Inspection on 27/02/09 for Charton Manor

This inspection was carried out on 27th February 2009.

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

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

Charton Manor 21/11/06

Charton Manor 09/01/06

Charton Manor 30/08/05

Charton Manor 13/12/04

Charton Manor 29/04/04

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The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Charton Manor Gorse Hill Farningham Kent DA4 0JT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 2 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Charton Manor Gorse Hill Farningham Kent DA4 0JT 01322863116 01322866248 mail@chartonmanor.org www.chartonmanor.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hawthorne Trust Ltd care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 17 The registered person may provide the following category/ies of service only: Care home not providing medicines or medical treatment - NM to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Up to 17 older people can temporarily make their home in Charton Manor (the Service). The Service is registered for people who want to receive Christian Science non-medical nursing care (and/or Christian Science study and rest). The Registered Provider is a charitable body. It describes its purpose in the following way: Charton Manor provides 24 hour short-term Christian Science nursing care to men and women aged 18 and over who have chosen to rely solely upon the Bible-based method of Care Homes for Older People Page 4 of 30 Over 65 17 0 Brief description of the care home spiritual healing, Christian Science. Most of the people who come to the Service do so for a period of several weeks. Often they havent been well. They need a period of reflective Bible study and physical nursing care before they can return home or move on to somewhere else. The property was purpose built in 1988. The accommodation for patients is on the ground floor. There is a training suite and some accommodation for Christian Science nurses on the first floor. When the Service is full, one of the bedrooms can be shared by two patients. All of the other bedrooms are for single occupancy. Each bedroom has got a private bathroom that has a toilet, shower and wash hand basin. There is a call bell system. There are call points in each of the bathrooms and toilets as well as in all of the bedrooms. This means that patients can ring for assistance. Each bedroom also has a telephone. People who want to find out more about the Service and about the fees charged, can phone the Service and speak with the Christian Science Nursing Manager or with the Administrator. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the patients who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was an unannounced Key Inspection. We arrived at the Service at about twenty past eight in the morning and we were there for about eight hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with four patients. We also spoke with the Administrator, the Christian Science Nursing Manager, the Training Centre Manager, the Services Manager, two Christian Science charge nurses, one of the Christian Care Homes for Older People Page 6 of 30 Science nurses, the chef, an activities coordinator, a housekeeper and the maintenance man. We walked around parts of the accommodation and we looked at a selection of key records and documents. After the inspection, we telephoned the Christian Science Deputy Manager because we needed to clarify one or two points of detail. The Registered Provider asks patients who are about to leave the Service how they think their stay has gone. We looked at six of the most recently completed questionnaires. Later on in our Report, well tell you some of the things people are saying in their replies. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 and 6. People who are thinking of moving in are asked about what Christian Science nursing care they need and how they want this to be done. Patients are actively supported to go back home when their treatment is finished. Evidence: The Christian Science Nursing Manager asks people who are thinking of moving in about what Christian Science nursing care they need and want. This is done so that everyone can be confident that moving into Charton Manor is the right thing for them. She also talks with family members. All of this is done so that she can build up a really good picture of how the person can best be supported. After shes got all of this information, she can then decide if Charton Manor can meet the persons spiritual and Christian Science nursing care needs. Care Homes for Older People Page 10 of 30 Evidence: We looked at the information that has been collected for one patient who has recently moved into the Service. We wanted to see what sorts of things were considered. There is lots of useful information. There is information about practical things such as the help needed in the bathroom. But there is also other information about quality of life things. Such as how the person has problems with swallowing and so needs to have their meals prepared in a certain way. The Christian Science Nursing Manager says that when she gets the information she shares it with the Christian Science nurses. This is done so that they know in advance about what Christian Science nursing care they will need to provide. We asked a Christian Science charge nurse and a Christian Science nurse about how all of this works out in practice. They say that they are indeed told about patients who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. We saw this process in action for ourselves when the Christian Science Nursing Manager kindly allowed us to sit in one on of the handover sessions. These sessions are held when shifts change so that the Christian Science nurses coming on duty can be told about how things have gone during the previous shift. In the session we attended, the Christian Science nurses talked about someone who had just been admitted to the Service. They discussed the patients needs for Christian Science nursing care and they made a point of saying how important it was to make the person feel welcome. We asked one person about their experience of moving in. They say, I knew all about Charton Manor because of my Christian Science connections and I could ask about any points of detail I wanted to at the time. As weve already said, its only intended that patients stay in the Service for as long as they need Christian Science nursing care and its associated reflective religious study. When someone moves into a residential setting theres always the risk that their stay might become longer than is necessary. The Christian Science Nursing Manager is aware of this. She says that she and the Christian Science nurses help patients to make any arrangements that are necessary for them to go home as planned. We saw evidence of this having been done for one patient. There is a record of the Christian Science Nursing Manager contacting the patients daughter to discuss how best to support the person once they leave the Service. