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Inspection on 16/06/05 for Chelston Park Nursing Home

Also see our care home review for Chelston Park Nursing Home for more information

This inspection was carried out on 16th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Chelston Park provides a well-maintained, secure and comfortable environment set in lovely grounds, which meets the needs of the current client group. Service users were observed using all communal areas and appeared comfortable and relaxed in their environment. Service users spoken to stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users praised the food. A good choice of wholesome food was given. The food was well presented and looked appetising. Lunchtime was unhurried and relaxed. Staffing numbers and the skill mix of staff were sufficient to meet the needs of current service users on the day of inspection. Staff spoken with stated that they felt well supported and happy working at the home. Staff training was well documented and the provision of training for staff is good. Staff looked and acted in a professional manner. The home appeared appropriately managed by the registered manager who is supported by a suitably qualified deputy manager. Staff and service users praised the support of the manager. The complaint received since the last inspection had been taken seriously and appropriate action had been taken.

What has improved since the last inspection?

The lounge had been refurbished to a high standard. The carpet identified at the last inspection as needing replacement had been. Foot operated bins had been purchased and placed in areas where most needed including the laundry and sluice identified at the last inspection. Staff recruitment files sampled included POVAfirst checks and references on commencement of employment as required at the last inspection. Monthly bed rail checks had been recorded. Mattresses sampled at this inspection were found to be clean and in good order.

What the care home could do better:

Evidence was not seen in the care plans sampled that service users and/or their representatives had been given an opportunity to be involved in setting up and reviewing their care plans. Care plans sampled did not reflect interventions in regard to nutritional assessments, where service users had been assessed as high risk. One care plan had been mainly written in pencil, which could have been changed; this contravenes Data Protection and the Nursing and Midwifery Council (NMC) guidelines on `Record keeping`. Types of pressure relieving equipment and manual handling equipment was not reflected in the care plans examined. This information is required if the service users needs are to be met.Registered nurses should examine their own practices in regard to medication administration, storage and recording in line with the NMC and Royal Pharmaceutical guidelines for Care Homes. Bed rails were not always fitted securely and in one case were not compatible with the bed. This could cause a potential risk of entrapment. So although checks are monthly and records maintained systems must be put in place to ensure those checking are familiar with the Medicines and Healthcare products Regulatory Agency, particularly MDA DB2001 (04) and to comply with this guidance. One service user was noted being unable to reach their call bell. This practice must cease and the staff must ensure that at all times service users can summon assistance. Overall a positive inspection with good outcomes for service users. The inspectors felt that the home remains suitable for its stated purpose, however issues rising from this inspection must be addressed.

