. The grounds were secure, which ensured that people could use them safely without the risk of wandering into the road, attractive and well maintained and were available for people’s use. Since the last inspection there had been a summer house and raised flower beds had been built in the garden. The manager explained that Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 19 there were plans for people to be able to do some gardening if they chose to and to provide a sensory garden for people to enjoy. Two service user surveys said that the home was fresh and clean. A person who lived at the home was spoken with and agreed that the home was clean. They showed the inspector their bedroom, which they said that they liked. Their bedroom contained personal memorabilia, such as photographs and framed tapestries. Some people had their names on the doors to their bedrooms and some had a picture of something that they liked, which provided people with dementia a reminder of which was their bedroom door. The manager explained that people could bring their personal belongings with them when they moved into the home. A relative survey included the comment ‘the care home makes sure that every resident feels as much at home as possible. Personal belongings and ornaments and room furnishings are encouraged so that no residents fear there are any cramping of rules or requirements’. All bedrooms were provided with an en-suite facility, which included a toilet, hand wash basin and a shower. Each of the three units in the home had communal toilets and bathrooms, with assisted baths, which provided people with a choice of using a shower or bath. The bathrooms had items such as fish ornaments and a fishing net in them, which provided an attractive environment for people to use. The manager reported that the bath seat in one bathroom was out of order and that they had reported it and were waiting for it to be repaired. They stated that people who wished to use the bath could do so in one of the other units until it was repaired. The communal toilets and bathrooms included hand washing facilities and disposable paper towels and hand wash liquid. It was noted that there were disposable gloves and aprons provided for staff use, which assisted in the prevention of cross infection. Bathrooms and toilets included aids such as grab rails to ensure that people could use them safely. Each unit in the home was provided with a hoist, each had the risk assessment and directions for use attached to it. The hoists had stickers attached to them, which identified that they were regularly serviced to ensure that they were safe to use. The laundry was viewed and the laundry staff member was met. The laundry was large and had large industrial machines in them, hand washing facilities were provided in the laundry, which included disposable paper towels and hand wash liquid. During a tour of the building it was noted that sluicing facilities were provided, which protected people from cross infection. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and laundry, which protected people from cross infection. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be supported by staff who are trained to meet their needs, to be protected by the home’s recruitment procedures and to be in safe hands at all times. EVIDENCE: Five staff recruitment records were viewed and held all the required documents, including evidence of CRB checks, which was written confirmation of the date of the CRB check and the reference number, work history and two written references. Six staff surveys stated that the organisation carried out checks such as CRB and references before they started work. Staff training records viewed evidenced that newly appointed staff were provided with an induction, which included the Common Induction Standards. The staff survey asked if their induction covered everything they needed to know to do the job when they started and five answered mostly. One survey raised concerns that the staff member had attended an induction since the last inspection and that they had been working at the home for several years. They were concerned that they had been asked to attend the training when they were already experienced in the role. The manager was spoken with and they Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 21 explained that all staff had been asked to refresh their induction training to reinforce care principles, following recent issues in the home. It was noted that the provision of refresher training was good practice to ensure that staff knowledge was updated to ensure the safeguarding of people who lived at the home. One staff survey commented ‘we have all been given new induction recently. I know more than I did’. A recently employed staff member was spoken with and confirmed that they had received induction training and that they had shadowed experienced staff on the first three days of their employment. They said at the time of the shadowing, they were introduced to people who lived at the home, read care plans and were advised by staff about how they met people’s needs. Two staff members had started working at the home on the day of the inspection. They were observed to be working with experienced staff and reading care plans. Staff working at the time of the inspection were observed to be attentive to people’s needs and staff were respectful towards people’s wishes. Comments made in relative surveys included ‘Nurses, carers and staff have genuine concern for all residents. I have frequently made unexpected visits and find (their relative) being given care and attention beyond the levels that could