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10. People are provided with the Christian Science nursing care they need. People are treated with kindness and respect. Evidence: Patients say that the care workers offer them all the assistance they need. There is a written individual plan of Christian Science nursing care for each patient. These are important because they are one of the ways that patients can say what assistance they want to have and how they want it to be done. Also, the plans give information to Christian Science nurses so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as helping people in the bathroom, about health care and about keeping people safe. In more detail, one patient needs to be helped to lie in a certain way so that they dont put too much pressure on a bad foot. Someone else needs to be supported to promote their continence. Care Homes for Older People Page 12 of 30 Evidence: We asked Christian Science charge nurses and Christian Science nurses about some of these things. We wanted to see if they know about this written information. They do know all about it and we saw them using it in practice. The Christian Science Nursing Manager says that the nursing plans are kept up to date so that they are accurate. This involves Christian Science nurses making daily notes about how things are going. We checked these and they are being done. There are also more detailed reviews. This is when the Christian Science Nursing Manager looks at the various records and generally checks things out. She does this to see how things are going and what might need to be changed. Sensible steps are taken to ensure that people dont have any avoidable accidents. For example, some patients may ask to have rails put up on the side of their beds. These can be useful if someone is worried about rolling out of bed and hurting themselves. However, in other circumstances they can cause problems. The Christian Science Deputy Nursing Manager says that he is aware of this. He says that careful consideration is given before bed rails are used. Patients are helped to keep healthy. As weve already said this includes the provision of Christian Science nursing care and spiritual support. When patients agree to move into the Service its made clear to them that the Christian Science nurses will not be responsible for deciding to contact conventional medical doctors and they will not administer medication. Each month each patient signs a written agreement. This explains that the Service will not take, responsibility for making health care decisions for the patient, diagnosing, recording and maintaining a record of symptoms or conditions, summoning medical care except at the request of the patient or responsible party, administering medication (and) using and administering medically oriented techniques, equipment and technology. However, there are arrangements in place to respond to situations where a patient decides that they want to receive conventional medical attention. The Service will arrange for someone to attend a medical appointment and if requested it will accompany them. If a patient wants to take medication, this will need to be administered by themselves, while they are waiting for a place in a conventional residential care service or a conventional nursing service to be found for them. As necesary, the medication will be retained by the Christian Science nursing staff in a secure place when its not being used. When we were in the Service, we asked a number of patients what they think of the Christian Science nurses. They praise them saying that they are courteous and attentive. One person summarises the general mood when they say, the (Christian Science) nurses are so kind and loving, they will do anything for you and I feel that Care Homes for Older People Page 13 of 30 Evidence: Im completely safe and loved here. This place is part of our church and all the (Christian Science) nurses are committed to the principles of truth and kindness. You dont need anything else but that, to make Charton Manor a very special and loving place. The Christian Science Nurses are relaxed and informal in how they are. Things arent rushed at all. People are supported to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the phone if they want. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15. There are some interesting things for patients to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: Each day there is an opportunity for patients to join together for a Bible Lesson or for some other religious activity. In addition to this, most patients also undertake private Bible study and reflection. From Monday to Saturday, there is an activities coordinator on duty. She organises a range of recreational things that people can do. For example, patients can watch films, do arts and crafts and attend talks on points of general interest. On the day we were there, three patients went out in the Services specially adapted vehicle for a drive in the country. When they got back they told us how much they had enjoyed the outing. We asked two patients about social activities in general. One says, we do Bible Lessons every day and we go out to church. We have things like arts and crafts and most afternoons theres something to do. I never get bored here and theres no need for boredom because theres always time for private study. The other person says, I like going out for a drive for a change and then we have other things to do in the afternoon. Ive never been at a loose end here. In the course Care Homes for Older People Page 15 of 30 Evidence: of the past year, the range of activities has been increased. We spoke with one of the activities coordinators. She says that the things that patients can do will continue to be kept under review. This is to that patients can continue to suggest developments to the social calendar. Patients are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Christian Science Nursing Manager keeps in touch with family members so that they know how things are going. For example, she lets them know if someone is not well and needs extra Christian Science nursing care. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids misunderstandings about who has the right to do what. Instead, most people get help from members of their family. People say that they receive good quality meals and that they have enough to eat. People consider meal times to be a relaxed and pleasant affair. In its questionnaire, the Registered Provider asks, are you satisfied with the meals provided by the house? and do you have enough choice of meals? Everyone answers yes. Several people also comment further about the meals. One person summarises these when they say that they are, extremely good. There is a choice of dish at each meal time. We looked at the variety of meals provided over a period of two or three days. There is reasonable balance. The main lunchtime dishes including things like mushroom risotto, lamb curry and spinach pasties. There are tea making facilities in the dining room and we saw a patient making themselves a drink around about mid morning. We asked Christian Science nurses about the arrangements for doing light snacks and drinks in between meal times. This is important because its a part of normal living. Also, it can be a long time for some people between the late evening milky drink and breakfast the next day. The Christian Science nurses say that they are quite happy to do drinks and snacks whenever. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18. There is a complaints procedure. The Christian Science Nursing Manager and the Administrator know how to properly deal with complaints. People are kept safe. Evidence: We asked several patients about making complaints. They say and show by their relaxed manner they feel quite okay about raising a complaint should they need to. One person says that, I have never had anything, even the slightest thing, to complain about here. If I did I would speak with any of the (Christian Science) nurses or with (the Christian Science Nursing Manager) or (the Administrator) and Im completely certain that it would be sorted out in a loving way. The Registered Providers questionnaire asks, do you think that your comments, suggestions and complaints about the house are listened to? Everyone answers yes. Theres a written complaints procedure. This explains how to go about making a complaint or raising a less formal concern about something. Since our last inspection, the Registered Provider has looked into three complaints. These involved various things. There was an incident when a patient thought that a Christian Science nurse was being abrupt. The Christian Science Nursing Manager looked into this by speaking with everyone involved. It seems that the incident was just a misunderstanding in that the Christian Science nurse had been trying to be Care Homes for Older People Page 17 of 30 Evidence: helpful. Another complaint was about someone not having been taken to the lounge and so missing an activity. Again, the Christian Science Nursing Manager spoke to everyone concerned. She found that there had been a miscommunication in one of the handover sessions that led to the patient being overlooked on this occasion. She apologised to the patient and the matter was resolved. The third complaint was gathered from one of the Registered Providers questionnaires. The patient concerned thought that they had spent too much time on their own in their bedroom. The Christian Science Nursing Manager looked at the patients nursing plan. This showed that they had been invited to attend various social things and that they had declined to do so. All in all, we think that the Christian Science Nursing Manager has promptly looked into the complaints that have been received. Also, we think that she has made sure that they have been sorted out in a sensible and fair way. Its very important that people are confident that they are safe. The Assessment commits the Registered Provider to promoting this. We asked some Christian Science nurses about this matter. None of them have any concerns about how things are going. One of them summarises the general response given when they say, if I feel myself getting annoyed with someone I stop and think that this is one of Gods people so how can I be annoyed with them. I need to show kindness and love and then they will respond to me with the same. The Registered Provider has a written policy and procedure about this matter. It says what someone should do if they become concerned about a patients wellbeing. The patients say and show us that they feel safe in Charton Manor. In the Registered Providers questionnaire, they are asked, do you feel happy at Charton Manor? Everyone says that yes they are. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19, 22, 25 and 26. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: On the outside, the building is well maintained. There is a well kept garden at the back and there is footpath that leads to a private orchard walk. On the inside, the accommodation is well decorated and furnished. Although its purpose built, Charton Manor has a homely, lived-in feeling to it. The bathrooms are neat and clean. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that when the fire brigade people last looked at the system they said that it continues to meet the national standard. The Registered Provider has a system of doing regular fire safety risk assessments. This is where the Administrator goes around the place to check out that everything is still working in the right way. We looked at the records of the most recent one. It says that everythings in order. The local Department of Environmental Health called to look at the kitchen earlier this Care Homes for Older People Page 19 of 30 Evidence: year. Its report gives the kitchen four out of possible five stars. The wording reads, good food safety management. (There is) a high standard of compliance with food safety legislation. The report identifies the need for three improvements to be made. Two of them are about relatively minor administrative things. The third is about the need to install a new and extra piece of equipment. The Administrator says that all of the improvements have been made. We checked out the provision of the new item of equipment and we found it