CARE HOMES FOR OLDER PEOPLE
Chelston Park Nursing Home West Buckland Road Wellington Somerset TA21 9PH Lead Inspector
Shelagh Laver Unannounced Inspection 12th September 2007 09:30 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 Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 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. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chelston Park Nursing Home Address West Buckland Road Wellington Somerset TA21 9PH 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) 01823 667066 01823 653163 info@chelstonpark.co.uk Chelston Park Nursing & Residential Home Limited Mrs Joanne Girdler Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to four persons of either sex, in the age range 40-59 years, who require general or nursing care. Up to six places for personal care Maximum of 30 nursing care place Date of last inspection Brief Description of the Service: Chelston Park is a large house that was adapted and extended to become a care home in 1986 (formerly known as the Pennant). The home offers general nursing care for persons over 60 years of age and has four places for persons aged between 40 - 59 years. Personal care only can be offered to people who are at least age 65 years on admission. The home is spacious and comfortable and sits in large landscaped grounds. There are excellent views of the Blackdown Hills and Wellington Monument from some rooms. There are plans to develop and extend the home, including the kitchen during 2006. The home is well maintained and adapted for purpose. There are assisted bathing and disabled toilet facilities and adequate communal facilities. Staff are well trained and managed. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector over a 5-hour period on 10/09/07. A second inspector visited the home to inspect the medication on 17/09/07. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: - excellent, good, adequate and poor. The inspector was able to spend time in the home talking with people living in the home and with staff. There were opportunities to observe care practices. The manager, Jo Girdler was available throughout the day and all records requested were made available. Prior to the visit the home completed a comprehensive and informative Annual Quality Assurance Assessment (AQAA). 10 people completed questionnaires. People who returned comment cards stated that they always or usually received the support they needed. They felt that staff listened to them and acted upon their requests. Other information gathered from the cards is included in the relevant section of the report. A tour of the premises was made and the inspector met with ten people in the communal areas and in private in their own rooms. The inspector observed staff working with service users and spoke to them. The building of a 50 bed new provision for people with dementia in the previous grounds of the home is nearing completion. The project as been managed to minimise disruption and concern to people in the home and no complaints or concerns have been received. There remain ample grounds and pleasant outlooks for people. What the service does well:
This is a well run home where consideration is given to the well being of people who live there. People made positive comments about the care received in the home. “I have no complaints. The food is very good. Staff are very helpful.” A visitor said “….. is very well cared for here.” Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 6 Comment cards indicated that all service users who responded were satisfied with their care. They knew who to talk to if they were not happy and would know how to make a complaint although few had done so. All service users felt the home was “always” or “usually” fresh and clean. Medical support was available and activities are provided to suit a high proportion of service users. There is evidence of considerable investment and commitment to training in the home. The home reports having, 30 staff of which 75 have NVQ 2 or above. 8 staff either have NVQ3 or equivalent or are studying towards this level. There are opportunities for Registered Nurses to up-date their skills and to study at a professional level. Training is managed and recorded in an efficient and effective manner reflecting an overall training plan for the home. Training is delivered in a flexible and creative manner utilising in-service training, medical representatives and external courses and trainers. The home has Investors in People award. There is a real effort in the home to provide some enjoyment and social activities in the home. There is a varied and imaginative programme of events that are advertised as a weekly programme. The Annual Quality Assurance Assessment states “Chelston Park ensures that the passing of the year is marked with activities e.g. Xmas and party activities spring cheese and wine party, summer garden party and day trips to the beach, seaside resorts such as Sidmouth, autumn bingo and fireworks party. These are planned at the beginning of the year ensures that Chelston Park has a framework to base activities around.” Records in care plans showed some people enjoyed a variety of activities at the home. “…….came out for a drive, joined in with planting hanging baskets and was interested in the chat and pictures of Australia.” Another entry stated “attended funeral…. clinic appointment and shopping …newspapers…. lunch out…enjoyed using garden…. and trip to Dunkeswell.” There is an art group running. In the summer some people went to Blue Anchor and enjoyed a cream tea. The gardens of the home are very pleasant and are accessible and used by the service users and their visitors. The environment continues to improve and to reflect investment in the home. Attention has been paid to the requirements and recommendations of the last inspection report. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better:
There was one comment card returned indicating that the family member did not feel fully informed of their relatives’ progress. The large sitting room is not conducive to people having conversations with their visitors. There are other areas where visitors can be received more privately. Some relatives are able to move people to these areas themselves. It would be helpful if staff asked other relatives if they were happy in the large room or wished to move to a more comfortable area. The overall layout of the large sitting room should also be considered in order to create opportunities for conversation where possible. It is important that staff from other countries always speak English when caring for people. This was a concern expressed by two people in the home. Please contact the provider for advice of actions taken in response to this
Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 9 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 Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 4 6 Quality in this outcome area is good. Information is provided to enable prospective service users to make an informed choice. The Manager of the home or her Deputy assess thoroughly to ensure the needs of prospective service users can be met prior to a decision being made about admission This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Assessment document confirms that all people considering coming to Chelston Park are offered a visit to the home and receive brochures and information. The manager or her deputy would make an assessment to ensure that care needs can be met at the home. The pre-inspection information indicated that there has been no alteration to the homes statement of purpose. The home makes available the statement of purpose and service user guide to all service users.
Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 11 Prospective service users and their families/carers are welcome to visit the home. The manager or her deputy would make an assessment to ensure that care needs can be met at the home. Service users who completed comment cards stated that they had received enough information about the home prior to entering the home. Most people knew they had received a contract and examples of these were seen. Care plans were seen and those sampled demonstrated evidence of the homes manager making an assessment prior to admission. Examples of documentation contributing to the assessment were seen in service user files for example information from hospitals and social workers. There was evidence of the input by the District Nurse assessor and the community CPN when service users were assessed for their level of nursing care input/funding. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is good. Peoples’ health needs are met in the home. Staff treat people with respect and kindness. Care plans are detailed and comprehensive. The medication systems were assessed to be mostly satisfactory. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Ten people were spoken to during the inspection. Staff were observed to be relaxed and considerate when talking to people or assisting them. People confirmed to the inspector that staff are kind and helpful. Written feedback from ten people was made to CSCI via comment cards. All stated that they received the care and support that they needed “usually” or “always”. Service users spoken to confirmed that staff treat them well and that their privacy is respected. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 13 There was evidence at this inspection that time had been spent reviewing and developing the care plans. Time is allocated to key nurses to review care plans. Pressure relieving equipment was seen and was documented in care plans as being in use. A form has been developed which confirms service user involvement in the care planning process and their access to their own care records. There was evidence that people’s health needs are met in the home. Contact with visiting professionals was documented indicating regular visits from opticians, chiropodists and contact with the Community Psychiatric Nurse when required. Monthly reviews are made. There was evidence that staff addressed service users short-term and long-term health needs. People confirmed that the doctor visited them when they were ill and that staff listened to their health concerns. The medication systems were assessed to be mostly satisfactory. The home has written protocols in place on the Medication Administration Records for the administration of most medications. There were no gaps evident in the Medication Administration Records and the registered manager explained that the home has adopted the good practice of weekly auditing of the medication records and action is taken for any gaps noted. There was evidence of variable doses being recorded and hand transcribed entries being signed by 2 staff, however it was noted that on 4 occasions these hand transcribed entries were not dated. This is required to enable a clear audit trail of the date of medication commencement. The registered manager has implemented a system to record the administration of all prescribed creams on the Medication Administration Records. People using the service have the option to self medicate should they want to and risk assessments are in place to ensure safe practice is maintained. Lockable storage is available as required. A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. Oxygen storage has been improved and a lockable outdoor cupboard is now provided. Appropriate signage is necessary to alert people to what is being stored there and the risks associated with that storage. People using the service currently using oxygen have signage alerting staff of cylinders in use but does not contain the hazards involved in storing oxygen in the room. One cylinder was stored in an upright position but did not appear to be secured to the wall. There was evidence at this inspection that time had been spent reviewing and developing the care plans. Time is allocated to key nurses to review care plans. All medications were stored safely and securely with systems in place for ordering and disposal. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were able to make choices about their individual daily living. People are offered a choice of diet and the opportunity to eat together in attractive surrounding EVIDENCE: The AQAA states, “Views of service users are sought and staff are aware of individual preferences. Routines are kept to a minimum and a balance is sort between the safe and smooth running of the home and individual preferences.” The home offers a range of activities. Visitors are welcome in the home at any time.” Service users are able to spend their days in a variety of ways. One person has a range of computer equipment. One person has reached 109. Her companion was a contented cat. Another person enjoyed the quizzes. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 15 There are regular musical events in the lounge. There is Flexercise. The gardens of the home are very pleasant and service users enjoyed going outside for a cup of tea and using the gardens to sit in. Good records of activities and service user participation are made in care plans. People in the home and two visitors confirmed that family and friends were made welcome at all times. Most people enjoyed the food and were complimentary although one person found it lacked flavour. The “summer menu” showed a nutritious range of meals. As well as traditional roast lamb or beef and cottage pie people can try oriental chicken rice and peas or spaghetti bolognaise. There is a choice at lunch and suppertime. People said that if they did not like the main choices there were always alternatives. There was evidence that special diets and individual needs are catered for. People had access to drinks throughout the home. When hot drinks were served there was attention to individual preference and a choice of biscuits was offered. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear complaints procedure. Complaints are responded to promptly and records are kept. EVIDENCE: There is a documented Complaints policy and all complaints are dealt with initially within 7 days. There have been no complaints since the last inspection. Any concerns regarding the welfare of people in the home are recorded and dealt with promptly. All service users who returned comment cards knew how to make a complaint and who to speak to if they were unhappy. No issues of concern were raised during this inspection. Two relatives said they are aware of the homes complaints procedure and none had ever made a complaint. One said, “Things would be quickly dealt with by the manager. We would not need to make a formal complaint.” Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 22 24 25 26 Quality in this outcome area is good. Service users live in a clean and comfortable environment that meets their assessed needs. Service users have access to specialist equipment where it is required for their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had been suitably adapted to meet the needs of the people in the home. The conservatory and dining space provide an attractive alternative place to sit and meet with families. The home is being steadily upgraded. On the day of inspection the home was clean and attractive. Cleaning is carried out to a managed schedule.
Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 18 The laundry now has the Otex system to reduce the risk of cross infection and use low temperatures for washing. The sluice rooms were seen and were clean and well managed. A range of coloured mops and clear instructions enable cleaning to be carried out hygienically. It was noted, as good practice that hand cleansing gel is available throughout the home. Service users rooms were personalised, comfortable and well maintained. The building complies with the local fire and environmental health service requirements. The home has a large communal lounge; the room is well appointed and comfortably furnished. The home has attractive domestic style lighting and furnishings in the communal areas and had good ventilation. All windows above ground floor have been restricted in opening to a safe limit. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. There is a robust recruitment system for staff entering the home. People in benefit from well trained and managed staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing was adequate on the day of inspection. The Registered Manager can authorise additional staff in the event of an emergency. The Registered Manager was available and there was also a Registered Nurse on duty. Staff spoken to confirm supervision and staff appraisals. Copies of duty rotas were seen during the inspection these indicated that minimum staffing levels were maintained. Domestic and catering hours also appeared adequate. There was evidence of considerable investment and commitment to training in the home. A notice board displays the training schedule for the year and includes reminders of up-dates for staff. The home reports having, 30 staff of which 80 have NVQ 2 or above. The home benefits from an enthusiastic trainer employed by the home. Training is managed and recorded in an efficient and effective manner reflecting an overall training plan for the home. There was evidence of investment in PREPP level courses for Registered Nurses. The home offers
Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 20 placement opportunities for student nurses and some are employed as part time members of staff. Training is delivered in a flexible and creative manner utilising in-service training, medical representatives and external courses and trainers. The home has Investors in People award. Recruitment files showed evidence of a robust procedure including CRB checks and induction. Records of interviews should be kept. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. The home is well managed. There is organised and methodical management and implementation of health and safety requirements. Service users finances are well managed. Records are maintained and stored appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 22 The Registered Manager is Mrs Joanne Girdler. She is a Registered nurse and has relevant experience and qualifications. She has taken relevant updating and training to maintain her competencies and holds an Open University Management Diploma. In discussion with the manager and staff there was evidence of sustained review and improvement of practice in the home. Meetings are held and minuted. Individual staff induction, training and supervision records were made available. Infection control training includes food hygiene and is run at two monthly intervals. This also covers COSHH and HACCUP and is managed by an outside trainer. There is a planned professional approach to maintenance in the home. Maintenance records were sampled and were comprehensive and well organised. Water is managed according to requirements to prevent Legionella (19/07/07). Cold-water temperatures are checked and regulated. In house auditing of infection control, beds, and first aid boxes are carried out. The home has an emergency lighting system and an outside contractor services this annually with the main alarm. LOLER Six monthly servicing on hoists was last completed on 17/07/07. There were records of wheelchair servicing and checks. The nurse call had been serviced in May. There was evidence that medical equipment is maintained regularly. Bed rails are checked monthly. A sample of service users finances were reviewed and found to be accurate. Fire records showed regular alarm testing, staff training and maintenance of equipment. There is an organised “Fire Marshall” system. The fire risk assessment documentation was revised and up-dated in August 2007. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 23 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 3 3 3 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP13 Good Practice Recommendations Staff should offer people the choice of meeting visitors and friends in privacy. Chelston Park Nursing Home DS0000003249.V348836.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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