CARE HOMES FOR OLDER PEOPLE Chelston Park Nursing Home West Buckland Road Wellington Somerset TA21 9PH Lead Inspector Caroline Baker Unannounced 16th June 2005 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. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 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 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 666986 Chelston Park Nursing & Residential Home Ltd Mrs Joanne Girdler Care home with nursing 36 Category(ies) of Old age (36) registration, with number of places Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 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 23rd November 2004 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 persons who are at least age 65 years on admission. There is a small home in the grounds called The Bungalow this is registered separately, and offers residential care only to more independent residential category clients. All staff operate from and are managed from the main home.The home sits in large landscaped grounds with views of the Blackdown Hills and Wellington Monument. There are plans to develop and extend the home, including the kitchen during 2005. The home is spacious and adapted for purpose. There are assisted bathing and disabled toilet facilities. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 23rd and 24th November 2004. At that inspection four requirements were identified and two recommendations were made. This inspection was unannounced and conducted by two inspectors Caroline Baker and Barbara Ludlow over one day (7.5 hours). At the time of this unannounced inspection all but one of the requirements had been complied with and both recommendations had been actioned. Twenty-nine service users were residing at the home. There were two vacancies. Staffing levels were adequate on the day of inspection. An assessment of the premises took place where a selection of bedrooms and communal areas were seen. At least eight service users were spoken with. The registered manager was available throughout the inspection. Throughout the day the inspectors were able to observe interactions between staff and service users. Records relating to the care of the service users, staff and health and safety were examined. The inspectors would like to thank service users and staff for their time and help during the inspection. What the service does well: Chelston Park provides a well-maintained, secure and comfortable environment set in lovely grounds, which meets the needs of the current client group. Service users were observed using all communal areas and appeared comfortable and relaxed in their environment. Service users spoken to stated that they liked their bedrooms and were happy and felt safe at the home. Service users were well attired and looked well cared for on the day of inspection. Service users praised the food. A good choice of wholesome food was given. The food was well presented and looked appetising. Lunchtime was unhurried and relaxed. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 6 Staffing numbers and the skill mix of staff were sufficient to meet the needs of current service users on the day of inspection. Staff spoken with stated that they felt well supported and happy working at the home. Staff training was well documented and the provision of training for staff is good. Staff looked and acted in a professional manner. The home appeared appropriately managed by the registered manager who is supported by a suitably qualified deputy manager. Staff and service users praised the support of the manager. The complaint received since the last inspection had been taken seriously and appropriate action had been taken. What has improved since the last inspection? What they could do better: Evidence was not seen in the care plans sampled that service users and/or their representatives had been given an opportunity to be involved in setting up and reviewing their care plans. Care plans sampled did not reflect interventions in regard to nutritional assessments, where service users had been assessed as high risk. One care plan had been mainly written in pencil, which could have been changed; this contravenes Data Protection and the Nursing and Midwifery Council (NMC) guidelines on ‘Record keeping’. Types of pressure relieving equipment and manual handling equipment was not reflected in the care plans examined. This information is required if the service users needs are to be met. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 7 Registered nurses should examine their own practices in regard to medication administration, storage and recording in line with the NMC and Royal Pharmaceutical guidelines for Care Homes. Bed rails were not always fitted securely and in one case were not compatible with the bed. This could cause a potential risk of entrapment. So although checks are monthly and records maintained systems must be put in place to ensure those checking are familiar with the Medicines and Healthcare products Regulatory Agency, particularly MDA DB2001 (04) and to comply with this guidance. One service user was noted being unable to reach their call bell. This practice must cease and the staff must ensure that at all times service users can summon assistance. Overall a positive inspection with good outcomes for service users. The inspectors felt that the home remains suitable for its stated purpose, however issues rising from this inspection must be addressed. 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. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 8 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 Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 9 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) 1, 2, 3, 4, and 5. NMS 6 does not apply to the home Prospective service users are provided with information to allow them to make an informed choice. The home takes appropriate steps to ensure the needs of prospective service users can be met prior to a decision being made about admission. EVIDENCE: An up to date Statement of Purpose and Service User Guide was available. Evidence was seen in care records examined that a full pre-admission assessment had been undertaken to ensure the home could meet individual service users needs prior to admission. It was evident that the staff individually and collectively had the skills and experience to deliver the services and care which the home offers through staff files examined and training records seen. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 10 Some service users spoken to confirmed that their family or themselves had been able to visit the home prior to admission. Evidence was seen that service users are issued with an ‘Agreement for the Provision of Services’ at the home and are asked to sign this and keep a copy. The fees are dependent on the size of the room occupied and the needs of the service user. Dry cleaning, private healthcare, hairdressing, private phones, newspapers, accompanied outings or appointments, toiletries, or the cost of having portable equipment tested are not included in the fee. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 11 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, 9,10 and 11. Each service user had a care plan the processes needed improving and there was no evidence of service user input. The privacy and dignity of service users was respected. The procedures for the management and administration of medication were generally good however discrepancies were found potentially placing service users at risk of harm. EVIDENCE: On examination of four individual care plans and meeting with the service users it was noted that current care needs and interventions were not always recorded. There was no evidence of service user input. Nutritional assessments had not always been completed or reassessed to reflect loss of weight and action to be taken. Types of pressure relieving equipment were not reflected in the care plans as required at the last inspection. Bed rail risk assessments or rationale for use Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 12 were not detailed. Types of manual handling equipment used for individual service users were not reflected. One care plan had been written mainly in pencil, which contravenes the Nursing and Midwifery Council’s (NMC) record keeping guidelines. On examination of medication administration, storage and recording gaps in signatures were noted on Medication Administration Records. Hand transcribed medications did not always carry two signatures. Prescribed creams were stored inappropriately in service users rooms without a name in some cases and all without dates of opening or expiry. An Immediate Requirement Notice was issued. It was agreed that a signatures form be placed at the front of the Medication Records to enable identification of signatures. In regard to maintaining privacy and dignity service users spoken to praised the staff stating that they were always kind and caring and treated them with respect. The Inspectors noted that the interaction between staff and service users was kind and friendly throughout the inspection. The inspectors were able to assess the care and provision for service users when they are very ill through case tracking. It was evident that a high standard of care was delivered and comfort was assured. Care plans examined did not all reflect the funeral arrangements for individual service users should they become very ill. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 13 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, 14, and 15. The home’s arrangement for meeting service users social needs was fair. Service users were able to have choices in regard to their individual daily living. Service users benefited from a well balanced diet. EVIDENCE: Many service users were spoken to during the course of the inspection including four who were case tracked as part of the inspection process. All of the service users stated that they were happy at the home and felt it met their individual needs. It was evident that a choice had been given to service users for the time they got up in the morning. The routine of the home appeared to be dictated by service users choice. Social interests were not detailed in the care plans examined. An activities record was not seen however attendance to activities was reflected in the care plans examined. These were minimal however. This was discussed with the manager who agreed to highlight this with the activities co-ordinator to explore ways of recording social needs and fulfilment in the individual care plans. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 14 An open garden and strawberry cream tea had been arranged and details posted up for Saturday 18th June 2005. A donkey visits the home on occasions. A garden party was arranged for 29th June 2005. The service users were able to join in with quizzes and from outside entertainment such as ‘Songs from the Shows’. Visitors were seen on the day of inspection and relatives spoken to expressed their satisfaction of the care provision at the home. The visitor’s book indicated many visitors to the home at varied times. The lunchtime meal was assessed. Evidence was seen that a choice was given. Records of service user choice were seen in the kitchen. Meals looked appetising and well presented. Service users spoken to indicated that the food was very good. The kitchen was clean, tidy and well organised on the day of inspection. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 15 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, 17 and 18. The home had a satisfactory complaints system in place with evidence that views were appropriately acted upon. The home’s procedures for ensuring that service user’s legal rights are protected were good. The home’s staff recruitment procedures protected service users from the potential risk of abuse. EVIDENCE: There is a documented Complaints policy and all complaints are dealt with initially within 7 days. There had been one complaint made to the home since the last inspection. The complaints had been investigated thoroughly and openly and dealt with appropriately. Any necessary action has been taken. A record was kept and was available for inspection. The CSCI had also been informed. Service users are registered to vote in local elections. Postal voting is mainly used the manager informed the inspectors. There is a whistle blowing policy at the home. The home seeks to protect residents through its policies, procedures and practices. CRB disclosure checks were carried out via the Registered Care Providers Association (RCPA) on behalf of the home; action had been taken for staff recently recruited according to the files examined. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 16 Staff who were asked were aware of the procedures should they have concerns about the care of vulnerable adults. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, and 26 Service users live in a safe and comfortable environment, which is able to meet the assessed needs of service users living there. The monitoring of bedrails was not robust enough for the safety of two individual service users. Service users have access to specialist equipment where there is an assessed need. The standards of cleanliness were good. EVIDENCE: The home had been suitably adapted to meet the needs of the service user group. The lounge had been refurbished since the last inspection to a high standard. The home was well maintained and was being steadily upgraded. Plans are for the laundry and kitchen to be refurbished and the provision of a further dining area. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 18 The grounds are very attractive and were well maintained to a high standard. The building complied 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 large dining area extends into the conservatory. The conservatory is bright and becomes quite very warm in the sunny summer weather. The home has appropriate domestic style lighting in the communal areas. There are sufficient assisted bathing facilities to meet the needs of service users. Much of the individual accommodation is en suite, there are toilets appropriately situated around the home. The home has separate sluice facilities on each floor. The automatic sluice disinfector is situated on the ground floor; the others are slop hopper types only. The home is suitably adapted for the current residents. There is a nurse call system in all areas of the home accessed by service users. There are 24 bedrooms environmental guidelines. 19 having en-suite facilities. All meet NMS A number of rooms were sampled on each floor. The bedrooms were generally satisfactory and had sufficient furniture and fittings. They were all clean and tidy. Bedrooms had been personalised with pictures, photographs and service users’ special possessions. Adjustable beds and profiling hi-low beds were seen in rooms sampled. During the inspection one bed was identified as having unsuitable bed rails fitted which could cause a risk of harm to the service user, another bed although had bed rails well fitted were too low. This was brought to the attention of the manager for immediate action to be taken. Bed linen and mattresses checked were clean. The carpet identified at the last inspection as in need of replacement had been. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 19 There was adequate domestic style electric lighting in communal areas and bedrooms. The home was light and airy. All windows above ground floor were restricted in opening to a safe limit, in line with the Health and Safety requirements for Care Homes. Hot surfaces such as pipe work and radiators have been adequately guarded. Hot water temperatures were monitored ‘in house’ on a monthly basis. The home has an emergency lighting system and an outside contractor services this annually. It is now checked in house on a monthly basis according to ‘in-house’ records seen. