Inspection on 03/07/08 for Chelston Park Nursing Home

This inspection was carried out on 3rd July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chelston Park Nursing Home 12/09/07

Chelston Park Nursing Home 10/08/06

Chelston Park Nursing Home 17/01/06

Chelston Park Nursing Home 16/06/05

Chelston Park Nursing Home 23/11/04

Chelston Park Nursing Home 24/06/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Chelston Park Nursing Home West Buckland Road Wellington Somerset TA21 9PH Lead Inspector Shelagh Laver Unannounced Inspection 3rd July 2008 08:00 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.V362521.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.V362521.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 Mr Derek Lott Mrs Joanne Girdler Care Home 86 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (36) of places Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) 2. Dementia (Code DE) maximum of 50 persons The maximum number of service users who can be accommodated is 86. 12th September 2007 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. The home offers general nursing care for older people. In November 2007 a major variation to the home was made. A 50 bed separate building known as Chelston Gardens has been built to provide care for people with dementia. The home has been designed and finished to a high standard. There are now two registered managers, Jo Girdler as manager of Chelston Park and Derek Lott as manager of Chelston Gardens. The new build is spacious and comfortable and sits in large landscaped grounds. There are excellent views of the Blackdown Hills and Wellington Monument from some rooms. Fees are currently; Chelston Park - £522 to £850 Chelston Gardens - £552 - £795 Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use this service experience poor quality outcomes. 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. This inspection was the first opportunity to inspect the 50 bed new building that has been developed in the grounds of Chelston Park known as Chelston Gardens. This was completed and registered in November 2007. Chelston Gardens has been designed to provide nursing care for people with dementia. An Annual Quality Assurance Assessment had been received prior to the inspection. This presents information about the service and highlights achievements and plans for the coming year. Both Chelston Gardens and Chelston Park have beds “block booked” by Somerset Community Directorate. The AQAA states that there has been a contract review from social services and no issues have been raised. The inspectors made a tour of the building speaking to people who live in the home when possible and to staff and visitors. Care and staff records were reviewed. Direct observation of care practice was made throughout the day. It is unfortunate that the concerns about some aspects of care at Chelston Gardens has resulted in an overall poor rating for both services. The provision is registered as one service however in many respects Chelston Park and Chelston Gardens operate independently. There are two managers and two staff groups. The homes share the kitchen and laundry services. The manager at Chelston Gardens is Mr Derek Lott who was appointed in 2007. Mr Lott has an extensive knowledge base that includes experience and qualifications in clinical nursing, palliative and end of life care, social care, and person centred dementia care. He has been registered as a RMN (Registered Mental Nurse) since 1974 and has continued to develop and up-date his skills throughout his career. Derek Lott and Jo Girdler (the registered manager previously registered at Chelston Park) are responsible and liable under the Care Standards Act 2000 for both parts of the service. This Key inspection took place over one day and involved 3 inspectors including the Commission’s Regional Lead Pharmacist. It concentrated on Chelston Gardens although Chelston Park was visited and some care plans reviewed. Following the inspection the proprietor and managers met with the Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 6 inspectors and presented further evidence of care in the home that has been included in the report. Chelston Park was rated as good at the last inspection and there is continuing improvement in the environment under the direction of an established manager. The registration application for Chelston Gardens stated that there were to be four self contained units to give people a sense of security and to enable them to get to know their environment. On the day of the inspection three units were occupied. The second unit on the top floor is not currently occupied. On the ground floor it was clear that the two units were running as one floor. This has then created one large area. The manager stated that many people admitted had high levels of physical dependency as well as a diagnosis of dementia. During the inspection there were some concerns about the provision of specialist care for people with dementia. Immediate requirements were made relating to medication administration. A letter of serious concern was sent relating to the nutrition and hydration of people in Chelston Gardens. A response has been received in relation to both areas of concern. The proprietor and managers of the home have submitted detailed action plans and work was rapidly underway to address concerns about the aspects of care at Chelston Gardens. What the service does well: Letters from relatives and friends of people who lived at Chelston Gardens were positive. Some were received after a person had died and families were grateful for care given to their loved ones. “I need to write and give my grateful thanks at providing such a wonderful care home at Chelston Gardens. My mother was fortunate to be cared for by very caring and kind staff. Yes, the staff looked after her physically but they also gave her dignity, respect and love.” “The memory of the day will remain with us forever. He looked so peaceful and comfortable. “ “I wish to thank all those concerned with the care and well-being of the residents in their charge at Chelston gardens.” The home marks peoples birthdays including cakes and gifts. Families are shown hospitality and welcomed into the home. “Thank you for your kindness to Mum on her 99th Birthday last week. Please thank the chef for the lovely cake.” There has been considerable investment in Chelston Gardens. The building is equipped to the highest standard and consideration has been given to providing an environment that reflects current design advice for people with dementia. There is appropriate signage throughout Chelston Gardens to assist people to find their own and communal rooms. There has been continued environmental improvement at Chelston Park, which is still ongoing. