CARE HOMES FOR OLDER PEOPLE
Chegworth Nursing Home 23 Downs Side Sutton Cheam, Surrey SM2 7EH Lead Inspector
Alison Ford Unannounced 26 July 2005 10:30 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. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Chegworth Nursing Home Address 23 Downs Side, Sutton, Cheam, Surrey, SM2 7EH 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) 020 8642 9453 020 8642 8834 Bayswift Ltd Mrs Puspavani Barkakaty Care Home 37 Category(ies) of (OP) Old Age registration, with number of places Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Day care may be provided for a maximum of 3 people. Date of last inspection 10 February 2005 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 accomodation in twenty-nine single bedrooms, three of which have en-suite facilties 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. Two bedrooms include fire escapes which would not be aceptable under current standards however there are additional fire escapes available. The home is well maintained with a beautiful rear garden. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was the first statutory inspection of the year 2005/2006 and was unannounced. It was well received by the homes matron and her staff and the Registered Provider arrived during the morning. The visit took place over four hours and included a partial tour of the premises including the kitchen and laundry, examination of a selection of care plans and staff files and conversations with the majority of the residents, one relative who was visiting and the management team in the home. Prior to the inspection comment cards, routinely sent out by The Commission, had been received from eighteen residents and fifteen relatives. All of these contained favourable comments relating to the standard of care provided by the home and the kindness of the staff. This was reinforced by the conversations, with residents, held in the home during the inspection. Since the last inspection, two complaints about the home had been referred to The Commission. The first was found to be unresolved and the second is still in the process of being dealt with by the home. What the service does well:
This home provides 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. On the day of the inspection the hairdresser was visiting, as she does every week. 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. A doctor visits regularly and other healthcare professionals 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”. Several residents commented on how lovely the garden was` and how much they enjoyed sitting out there in the summer. 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 had ever felt the need to use it. They were confident that any issues would be dealt with promptly by the management team as they occurred.
Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.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 Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.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 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: Four care plans of recently admitted residents were seen. All contained evidence of a comprehensive pre-admission assessment. Where they had been admitted through care management arrangements, copies of the relevant assessments had been obtained. The home uses a care planning system, “Standex” and the assessment forms the basis of subsequent care planning. There was evidence that relatives had also been involved in this process. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 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. EVIDENCE: A sample of care plans were reviewed and these indicated that this standard is met for those people for whom the home is registered. Risk assessments were in place for manual handling, prevention of pressure sores and maintenance of safety. There was evidence that relatives have been asked to contribute to theses plans and are aware of their content. These plans are reviewed monthly in audition to resident’s annual reviews. 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. Two care plans of residents with pressure sores confirmed that the tissue viability nurse had been consulted about their treatment plan. Other members of the multidisciplinary healthcare team such as dentists, chiropodists and opticians make regular visits to the home and these are documented. The majority of the residents are registered with the same GP who visits regularly.
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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) 12,13,15 Residents in this home are able to participate in a range of activities, which suit their needs, to maintain contacts with their families and friends and to exercise choices in their daily living in order to maintain their independence. A wholesome appealing diet is served which adds variety and interest to their lives. EVIDENCE: The activities programme in the home has been expanded to add interest to resident’s daily lives. A new activities coordinator has been employed and several residents have been taken out to the local park. An entertainment company recently provided a show for the home and on the day of the inspection the garden was being prepared for a strawberry tea at the weekend to which relatives and friends were invited. Art classes are held weekly and resident’s work is displayed in the home. Residents confirmed that their relatives were always made to feel welcome in the home and this was supported by the comments made on the preinspection survey. Regular contact is maintained with church representatives and all residents are registered with the Dial-a-Ride scheme. All those spoken to expressed their satisfaction with the food served in the home, there is always a choice and the chef regularly visits the resident’s in order to discuss their preferences.
Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 11 Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Residents in this home are confident that the complaints procedure in use within the home will ensure that any complaints that they might make will be treated promptly and with sensitivity. EVIDENCE: There is an appropriate and comprehensive complaints policy in use in the home and details are in the service users guide. One complaint had been investigated by the Commission since the last inspection and was unresolved. There had been no evidence that it was substantiated. At the time of this inspection, the Commission had received copies of correspondence between the home and the relative of a former resident. The issues were in the process of being dealt with. Some areas of concern were raised regarding pre-employment procedures and the protection of residents; these are dealt with under standard 29. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 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 although an area of the carpet in the downstairs corridor requires repair. One fire door in the downstairs corridor is protected by a keypad however it was evident that not all of the staff are aware of the code. This is not the only means of escape in the event of a fire however the issue must be addressed or an alternative way to secure the door found. Some bedroom doors have been fitted with a closer, which operates automatically in the event of a fire, however others were seen to be wedged
Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 14 open. These closers must be fitted to the door of any resident wishing to have their door held open. The home was clean and tidy and free from odour on the day of the inspection and, laundry facilities are sited away from areas used by residents. Bedroom carpets of residents who may suffer from incontinence have, in consultation with their relatives, been replaced with a covering that is easier to keep clean. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 15 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 Staffing levels in this home are sufficient to meet the needs of its residents however recruitment procedures are not always sufficiently robust to ensure their safety. EVIDENCE: The off duty sheets were seen and indicated that staffing levels are always adhered to with a mixture of trained nurses and care staff. Staff personnel files were seen for newly appointed staff and these did not always contain evidence of clearance from the Criminal Records Bureau and Protection of Vulnerable Adults register. An immediate requirement was issued to provide evidence that these had been applied for with a timescale for compliance within the next four weeks. One member of staff was found to be working without a valid work permit from the department of immigration. An immediate requirement was issued to prevent his working until this was rectified and this was complied with on that day. Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 16 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) Theses standard were not assessed at this inspection. EVIDENCE: Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 18 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. Standard 19 Regulation 13(4) (c ) Requirement The Registered Provider must ensure that a device which ensures closure in the event of a fire is fitted to the bedroom doors of any resident wishing them to be kept open. ( Previous timescale30/5/05 not met.) The Registered Provider must ensure that the fire door can be opened by all members of staff in the event of a fire. The Registered Provider must ensure that the carpet in the coridor is repaired. The Registered Provider must ensure that no member of staff is working in the home without valid clearance from the Criminal Records Bureau and Protection of Vulnerable Adults register. The Registered Provider must ensure that any member of staff requiring a work permit is in possession of one before commencing employment. Timescale for action 30/10/05 2. 19 23(4) (c )(iii ) 13(4)(c 19(1)(b) Schedule 2 30/8/05 3. 4. 19 29 30/8/05 Immediate requiremen 30/8/05 5. 29 19(1)(b) Schedule 2 Immediate requiremen t 26/6/05 Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Chegworth Nursing Home G53-G53 S19083 ChegworthUI V190738 260705.doc Version 1.40 Page 20 Commission for Social Care Inspection Croydon, Kingston & Sutton 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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