Inspection on 25/01/06 for Chantry House Residential And Nursing Home

This inspection was carried out on 25th January 2006.

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

The inspector 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... 14/04/08

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

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

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

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

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

Similar services:

Chesham House

Argyll House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

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 Jane Offord Unannounced Inspection 25th January 2006 09:30 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 DS0000024354.V280644.R01.S.doc Version 5.1 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. DS0000024354.V280644.R01.S.doc Version 5.1 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 Anchor Trust Mr Jonathan Archie Ellis 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) DS0000024354.V280644.R01.S.doc Version 5.1 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. The Registered Manager, Mr Jon Ellis must arrange and attend a suitable Protection of Vulnerable Adults course. A copy of the certificate of attendance must be sent to The Commission for Social Care Inspection (CSCI) on completion of the course. 24th August 2005 2. 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 Trust, 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. DS0000024354.V280644.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 9.30 and 15.00. The registered manager was away at a meeting and the deputy manager was on a training day. The senior nurse was able to help with the inspection and provided all the documents needed with the exception of staff files to which they had no access. Three residents’ files and care plans, called Individual Lifestyle Agreements (ILA), the complaints log, some medication administration records (MAR) sheets and some of the home’s policies were all inspected. A tour of the home including the kitchen, the laundry and the snoozelum was undertaken. A number of staff, residents and visitors were spoken with during the day. Part of a medication round and the serving of lunch were observed. On the day of inspection the home was clean, tidy and bright. In spite of the very low temperatures outside the home was warm and residents all looked comfortable and well dressed. Interactions between staff and residents were respectful and caring. What the service does well: The staff spoken with were clear that the care of residents was paramount and responded to needs willingly and rapidly. The staff team has not had many changes and work well together. They demonstrate a depth of knowledge about individual residents that enables them to meet their needs. Mealtimes are important and the quality of the meals produced is high. The staff were observed to help residents with their meals with care and sensitivity. The décor and furnishings throughout the home were attractive and homely. Efforts have been made to co-ordinate curtains and duvet covers in residents’ rooms and all the rooms seen looked pleasant. There were many personal items on display in the bedrooms. Although many of the residents have a very short attention span efforts are made to offer suitable activities to engage their interest. The home employs an activities co-ordinator for fourteen hours a week and an activities assistant who does some additional hours once a week. DS0000024354.V280644.R01.S.doc Version 5.1 Page 6 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. DS0000024354.V280644.R01.S.doc Version 5.1 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 DS0000024354.V280644.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People who use this service can expect to have an assessment of needs undertaken prior to being admitted. This service does not offer intermediate care. EVIDENCE: In two of the three files seen there was documentary evidence that a preadmission assessment had taken place. The assessments were dated some few days prior to the recorded admission date of each resident. The areas assessed included nutrition, personal hygiene, mobility, physical and mental health, continence and skin condition. There were also areas to record the resident’s daily routine and their rising and bedtime preferences. DS0000024354.V280644.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 11 People who use this service can expect that their health needs will be met and that they have a plan of care. They can expect that they and their family will be treated with sensitivity at the time of death but they cannot be assured that present practice with regard to medication administration will protect them. EVIDENCE: All three files seen had evidence of health assessments and the interventions generated. Some areas covered included mobility, continence, personal care, tissue viability, sleep pattern and emotional needs. One resident had a poor sleep pattern due to their confusion and that they had been a night shift worker previously. One of the interventions to assist them sleep was ‘use the radio in the room – Classic FM played quietly’. Each file had contact details of health professionals involved with the resident. There were records of visits made by or to the GP, the dentist, the psychiatrist, podiatry clinic and optician. On the day of inspection one resident had attended the dentist with a carer. There was evidence of a number of risk assessments in the files including such areas as wandering, falls, nutrition, aggression and Waterlow scores. DS0000024354.V280644.R01.S.doc Version 5.1 Page 10 Interventions based on the