Inspection on 13/09/05 for Charnwood Hall Nursing Home

This inspection was carried out on 13th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Charnwood Hall Nursing Home 20/07/06

Charnwood Hall Nursing Home 12/01/06

Charnwood Hall Nursing Home 10/03/05

Charnwood Hall Nursing Home 22/09/04

Charnwood Hall Nursing Home 08/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Charnwood Hall Nursing Home 38 Charnwood Road Shepshed Leicestershire LE12 9QF Lead Inspector Debbie Williams Unannounced 13 September 2005 9:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Charnwood Hall Nursing Home Address 38 Charnwood Road Shepshed Leicestershire LE12 9QF 01509 650717 01509 506300 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Care Midlands Ltd Mrs Lynne Stinchcombe Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability over 65 years of age of places (25) Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No additional conditions of registration apply.l Date of last inspection 10/3/05 Brief Description of the Service: Charnwood Hall Nursing Home is a Care home situated centrally in Shepshed Leicestershire. The home is owned by a Limited Company called Quality Care Midlands Limited. It is registered to accommodate twenty-five service users with physical disability and old age. It is situated on a main road within a fiveminute walk of the town centre. It is also on a public transport route. Facilities close by include several churches, and a number of social amenities including restaurants, a bowling green, local market and a number of public houses. The local community centre is within walking distance of the home. The registered provider employs Registered General Nurses, care and ancillary staff (a number of whom have been employed for many years). The town has two main GP practises which service users are registered with. Charnwood Hall was originally a Manor House, which was developed and modernised by the present owners. It is traditional in design and is furnished and fitted to a reasonable standard and offers service users comfortable, homely surroundings. It has a main lounge, which includes a dining room. A separate dining room is located next to the lounge. The home has two floors with a passenger lift between each floor. The home has fifteen single bedrooms and three double of which seven are en-suite. The home has off street parking Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over three hours on the 13th of September 2005. The main method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. The inspector spoke with three residents, two visitors and one staff member. The CSCI sends out service provider pre inspection questionnaires and resident questionnaires throughout the inspection year. These are questionnaires to ascertain the satisfaction of service users, relatives / visitors and professionals as to the standard of care and service provided. At the time of this inspection the inspector had received the providers pre inspection questionnaire and four resident/relative questionnaires. All questionnaires provided gave very positive feedback of the quality of care and service. What the service does well: Residents and visitors spoken with spoke highly of the staff employed at the home. Visitors also said they felt welcome at the home and could visit at anytime. The inspector observed interactions between staff and residents and found these to be positive and respectful. Staff spoken with demonstrated a good understanding of their roles; they possessed very caring attitudes and were obviously working towards serving the best interests of the residents. The registered manager had a ‘hands on’ role in the day-to-day running of the home and as a result of this had a very good awareness and understanding of the residents and staff needs. The management approach appeared very open and helped to create a homely environment in which residents could make full Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 6 use of the facilities and services and staff felt supported to carry out their work. 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. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 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 standard(s) 3 Residents have their needs assessed prior to moving into the home, this ensures that residents needs can be met. EVIDENCE: Care records for three residents were inspected. Care records included all relevant assessment information including risk assessments. Where applicable social worker assessments and care plans were in place. Residents spoken with confirmed that the registered manager had met with them and assessed their needs prior to admission. The registered manager said that all residents are assessed prior to admission. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10. Resident’s health, personal and social care needs were being met. Safe medication administration procedures were in place, therefore risk was minimised. EVIDENCE: Care plans for three residents were inspected, these appeared to address all assessed needs. Assessments were in place for the risk of developing pressure sores. Records were seen of GP and community nurse visits. Administration records for the three case tracked residents were seen and appeared to be in good order. Residents spoken with said that staff administered their medication accurately and on time. Residents praised the staff employed and felt they were treated with respect and their privacy and dignity maintained. All medication is administered by qualified nurses, the registered manager assesses their competency. Although care assistants do not administer medication, most have received medication training and have an awareness of safe medication procedures. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15 Activities of daily living were made flexible and therefore residents were able to exercise personal autonomy and choice. A wholesome and appealing balanced diet was being provided. EVIDENCE: Residents and staff spoken with said they were able to choose how to spend their time and that staff were flexible with all aspects of care and services provided. Activities on offer included – bingo, videos, in house entertainers, music and movement, music, card games and trips out. Residents and visitors spoken with said they were able to visit the home at anytime, visiting could take place in private and that visitors were made to feel welcome at the home. The lunchtime meal was served during this inspection. Meals being served appeared nutritious and appealing. There are two dining rooms on the ground floor. Residents may also take their meals in their rooms if they wish. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 11 Staff were observed assisting residents with their meals in a sensitive and appropriate manner. The inspector briefly spoke with the cook and inspected menu records. A good variety of wholesome and nutritious meals were on offer with an alternative menu always available. Residents, visitors and staff spoken with spoke highly of the meals provided. At the time of this inspection diabetic and soft diets were also being provided. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Adult protection policies and procedures afford maximum protection for residents. EVIDENCE: Robust complaints and adult protection policies in line with national guidelines were in place. Staff spoken with were aware of the correct procedures to follow in the event of suspected abuse. Residents and visitors spoken with said they would feel happy to complain to the home’s manager if they were unhappy about any aspect of the service. The company complaints procedure was displayed on the home’s notice board. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 A programme of routine maintenance and redecoration was underway at the time of this inspection. All areas of the home inspected appeared comfortable and homely and provided a safe and environment for residents. EVIDENCE: A programme of routine maintenance and redecoration was underway at the time of this inspection. The upstairs corridor was being redecorated and plans were in place to replace the lounge carpet and to redecorate and refurbish the dining room and small sitting room. The home employs a maintenance person to carry out routine maintenance and health and safety checks. Infection control policies were in place and staff spoken with were aware of and confirmed they had access to all policies. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 The numbers and skill mix of staff deployed were sufficient to meet the needs of residents accommodated. EVIDENCE: The duty roster for the week in which this inspection took place was inspected. At the time of this inspection twenty-four residents were living in the home. At least one qualified nurse was on duty at all times, there were five care staff on duty every morning, four care staff in the afternoon/evening and one care assistant at night. Residents spoken with felt that staff responded to their needs in a prompt and efficient manner. Fourteen of the seventeen care staff employed had achieved a National Vocational Qualification in care to at least a level two and three care assistants were due to commence NVQ training later in the year. The home is commended for this commitment to staff training. Staff training records were inspected, these included induction training records and all mandatory training. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 and 38 Health and safety procedures are in place and minimise risk to residents. The management approach at the home is open and inclusive and therefore ensures that the home is run in the best interests of residents. EVIDENCE: Staff and residents meetings are regularly held. Residents and staff spoken with felt that the management approach at the home was open and inclusive. Staff receive regular supervision, records of this are maintained. The homes pre inspection questionnaire stated that all health and safety policies were in place and that all necessary routine maintenance checks had been carried out. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 16 All staff had been provided with a twelve-week training course in safety compliance. Maintenance records were seen and these included hot water temperature checks to ensure that hot water was maintained within safe temperature limits. Risk assessments had been carried out and records maintained regarding safe working practice within the home. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x 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 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 4 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x 3 x 3 Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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 15 Good Practice Recommendations It is recommended that staff involve residents in the care planning process. This could be acheived by discussing the care plan and the experince and expectaions of residents when care plans are reviewed. Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX 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 Charnwood Hall Nursing Home C51 C01 S54117 Charnwood Hall NH V243634 130905 Stage 4.doc Version 1.40 Page 20 - 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. 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