CARE HOMES FOR OLDER PEOPLE
Chegworth Nursing Home 23 Downs Side Sutton Cheam Surrey SM2 7EH Lead Inspector
Alison Ford Unannounced Inspection 20th December 2005 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chegworth Nursing Home Address 23 Downs Side Sutton Cheam Surrey SM2 7EH 020 8642 9453 020 8642 8834 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bayswift Limited Mrs Puspavani Barkakaty Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Day care may be provided for a maximum of three people. Prior to any day care patients being admitted, the National Care Standards Commission must be informed in writing of the purpose of the placements, the facilities to be provided, together with the arrangements for staffing, needs assessments and care planning. A variation has been granted to allow one specified service user under the age of 65 to be accommodated subject to evidence of regular review of the situation and the service user`s assessed care needs. 26th July 2005 2. Date of last inspection Brief Description of the Service: Chegworth is a residential care home registered with The Commission for Social Care Inspection to provide personal and nursing care for up to thirtyseven older people. No other categories of registration apply. The home is a large, detached, domestic style house providing accommodation in twenty-nine single bedrooms, three of which have en-suite facilities and four, which have W.C facilities, in addition there are four double bedrooms. There are two lounge areas separated by an office area and nursing station. There is no designated dining room; residents choose either to eat in the conservatory or at cantilever tables in the sitting room. The usual facilities such as kitchen, laundry, toilets and bathrooms are all in place in sufficient numbers. The home is well maintained with a beautiful rear garden. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the second statutory inspection of the year 2005/2006 and was unannounced. It was well received by the homes matron and her staff; the Registered Provider was away on holiday. The visit took place over two hours and included a partial tour of the premises examination of a selection of care plans and staff files and conversations with several of the residents and one relative who was visiting. Following the last inspection, an issue had arisen concerning appropriate Criminal Records Bureau clearance for staff. This has now been resolved. Over the course of the year all of the standards, considered by The Commission to be key to the inspection process, have been assessed and this report should be read in conjunction with the one produced following the inspection on 26th July 2005. What the service does well:
This home continues to provide a safe, clean and well-maintained environment for the residents who live there. The atmosphere is homely and aids and adaptations have been provided to suit their needs. At the time of this inspection the home had been decorated for Christmas and residents had recently enjoyed a party. A full and comprehensive pre-admission assessment ensures that the healthcare needs of residents will be met and provides the basis for individual care planning. These care plans are subject to regular review and there is evidence of involvement of the residents and their relatives. Staff benefit from the input of a nurse tutor who works with them on a weekly basis helping to provide a high standard of care to residents. A doctor visits regularly; he was there on the day of the inspection, and other healthcare professionals are involved as required. Residents that were spoken to during the course of the inspection expressed their satisfaction with the home describing it as “home from home” and “a lovely place to live”. All of them agreed, “how kind the staff were to them”. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 6 The food served in the home was generally considered by the residents to be tasty and well presented and they enjoyed the range of activities that were offered to them. A robust complaints procedure is in place however none of the residents spoken to have ever felt the need to use it. They were confident that the management team would deal with any issues promptly as they occurred. 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.
Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 A full and comprehensive pre-admission assessment, undertaken by a senior member of the nursing staff, ensures that this home is able to meet the assessed healthcare needs of potential residents and forms the basis for subsequent care planning. This home does not offer intermediate care EVIDENCE: Two care plans of recently admitted residents were seen. Both contained evidence of a comprehensive pre-admission assessment and copies of the relevant assessments had been obtained from the Care Managers. The home uses a care planning system, “Standex” and the assessment forms the basis of subsequent care planning. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents in this home have an individualised plan of care, which is subject to regular review in order to; ensure that their assessed healthcare needs remain met and they are confident that they would always be treated with dignity and respect. The medication procedures in place in the home do not always ensure the protection of residents. EVIDENCE: Two care plans were reviewed, of residents recently admitted, and these reflected the care and support currently required. Risk assessments were in place for manual handling, prevention of pressure sores and maintenance of safety. A range of pressure relieving equipment was seen in use throughout the home and care plans contained evidence of regular monitoring of skin integrity and body weight and advice from the Tissue Viability Nurse. Photographic records provided evidence of the wound healing process. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 10 Other members of the multidisciplinary healthcare team such as dentists, chiropodists and opticians make regular visits to the home and these are documented. The homes doctor was visiting on the day of the inspection. Trained nurses administer all medication and records and storage were seen and were orderly. However, it is dispensed in a way that does not identify individual drugs appropriately. All those nurses that administer medication must be able to identify the individual drug that they are giving and this issue will need to be addressed. During the inspection it was observed that staff were treating residents in a kind and respectful manner, which respected their individuality and dignity. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents in this home enjoy various activities that are suited to their needs and provide interest and stimulation EVIDENCE: Organised activities, including those providing exercise, take place daily and residents said how much they enjoyed them. At the time of this inspection the home had been decorated for Christmas and pictures were seen of the recent party. Carol concerts had also been organised from the local church and Father Christmas was due to visit and bring gifts on Christmas morning. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 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 the following standard(s): 18 Residents in the home can be confident that there are measures in place to protect them from abuse. EVIDENCE: The homes trainer has held sessions for care staff and they are aware of the procedures to be followed and all staff have received clearance from the Protection Of Vulnerable Adults Register. The home does not take responsibility for any of the financial affairs of the residents. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 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 the following standard(s): 19 This home provides a clean pleasant and well-maintained environment, which meets the needs of its residents in a homely and comfortable way. EVIDENCE: The home is situated in the suburbs of Cheam and there is a bus route nearby. Some parking is available in the front and there is a large rear garden. A shaft lift ensures that the entire home is accessible to its residents and adaptations have been made throughout the home, which are suited to the needs of older people. The overall ambience is homely although some room sizes would not meet the requirements of a newly built home. The Registered Provider is hoping to extend the home in the future. All areas are well maintained and there is a planned redecoration programme for the coming year. All areas of the home were clean and tidy on the day of the inspection. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29,30 Residents can be confident that staff are trained and competent to do their jobs and they are protected by the homes recruitment procedures. EVIDENCE: Staff training is given a high priority in the home and recent training has included sessions dealing with infection control, palliative care and dementia. Four more care staff are undertaking an NVQ level 2 qualification and The Registered Manager and her deputy are continuing with an NVQ level 4. Two staff files were seen, from trained nurses that had recently been employed, and both contained all of the necessary documentation and evidence that appropriate checks had been made. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 Residents can be confident that the home is managed by a competent person and in their best interests and that procedures are in place to ensure their health and safety. EVIDENCE: The Registered Manager has been in post for some time and is supported by a deputy and senior trained nurses. Both she and her deputy are currently undertaking an NVQ level 4 qualification. There are relatives meetings arranged in the home every three months however attendance is poor and there is no formal quality assurance tool in place. The management team must explore some ways of involving residents and relatives and gaining their views about the care that is provided in the home. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 16 Documentary evidence has been provided to show that equipment has been properly maintained and that relevant policies and procedures are in place in the home. Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement The Registered Manager must ensure that the pharmacist dispenses medication in a manner, which ensures that those administering it can identify the individual drugs. The Registered Manager must devise a method to gather and record residents and their relative’s views of the home and the care that they receive. Timescale for action 30/01/06 2 OP33 24(1) 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chegworth Nursing Home DS0000019083.V271449.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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