assessments were recorded in the care plans. One record relating to a nutrition assessment recorded where the resident preferred to eat their meals. There was evidence that the assessments and interventions were reviewed regularly and updated. The home is divided into three units. Each unit has its own medicine trolley that is kept securely in a locked room. The lunchtime medication round was observed in one unit. Medication was offered to residents in a sensitive manner and help was given when required to manage tablets or syrups. The MAR sheets all had a photograph of the resident on the front page. It was noted that some MAR sheets had some gaps in the signature boxes so it was unclear whether the medication had been given or not. The medication policy was seen and is comprehensive. There was guidance on administering homely remedies and the circumstances when covert administration of medication is acceptable. Some GPs had written agreements to allow the nurses discretion in the use of dressings for wound care. The controlled drugs (CD) cupboard was seen. A check was made on the contents of the cupboard and the CD register and they tallied. One of the staff spoke about the way the death of a resident would be handled. They were clear that any family or friends would be kept informed and could stay with the resident if they wished. The files had an area to record the resident’s final wishes. The member of staff said that they tried to ascertain what a resident wanted but sometimes they had to rely on family members to inform them. DS0000024354.V280644.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 People who use this service can expect to be offered activities that are appropriate to their abilities and be encouraged to maintain contact with their family and friends. They can also expect to receive good quality, appealing meals. EVIDENCE: The service employs two part time activities co-ordinators. On the day of the inspection one co-ordinator had taken a resident to a dentist appointment and the other was working around the units playing Scrabble with one resident, talking to another, helping one with their knitting and, at lunch time, helping people with their meals. The activities co-ordinator said that most of the present residents do not have the ability any longer to engage in organised games so they try to respond with individual attention. They will varnish residents’ nails, offer hand massage and hair setting. They have booked some entertainers for a couple of sessions in February and a minibus for seven outings in the summer to places like Felixstowe, Banham Zoo and Easton Farm Park. In the home there is a room that has been equipped as a snoozelum and some residents enjoy spending time in there. One resident regularly attends church services. During the day there were a number of visitors to the home. The residents had a choice of where to see them and some preferred to meet in their own DS0000024354.V280644.R01.S.doc Version 5.1 Page 12 room while others used the communal areas. Visitors were offered tea or coffee and biscuits to have with their relative. Visitors spoken with all said they were very happy with the standard of care given in the home. A resident who has been in the home for a year said they had settled down well and were happy now. The staff will ‘cater for any whim’. The lunch on the day of inspection was crab cakes with carrots and peas followed by a trifle. The residents who required some help with their meal were served first and the staff ensured the food was hot by using a microwave if a resident took a long time to eat. Help was offered sensitively and at a speed the resident could manage. One resident said they thought the food was good. They were ‘fussy about my food but the kitchen always finds something I like’. In the kitchen the chef talked about the changes they want to make to the menus. They had recently been requested to put ‘rabbit in cider’ back on the menu, as it was a favourite with the residents. One of the newer residents is from abroad and the chef has found some recipes on the Internet from the resident’s home country that they intend to include in the menus. There are always alternatives to the main dish such as omelettes, jacket potatoes, salads or fish. Soups are always home made and the soup of the day was celery and Stilton. There are fresh cakes made daily and a variety of breads are made for the main meals. There was a folder with a record of individual residents’ likes and dislikes, compiled with the resident on admission, so that when a resident can no longer make a choice they have documentation to enable them to still base meals on the resident’s preferences. The kitchen was clean and tidy with store cupboards well stocked with good quality provisions and fruit and vegetables. The record of the temperatures of probed food and deliveries was seen and showed all food was within safe range. The records of the readings from the refrigerators and freezers also showed them to be functioning within the safe zone. The chef has a number of reference guides to help them ensure that residents receive adequate nutrition and hydration. There were books from the Caroline Walker Trust about catering for people with dementia and a recipe book specifically for making high calorie meals. DS0000024354.V280644.