to be in place. We also looked more generally in the kitchen. Its well equipped, clean and well organised. Sensible things are done to ensure good food hygiene. For example, once food is opened it is covered. The temperatures of the fridges and the freezers are checked and recorded to make sure that they are cold enough. The chef knows the importance of making sure that hot foods are checked to make sure that things have fully cooked through. She also knows the importance of good hygiene. Patients who need it are helped to get about. There is a shared use bathroom for use by patients who dont want to use their private shower. The bath is fitted with a special chair that goes up and down. This is useful for patients who find it hard to sit down and then get up. In the private bathrooms attached to the bedrooms, the showers are fitted with rails on the walls. These are there for patients to hold onto so that they can get extra support. There is a mobile hoist. This may be needed if someone needs help to get into and out of bed or to get up and down to chairs. There are frames near to the toilets. Patients find these very helpful when they are getting down and getting back up again. There are other less obvious things to help patients get about. For example, there are special belts that can be used to give patients that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help patients change position in bed. When someone moves into the Service, the Christian Science Nursing Manager makes a note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked the Christian Science nurses about this. They know what theyre doing. We asked patients how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The accommodation was pleasantly warm, even though it was a cold day outside. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by patients are temperature Care Homes for Older People Page 20 of 30 Evidence: controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. We looked in the laundry. Its neat and clean. There are two commercial washing machines. These have an extra cycle for items that need an especially hot wash. There is a sluice thats useful for rinsing items off before theyre put in the wash. Theres a large dryer. The Christian Science Nursing Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. When we were in the laundry, we checked some of the garments that were folded up there after having been washed. All of them were marked with a room number. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30. There are enough Christian Science nurses around. They know what theyre doing. Some parts of the training arrangements can be strengthened. Security checks are completed on new Christian Science nurses. Evidence: The Christian Science Nursing Manager says that there are three Christian Science nurses on duty from early in the morning until late in the evening when the night time arrangements start. During the day, there is always a Christian Science charge nurse on duty. She is a senior person who leads the shift. There are kitchen staff who do nearly all of the catering and there are housekeepers who do most of the cleaning. We looked at the written nursing roster in detail for a period of two recent days. It confirms the Christian Science Nursing Managers account. We asked several members of staff if they think that the Service is adequately staffed. They say that it is. The Registered Providers questionnaire asks, do you feel that staff are always close at hand at all times to help you? Everyone says that yes there are. Its very important that only honest and trustworthy people are employed as Christian Science nurses. With this in mind, the Registered Provider completes a number of Care Homes for Older People Page 22 of 30 Evidence: security checks on new people. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one Christian Science nurse who has been appointed since our last inspection. The necessary checks are all in place. Since our last inspection, parts of the arrangements used to check what references are needed for each person have been strengthened. This has been done to help make sure that nothing gets missed. The Service is a national training resource. This means that student Christian Science nurses come from all over the country and from overseas to study and to qualify for registration as a Christian Science nurse. The course lasts for about three years. Its administered by the Training Centre Manager. It entails periods of classroom tuition followed by periods of supervised Christian Science Nursing practice in the Service. This means that at any one time, one or more of the student Christian Science nurses may be on duty in the Service along with the established Christian Science nurses. The Christian Science Nursing Manager says that all new Christian Science nurses regardless of whether they are students or not, have introductory training before they join the roster. This entails them having instruction in important health and safety things. They also work alongside more experienced colleagues and generally start to get to know the patients. We asked one Christian Science nurse about their introductory training. They say that it was very useful. They say that they were introduced to the patients and that they were told their individual plans of Christian Science nursing care. In their own words they say, I have lots of training in the Service and am kept up to date with relevant knowledge and with the teachings of the Christian Science. We get good training about all the tasks that we are expected to do. This initial training is just to get them started. Theres a lot to learn after that. The Christian Science Nursing Manager and the Training Centre Manager say that all Christian Science nurses are expected to do regular and updated training in important subjects. For example, in how to safely support people move about, in food hygiene, in keeping people safe from harm and in basic first aid. Nearly all of this training is done in-house using the resources of the training centre. We looked at the records of the training that one Christian Science nurse has done. Theyve done quite a lot of relevant courses. However, there are quite a few gaps where courses dont seem to have been attended with the frequency intended by the Registered Provider. Also, at the moment theres no clear plan to sort out these oversights. The Christian Science Nursing Manager and the Training Centre Manager say that they are now going to review the skills and knowledge that each of the established Christian Science nurses has. This is so that arrangements can be made for each Christian Science nurse to have training in the future that will be of the most benefit for them. They are going to do this using a variation of a national model that we think is very well done. This is Care Homes for Older People Page 23 of 30 Evidence: quite a big bit of work to do. They hope to have it done within about a year. We spoke with several members of the Christian Science nursing team to find out what they know about particular parts of the Christian Science nursing support they will need to give patients. They know a lot about how each patient likes to be supported. For example, they know about helping older people to take care of their skin. They also know about things such as good hygiene and managing dressings. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38. Things are well managed. Patients are asked what they think of the Service. They are helped to buy what they want. There are some oversights in the fire safety arrangements. Evidence: The Nursing Manager is a qualified Christian Science nurse. She also has the management qualification that is recommended by the National Minimum Standards. This qualification is important. This is because its designed to help managers ensure that high quality support is reliably provided. The Christian Science Nursing Manager recognises that its really important to have good team work in the Service. She says that this is supported in several ways. There are the handover meetings at the beginning and end of each shift that weve already Care Homes for Older People Page 25 of 30 Evidence: spoken about. At the handover meeting we attended, the Christian Science charge nurse referred to the daily diary notes that weve also already mentioned. She then ran through how each of the patients was doing and what nursing and other tasks needed to be completed during the course of the next shift. There are team meetings every few months so. We looked at the records of the last two of these. We wanted to see what sorts of things are being discussed. Theyre practical and relevant. For example, the Christian Science nurses reminded each other to make sure that wet wipes are sealed when not in use to stop them drying out. Another thing was the suggestion that small treatment trolleys be provided. This is so that the Christian Science nurses can take them to patients bedrooms and have their own work surface for doing things such as preparing dressings. The Christian Science Nursing Manager says that these trolleys have now been provided. Its really important that the Registered Provider has a system for finding out what patients think about the Service. After all, theyre the experts because they live there and they know first hand what its like to receive nursing care in Charton Manor. The Assessment recognises the importance of this feedback. Weve already told you about the questionnaires that the Registered Provider asks patients to complete. One of the questions reads, overall, are you satisfied that the house provides you with a good quality service? Everyone says yes they are satisfied. All in all, the questionnaires are very useful. We think that it would be helpful to extend this exercise to now include members of staff. This is because they work in the Service. Usually, members of staff have lots of useful suggestions about how things can be improved further. The Registered Provider holds small amounts of money for each of the patients so that it doesnt get mislaid. It is then given to them as and when they want it so that they can buy things. Each patient has agreed to this. We checked out some of the records of the various transactions involved. Things are in order. In the record we checked the transactions are for reasonable amounts, the sums add up and the paper balance tallies with the persons cash balance. Since our last inspection, the Registered Provider has introduced a new audit system. This is where someone senior checks the records ever two weeks or so to make doubly sure that everything is right. The Registered Provider should be checking parts of the fire safety system regularly to make sure that everything is still working correctly. The Assessment says that, the fire alarm is tested weekly. We looked at the records and found that the routine checks of the fire alarms are significantly overdue. Some of the other routine fire safety checks are similarly overdue. The Administrator has assured us that these oversights will be put right immediately. The checks of the fire safety system that have to be completed by a contractor are up to date. There are regular fire drills. The Care Homes for Older People Page 26 of 30 Evidence: Christian Science Nursing Manager says that in addition to this, all members of staff are expected to attend a fire safety course once each year. This training is more detailed than the things that are done in a fire drill. The Christian Science Nursing Manager is now going to further strengthen the present arrangement. In future every member of staff will be asked to show that they understand key parts of the fire safety procedure at least once every six months. There are up to date reports from engineers about the gas appliances and about the electrical installation. They say that everything remains in good working order. After the inspection, we spoke with the Christian Science Deputy Manager about the record of accidents that have occurred in the Service since our last visit. He says that there have been very few and that there hasnt been anything major. He says that the Christian Science Nursing Manager and the Christian Science nurses keep an eye on who has had an accident and what has happened. This is done so that they can do something if there is a particular problem that is causing the accidents. The Christian Science Nursing Manager says that all members of staff regularly check the building as they go about their work. They do this to make sure that there isnt anything that might result in someone having accident. For example, theyre looking for things like frayed carpets that might cause someone to trip over. She says that they havent found anything that needs attention. We kept our eyes open when we were walking around. We didnt see anything either. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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