Inspection on 20/07/05 for Chatterwood Nursing Home

This inspection was carried out on 20th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chatterwood Nursing Home 18/10/07

Chatterwood Nursing Home 21/09/06

Chatterwood Nursing Home 03/02/06

Chatterwood Nursing Home 16/02/05

Chatterwood Nursing Home 13/08/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Chatterwood Nursing Home Huntsbottom Lane Hillbrow Liss, Hampshire GU33 7PA Lead Inspector Val Sevier Unannounced 20/07/05 10.30 am 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. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chatterwood Nursing Home Address Huntsbottom Lane, Hillbrown, Liss, Hants, GU33 7PA 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) 01730 895485 Milkwood Residential Care Limited Mrs Joyce Gilfroy CRH 24 Category(ies) of PD, PD(E), TI, TI(E) registration, with number of places Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 5 service users may be admitted between the ages of 55 and 64 years. Date of last inspection 16/02/05 Brief Description of the Service: Chatterwood offers nursing for 24 residents over the ages of 55 years. There are twelve single, six shared bedrooms and the communal rooms are accommodated over two floors . The home has a shaft lift . The garden area is accessible from the front door and conservatory. The home is in a rural area and the local shops in Liss are assceesible with assistance. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 5 hours. The registered nurse and all staff assisted the inspector with the visit the administrator for the group also called to the home for feedback in the afternoon. The manager was on a course for the day. The inspector was able to speak with several residents, three visitors and a selection of staff that were on duty. There are plans for a new conservatory at the home with work to begin soon; this will increase the communal and dinning areas of the home. It is also planned that the area outside will be made level offering better access outside for the residents. What the service does well: What has improved since the last inspection? Several of the requests for action had been met since the last inspection. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 6 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. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.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 Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.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, 4 and 5. Standard 6 applicable. The home has an understanding of residents needs using the assessment process. There is sufficient information for prospective residents and families to make an informed choice about the home. EVIDENCE: The inspector looked at 3 care plans and each individual had had an assessment prior to moving to the home. The assessments contain information about the needs of the individuals. It was observed that the information gained through the assessment had been used to complete the care plans with the exception of one care plan where the individual had been admitted to the home the month prior to the inspection. A relative spoken with on the day, explained what had happened in the decision-making process regarding the home and how he had been involved. The residents spoken with although able to speak for themselves had been unable to visit the home due to physical frailty. The relatives spoken with felt that the admission process had worked, that they had been given adequate Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 9 information to assist with the decision, making process. The relatives felt that the needs could be met. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care plans do not always identify all needs and have not been revised as needs change; this could potentially place residents at risk of not receiving appropriate care. The systems for the administration of medication are variable and could potentially place residents at risk. Staff were seen to behave appropriately with residents with some identification of emotional and physical needs. EVIDENCE: The inspector sampled three care plans. One had not been completed fully as the person had recently moved to the home. This was of concern as the evidence in the daily notes indicated a change in behaviour in the two weeks prior to the inspection for which no pane had been written in how staff were to meet these changed needs. The second care plan was for an individual who had been at the home for two years. There was little information available regarding the needs of the individual. When this was discussed with the nurse she indicated that the needs had changed and that there was an increased dependency, there was no record to evidence this. The nurse agreed that the care plan needed revising. The third plan was very informative and gave a Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 11 clear indication of the individuals needs and action staff need to take to meet those needs. All the care plans had been signed to say they had been reviewed; there was evidence of risk assessments, moving and handling and other assessments and monitoring tools. Conversations with residents and relatives and observation of interaction by staff with residents indicated that there was knowledge about needs and that staff were able to meet the needs evident to them. There was evidence that health needs are addressed with regular doctor’s visits and chiropody available for residents. Medication stock and administration were seen on this occasion. The nurse said that the home was aware of the changes regarding disposal of medication, the administrator in the afternoon confirmed that local agreements had been made with the chemist. It was seen in the medication records that ‘as required’ medication mostly Paracetamol and Lactulose had been given daily. The nurse was advised that this might need to be reviewed. There was a domestic remedies list and box with some in them, including Ibuprofen, the nurse was advised that this was not on the list and should not be given. Some residents were prescribed Digoxin, there was no evidence that the pulse was taken before administration or at any time for monitoring, and there was no record in the care plan to say that monitoring was not needed. This was discussed with the nurse who said that she did take the pulse before giving. Where residents are diabetic and on insulin there was a record of blood sugar monitoring. For two residents there appeared to be an overstock of some medication the nurse explained that was how the stock was given, the inspector advised that the stock rotation need to be reviewed in order that the stock dispensed in April in one case, could be used. A box of medication was seen on the floor of the medication room, it as to be returned. Now that it has been established how the home is to do that this should now take place. The fridge temperatures were monitored and a record kept, the fridge contained appropriate medications. The controlled drugs cupboard was seen to contain two envelopes one with a ring ‘unknown’, the second with a residents name and several pieces of jewellery. This was discussed with both the administrator and nurse on duty. Staff were observed speaking and assisting the residents with dignity and respect. Affection was given appropriately to those residents who sought it. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to residents by the name they wished. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 12 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 14. Links with the community are good and support users social opportunities. Staff enable residents to make choices about their lives. EVIDENCE: Resident’s spoken with said that thy felt they had choices in their lives where possible about when they got up or went to bed. They felt able to express a decision about life in the home and that things were as expected. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 13 There is a range of activities available for residents including gentle exercise, arts and crafts, bingo and music. There was music and singing on the afternoon of the inspection for those residents in the lounge. Music had been heard through out the home during the morning. Some residents spoken with enjoyed the music for some it wasn’t their ‘cup of tea’ as it was ‘too old’. Ministers from two denominations visit the Home weekly or monthly and this was confirmed on one care plan seen that the resident received weekly communion. There is a visiting library, which provides talking books and large print books; one resident was seen to be taking advantage of that. Residents can also receive a daily paper, several of which were seen. It was noted that residents in the lounge had each had a table in front of them with their personal items on them papers, tissues etc, within easy reach. Residents spoken with said that they enjoyed the meals and that they were ’tasty’, they could have something else if they did not want what was on the main menu. The cook confirmed that there was little waste and that they seemed to enjoy the food. It was noted at the residents meeting in December several suggestions had been made by residents regarding meals and snacks, it was discussed with residents that these had been actioned. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 14 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 It would seem the manager has worked at establishing a sense of openness at the home so that relatives and residents can voice their concerns. Staff also feel that they can voice concerns especially regarding the care of the residents. EVIDENCE: The Home has a complaints policy and procedure and whistle blowing policy, which is shared with staff during induction. There have been no complaints made to the home or CSCI since the last inspection The inspector asked relatives if they were aware of the complaints process and they were, one pointed out the poster on the information board, which advised of the right to complain, and had the commissions address. The name needs to be changed to reflect the name change of the Commission. A request for action regarding staff training in adult protection had been made at the after the last inspection. It was noted that the manager has undertaken training in adult protection and that this will be cascaded to staff late July. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 15 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 - 26 The home is well maintained and feels homely. EVIDENCE: The inspector undertook to walk around the home. There is general maintenance of the home to ensure safety, carried out by the homes maintenance person. It was seen to be clean and homely with several residents having their belongings around their chair in the lounge. The garden is landscaped and accessible. The laundry was seen and was appropriately maintained with safety notices as needed. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 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 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, 29 and 30. The level of staff and training programme would seem to meet the needs of the residents. The recruitment procedures do not currently ensure the safety of the residents. EVIDENCE: The inspector viewed the rota for the week of the inspection and the weeks after. It was noted that the staffing was one nurse and four care staff from 8 am to 8 pm with one nurse and carer at night, they are supported by kitchen and domestic staff. The recruitment process was seen and three staff files were sampled. On the 1st file it was noted that the work permit was out of date and the CRB had not been requested. The administrator advised that the updated work permit had been received. On the 2nd file both references were dated after the start of employment and the CRB had not been requested. On the 3rd file there was no employer reference although the administrator stated that there had been a verbal reference, there was no record of this. A CRB had not been requested. The administrator and nurse were advised that no CRB was transferable and they had to be obtained urgently. Risk assessments of those staff are needed whilst this is being addressed and CSCI must be kept informed. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 17 Training has been planned for the year in risk assessments, adult protection, stroke care, food hygiene, NVQ and diabetes. The manager was on a days training course in dementia awareness and there was an indication that this information would also be passed to staff. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 18 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) 33 and 38 Resident’s views are sought and there is evidence that their views are acted upon. Health and safety seems to be maintained at the home, but needs to be monitored. EVIDENCE: There was evidence that the home is run with the residents enabled to have a say in the home. There were minutes available of the meetings held and residents were able to confirm that action had been taken. Relatives stated that they felt able to talks with the staff and manager at the home about any concerns that the always felt welcomed. The fire records were seen as two requests for action had been made after the last inspection. The checks had been carried out weekly and monthly with July’s tests due. The requests for action had been met. Fire training for staff took place in January and is arranged for August. During the tour of the home Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 19 it was noted for one bedroom that there was a fireguard on the door, however the bed was too close to the door and prevented it from shutting when the guard was released. It was seen that on two other doors the door did not close completely when the guard was released. These were mentioned to the nurse. When the inspector looked again the doors were closed but when opened and released still did not close completely. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 20 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 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 x 3 x x x x 2 Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 21 Yes 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. 2. Standard 7 9 Regulation 15 Sch3 13(2) Requirement Timescale for action 15/11/05 3. 29 19 Sch2 4. 38 23(4) Care plans must reflect individual needs and have action needed by staff to meet them. Prescribed and as required 31/08/05 medication must be monitored to ensure that it is appropriate. Only homely remedies listed are to be given. Stock must be monitored and excess stock or not required medication must be returned appropriately. Only medication must be stored in a controlled drug cupboard. The registered person must 31/08/05 undertake a thorough recruitment process as outlined in Schedule 2. (This is a repeated requirement). The registered person must 31/08/05 ensure that safety measures regarding fire are monitored and maintained within a risk assessment framework. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 22 No. 1. Refer to Standard Good Practice Recommendations Chatterwood Nursing Home H54 s38996 Chatterwood Nursing Home v240013 200705.doc Version 1.40 Page 23 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton, Hampshire SO15 1GW 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. 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