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service can expect that any complaint will be taken seriously and that they will be protected from abuse. EVIDENCE: CSCI have not received any complaints about this service since the last inspection and the complaint log for the home shows that the last complaint received there was in 1999. Staff spoken with could not recall the last complaint they had received. Relatives said they had never had cause to complain but did know who to speak to if they were unhappy about something. Since the last inspection POVA training has been done with the staff, including the ancillary staff. Training records were not available as the manager and deputy manager were not in the home on that day however staff were able to say when they had done the training. When asked they were also able to say in detail what they would do if they were confronted with a potentially abusive situation. The most recent county guidelines on POVA and the referral process have been obtained for staff reference since the last inspection. The folder also contained training notes and a list of relevant websites. DS0000024354.V280644.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 22, 24, 26 People who use this service can expect to live in a clean, comfortable home with specialised equipment available to maintain independence for as long as possible. EVIDENCE: The home has a large entrance area with comfortable seating arranged in sociable grouping. Each of the three units also has its own lounge/diner with a kitchenette area to prepare hot drinks and snacks. The front door has a security lock fitted. Other doors lead into enclosed gardens with level access for wheelchairs. Residents’ own rooms were personalised with some small pieces of furniture, photographs, pictures and small ornaments. Each room had views into the garden and, with large windows, they were all light and airy. The rooms were large enough to allow wheelchair use. Some residents had special pressure relieving mattresses on the beds and were using special cushions in their chairs. The mattress on one resident’s bed DS0000024354.V280644.R01.S.doc Version 5.1 Page 15 was seen to be permanently indented and needs replacing. There were hoists for moving people with reduced mobility and the communal bathrooms had special baths to allow easy access by lifting a side. The stairs had banisters on both sides. The laundry was seen and although all the machines were in use the area was tidy. The laundry worker explained the system for managing soiled linen to prevent cross infection. There was liquid soap and paper towels available at all the hand washing basins seen. Staff said protective clothing such as gloves and aprons were readily available and it was noted that cloth tabards were worn when staff were dealing with residents’ meals. DS0000024354.V280644.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 People who use this service can expect to be cared for by staff who are trained to do the job and are present in adequate numbers to meet their needs. EVIDENCE: The duty rotas were seen and showed that on an early shift there were two registered nurses and five carers, a late shift had one registered nurse with four carers and the night cover was one registered nurse and three carers. In addition three members of staff managed the domestic duties and laundry. There was also an administrator and, two days a week, a handyman. Staff spoken with all felt they were adequately staffed for the level of resident need. Visitors said they had no concerns about the staffing levels. The rotas showed there had only been three shifts covered by agency staff in the last fortnight. Training files were not seen during this inspection but staff talked about training they had done. That included moving and handling, first aid, working with people with dementia, POVA and fire awareness. Ancillary staff talked about Control of Substances Hazardous to Health (COSHH) training. There has recently been a deputy chef appointed and the chef showed documentary evidence of a comprehensive induction plan that they are working through with the new member of staff. DS0000024354.V280644.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 People who use this service can expect that their finances will be safeguarded by the system in place but their money will not work for them while it is saved. They can also expect that the staff receive formal supervision. EVIDENCE: As noted at the last inspection the system for managing residents’ personal finance is safe and allows an audit trail. However the policy implemented by Anchor Trust of using a single bank account for all the residents’ saved money, which does not pay any interest, should be reviewed. Staff records were not available on the day of inspection but staff spoken with said they had supervision monthly. They set their own agendas for the sessions and there were written notes of the meetings. DS0000024354.V280644.R01.S.doc Version 5.1 Page 18 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 1 8 3 9 1 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 X 3 X 2 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 2 3 X X DS0000024354.V280644.R01.S.doc Version 5.1 Page 19 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. 1. Standard OP7 Regulation 14 (2) Requirement Timescale for action 25/01/06 2. OP9 13 (2) 3. 4. OP24 OP35 16 (2) (c) 20 The documentation around the assessment of a resident must be completed to support the care plan interventions. The signature boxes on the MAR 25/01/06 sheets must be completed to show that medication has been administered or a reason why it has not been. The mattress identified as 28/02/06 deficient must be replaced. The central bank account titled 31/03/06 Residents Personal Monies Account (RPMA) must be reviewed to ensure that residents receive proportionate interest. This is a repeat requirement. 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 Good Practice Recommendations DS0000024354.V280644.R01.S.doc Version 5.1 Page 20 Standard DS0000024354.V280644.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000024354.V280644.R01.S.doc Version 5.1 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!