have been expected’ and ‘staff have incredible patience’. Staff were provided information about how to meet people’s needs and safeguard people who lived at the home. Newly appointed staff were provided with a handbook, which included an induction work book, details about the organisation and the home and key policies and procedures, which included diversity, equal opportunities, whistle blowing, communication, confidentiality and health and safety. Mandatory training was listed in the hand book, which included back care (manual handling), fire safety, health and safety, food hygiene, first aid and safeguarding adults. Further training included dementia, medication, tissue viability and infection control. Five staff surveys said that they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people and kept them up to date with new ways of working. During the inspection an observation was carried out and it was noted that staff were knowledgeable about individual’s needs and spoke to people clearly and kindly. Staff ensured that people with dementia were supported, by reminding them of issues such as the time, day, what they had previously said they liked and who had visited them. Training records were viewed, such as certificates for training, and evidenced that staff had been provided with the above training courses. All staff, including kitchen and domestic staff had recently been provided with training relating to the safeguarding of adults. Staff that were spoken with confirmed this. Two staff members said that they were provided with sufficient training to inform them about their role and that they were working on a distance learning course on infection control. Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 22 Staff training certificates were viewed, that evidenced that kitchen staff had attended training courses, which was relevant to their role including NVQ (National Vocational Qualification) level 2 in food safety in catering, NVQ level 2 in nutrition, food hygiene and dining with dignity, which related to ensuring that the dietary needs of people with dementia were met. A list of staff that worked at the home was viewed and the manager identified which staff had achieved qualifications that were relevant to their role. There were nine ‘bank’ nursing staff and thirty one permanent staff members. Six were qualified nurses and nine care staff had achieved a minimum of NVQ level 2 in care and two care staff were working on their award. The home had met the target of 50 staff to have achieved a minimum of NVQ level 2, which was identified in the National Minimum Standards relating to older people. The manager was spoken with and said that there had been little activity in relation to care staff registering on NVQ courses since September 2007 and that they were working on increasing staff NVQ qualifications, by identifying a staff member that had achieved an NVQ assessors award to mentor care staff in achieving their awards to ensure that staff were qualified to meet the needs of people who lived at the home. There had been issues with staffing at the home since the last inspection, staff had left and been dismissed from the home and agency staff had been used to ensure that staffing levels were adequate to meet the needs of people who lived at the home. The manager was spoken with and explained how efforts had been made to increase staffing levels. Increased numbers of ‘bank’ nursing staff and care staff had been employed. The manager explained that two care staff had started work at the home in March, a nursing staff was to start working at the home when they had received a satisfactory CRB check, one care staff, an administration assistant and a deputy manager had started work on the day of the inspection and that further interviews were planned for the day after the inspection. They said that there was a carer and domestic staff vacancy at the home, which they would be recruiting to when suitable applicants were identified. The three staff that had started work on the day of the inspection were met and two spoken with, regarding their previous experience and knowledge. One staff member had previously worked at another of the organisation’s homes and another stated that they were looking forward to working at the home. Staff meeting minutes were viewed and evidenced that staff had been advised about the appropriate methods of reporting areas of staff shortages, such as sickness and the non arrival of booked agency staff. Staff spoken with reported that there had been times that the home had been short staffed and that agency staff had worked at the home. However, they stated that there were staff recruited at the home, which had improved the situation. The staff survey asked if there were enough staff to meet the individual needs of all the people who use the service, two answered usually Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 23 and four answered sometimes. Comments included ‘high levels of sickness occur regularly. More could be done I believe to pursue return to work interviews to stop malingering’ and ‘lot of agency staff being used. Good care staff and nursing staff moved on. Recruitment ongoing’. Comments included in the relative surveys included ‘24 hour care is great. Staff work well and very hard’, ‘around Christmas 2007 the home seemed very under staffed. Since then, more staff seem to have been recruited and staff not now so stressed’ and ‘having regular staff, hygiene (cleaning) and care workers, to maintain trust from patient and make them feel comfortable and as normal as can be. We know there has been a lot of changes in staff recently but hope this will be rectified in the near future’. During the inspection there were two care staff working on each unit. During an observation staff were observed to meet the needs of people. It was noted that, during a tour of the building, that call bells were answered by staff promptly to ensure that people were supported when they needed to be. Chantry House Residential And Nursing Home DS0000024354.V362355.