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 20 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, 28, 29 and 30 The home’s recruitment procedures for staff were robust and protected service users from the risk of abuse. The numbers and skill mix of staff were appropriate to meet the needs of current service users. Staff morale was good. Agency staff were used to cover any shortfalls. EVIDENCE: Service users and staff spoken to at inspection indicated that they felt that staffing levels were adequate. Staffing was adequate on the day of inspection. The registered manager was available there was also a Registered Nurse on duty in the morning and afternoon. There were six care staff during the morning. The routine of the home ensured that staff were caring for between three and five service users each for the duration of their shift, which aids continuity of care. The copies of duty rotas given to the inspectors indicated that minimum staffing levels have been maintained over the past two weeks. Domestic hours appeared adequate. Four staff recruitment files were examined at this inspection of recently employed staff. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 21 The Registered Nurses had up to date Pin No’s. Evidence was seen of induction and mandatory training. All contained items as detailed in Schedule 2 of the Care Home Regulations 2001. Staff training records and speaking with staff and service users indicated that staff employed at the home are skilled and competent to do their job. There were nine qualified Registered Nurses at the home to include two with mental health training (RMN’s). Five care staff had gained a qualification in care to NVQ level 2, three of which were studying for NVQ level 3. And a further three staff were studying towards NVQ level 2. Once qualified this will give the home 42 of care staff with a NVQ in care. The NMS ask for 50 by 2005. The home should work towards this over the next six months. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 22 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) 31, 32, 34, 35, 37 and 38. The registered manager and her deputy effectively manage the home. The home is committed to staff training. The systems in place for ensuring the health and safety of service users and staff were generally good though some further improvements were required. EVIDENCE: 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. It was evident having spoken to staff and service users on the day of inspection, that the manager communicates a clear sense of direction, and leads the staff in a way that they understand. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 23 Individual staff supervision records were not seen at this inspection and will be followed up at the next inspection. The home had taken appropriate steps to safeguard any service users monies looked after on behalf of them. Financial records were sampled and examined. All transactions were recorded and monthly balance audits were carried out. The home displayed appropriate Employers Liability Insurance. Business and financial plans were not examined during this inspection. There is ongoing investment and development in the home. It was evident from the inspection that there is a programme of refurbishment and upgrading. The majority of the records that were seen at this inspection were comprehensive, well maintained and up to date. The home had adopted ‘Chroner’ policies and received updated copies in line with current legislation, which will be looked at more in depth at the next inspection. Medication records and care plans were not maintained in line with Schedule 3 of the Care Home Regulations 2001. Staff spoken to were aware of the homes health and safety policies and had received mandatory training in health and safety. Food was stored correctly in the kitchen. Fridge and freezer temperature records were up to date. The kitchen was clean and well organised. The manager and staff trainer oversee the catering process on a regular basis and records of this are maintained. All equipment service histories were found to be up to date. As mentioned previously the health and safety of service users was compromised by ill-fitting bedrails. This was also identified at the last inspection. As discussed at inspection risk assessments should be available to the person checking bedrails on a monthly basis to ensure compliance. An Immediate requirement notice was issued in regard to this. It was noted on one occasion that a service user could not reach their call bell putting them risk of not being able to alert staff to any problems they may have. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 24 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 N/A 3 3 N/A 3 1 Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 25 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 OP7 Regulation 15(1) and 17(1)[a] Schedule 3 (3)[m] 15(2)(a) and (c) 15(1) 17(1)[a] Schedule 3 (q) 17(1)[a] Schedule 3 (n) 13(2) Requirement Evidence of any intervention when nutritional assessments reflect a high risk must be recorded in the individual care records. Care plans must reflect where possible service user or their representatives input. Care plans must be written in ink not pencil, in line with NMC guidleines on Record Keeping. Bed rail risk assessments and rationalle for use must be detailed in the care plans. Types of pressure relieving and manual handling equipment used for the individaul service user must be reflected in the plan of care. In regard to medication administration, recording and storage the following must be actioned: All prescribed creams must have the service users name, be used solely for that service user and be dated when opened. All administered medication must be signed for or a definition of Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 26 Timescale for action 14 july 2005 2. 3. 4. 5. OP7 OP7 OP8 OP8 14 July 2005 14 July 2005 14 July 2005 14 July 2005 6. OP9 16 June 2005 why not. All hand transcribed medications must carry two signatures. All medications including creams must be stored securely within individual service users rooms and a risk assessment must be in place if they are accessible to service users. The registered provider must ensure that all bed rails are checked for safety and any necessary adjustments made. Reference should be made to guidance from the Medicines and Healthcare Products Regulatory Agency, particularly MDA DB2001(04) June 2001. Systems must be put in place to comply with this guidance.(Previous date of 31 December 2004 not met) All service users must have access and be able to reach their call bell at all times. 7. OP9 13(2) 14 July 2005 8. OP19 and OP38 13(4)[c] 16 June 2005 9. 10. OP38 13(4)[c] 16 June 2004 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. 2. 3. Refer to Standard OP9 OP7 OP12 Good Practice Recommendations The home should have a record of signatures of persons responsible for administering medications and be kept at the front of the MAR folder. Action to be taken should a service user become very ill to include funeral arrangements should be reflected within the care plans. Social needs of individual service users should be reflected within care records and within an individual activities folder which reflects a detailed timetable of activities accessed and the outcomes for service users The home should endeavour to meet a target of 50 of all D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 27 4. OP28 Chelston Park Nursing Home care staff to have gained an NVQ in care by end 2005. Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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. Extracts may not be used or reproduced without the express permission of CSCI Chelston Park Nursing Home D53 - D02 3249 Chelston Park Nursing Home V225301 240505 Stage 4.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!