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at the home can expect it to be well managed, for the home to be run in their best interests, to have their financial interests safeguarded and to have their health, safety and welfare protected. EVIDENCE: Since the last inspection a new manager had been employed at the home, they were spoken with and they had a good understanding of their roles and responsibilities. They were committed to improve the service to ensure that people who lived at the home were safeguarded and that their needs were met. The manager explained that they were waiting for the return of their CRB Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 25 check as part of our registered manager application process. The manager had experience in the care sector and had achieved a registered general nursing qualification and a mental health nursing qualification. They said that they were working on their NVQ registered manager award and NVQ A1 assessors award. Staff spoken with said that the manager was approachable and supportive. Staff at the home worked well with CSCI and regularly informed us of any notifiable incidents that had occurred, such as safeguarding referrals, deaths and staffing issues, which evidenced that they were aware of their roles and responsibilities in safeguarding people who lived at the home. The manager explained that they had organised a cheese and wine evening for people who lived at the home and their relatives and friends to inform them of changes in the home and to provide them with the opportunity to comment on their satisfaction with the service. The minutes from the cheese and wine evening were viewed and evidenced that people were advised about staffing changes in the home and the service that they could expect. During a tour of the building it was noted that there was information displayed on a notice board in the entrance to the home which provided the home’s registration certificate, and contact details of the Alzheimer’s society, Anchor and Customer 1st for the attention of people who may wish to contact the organisations. Regulation 26 visit reports were viewed and were undertaken on a monthly basis. The Regulation 26 visits included the monitoring of records and running of the home and discussions with staff, visitors and people who lived at the home about the service. Records of regular audits were viewed, which included audits on medication, care plans and health and safety. These showed that the daily running of the home was regularly monitored to ensure that people were safeguarded and that their needs were met. The home’s procedures for safeguarding people’s finances were viewed and it was noted that they were detailed and provided sufficient information to staff who supported people with their spending monies. There were records of people’s transactions, such as payments for hairdressing and receipts were maintained in the records, which ensured that transactions could be accounted for. The health, safety and welfare of people who lived at the home were promoted and protected. Health and safety records were viewed and it was noted that regular safety checks were routinely made, such as water temperature, fridge and freezer temperatures, food temperatures and electrical appliance safety. Fire safety records were viewed and regular checks were undertaken of fire safety equipment. The home had a fire risk assessment and a personal Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 26 evacuation plan for each person who lived at the home, which explained the support that they required in case of an evacuation emergency. There were fire safety notices posted around the home, which provided information of actions to take in case of a fire emergency. There was also a guidance displayed regarding support that would be provided in case of a heat wave. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling, COSHH (control of substances hazardous to health) and infection control. The home’s policy manuals were viewed and included COSHH, back care and health and safety. The manager explained that the home’s policies and procedures were being updated and were to be ‘rolled out’ to staff working in the home 28th April 2008. A document was viewed that explained the updating of the documents, which stated that there was new policies on restraint, end of life wishes, end of life care, blood sugar monitoring and continence management. Chantry House Residential And Nursing Home DS0000024354.V362355.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 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 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 X X 3 Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard OP9 Regulation 13 (2) Requirement MAR sheets must be completed with signatures or codes if medication is not given for any reason to ensure accurate records are kept of residents’ medicines. This is a repeat requirement. Timescale for action 18/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chantry House Residential And Nursing Home DS0000024354.V362355.R01.S.doc Version 5.2 Page 30 - 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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