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 7 The service has awarded a Dignity in Care award by Somerset County Council in 2008. Records of activities and photographs of trips presented after the inspection showed that people are offered a range of events. The kitchen was recently inspected by the food agency and was awarded 4 stars. The home has maintained Investors in People status. At Chelston Park there was evidence in care plans reviewed that the person’s condition had improved substantially since she had come to live in the home. Relatives spoken with at Chelston Gardens said they were pleased with the care of their relative. Most people spoken with at Chelston Park said they were well cared for and the food was good. There are sound recruitment policies and procedures that protect people living at the home. The management of both homes are pro-active and focussed on providing a good service for people. They have addressed the immediate concerns expressed at the inspection and are fully committed to working through the improvement plan. What has improved since the last inspection? What they could do better: At Chelston Gardens there were key areas that need attention. There must be systems in place that demonstrate that people are receiving skilled and appropriate assistance with nutrition and hydration. There must be a system of medication that is safe and addresses the requirements made in the report. The staffing levels in the home should be reviewed in view of the dependency of people in Chelston Gardens. There must be a system of staff supervision that enhances the development of people who work at the home and promotes best care practice. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 8 There must be a programme of staff training that is planned to develop further the skills and knowledge that nursing and care staff need to meet the needs of people in a specialist dementia unit. There should be consideration of the staffing and call bell arrangements at Chelston Park to ensure that people in the lounge always have access to drinks and can summon assistance readily. There were comments from people at Chelston Park that staff are “very busy” and don’t have time to chat. 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. The summary of this inspection report can be made available in other formats on request. Chelston Park Nursing Home DS0000003249.V362521.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.V362521.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 Quality in this outcome area is adequate. Whilst information about the home is available for people to make a decision about the home, the process of assessment prior to people moving into the home is not robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service user guide has been up-dated and resubmitted at the time of registering the major variation. It includes items set out in Schedule 1 of the Care Home Regulations 2001, and gives an informed choice for prospective service users. The Service User Guide for Chelston Gardens includes specific information about staff training and competence in dementia care. In both Chelston Park and Chelston Gardens people are assessed by a senior member of staff, usually the manager, before they come to the home. There had been many successful assessments resulting in appropriate placements. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 11 There was concern that in one case the procedure had not clearly identified that the home was unable to meet the persons needs despite indications. A younger person had been admitted for a rehabilitation placement. The assessment indicated that the person was “complex” and “easily bored” and prone to aggression. This placement was unsuccessful. Chelston Park Nursing Home DS0000003249.V362521.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 poor. Not all the plans of care set out how peoples personal, health and social care needs are to be met, or how they are to be supported with these. This means that it is sometimes unclear how their nutrition and hydration is to be maintained, their psychological needs met or their medicines safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care planning system consists of two folders that are used in conjunction with each other. One is the actual plan of care. The other contains assessments and associated documents. Care plans are in place at both Chelston Park and Chelston Gardens. At Chelston Gardens care plans are completed gradually after admission. At Chelston Gardens the standard of care plans varied. Some care plans were clear and comprehensive. One sampled greatly lacked detail in the management of behaviours. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 13 The inspectors were concerned about the amount of nutrition people were receiving and the interventions that were planned to ensure adequate food and drink was taken. The records of four people showed the following: One person had weighed 50.8kg on 9/12/07 and now weighed 45.3kg. The “dependency score” had remained the same although reviews indicated that this person had “deteriorated substantially.” The only reference to eating and drinking was “soft diet mainly by spoon.” A visiting professional had undertaken an assessment and provided details of food to be eaten. The person concerned was observed to be eating foods that presented a high choke risk. Another person seen by a health professional was advised to have a soft diet “due to weight loss”. There is a notice pinned to the office wall that is not dated giving some information about this person. The care plan says “able to choose diet”. On 27/11/07 the person weighed 77.3kg and on 19/05/08 60.00kg A person seen in bed all day had half a glass of orange juice recorded on his chart by 1pm. An interesting and appetising lunch was given to him but was still untouched at 2pm. Whilst it was explained that this person takes a long time to eat, it was noted that there was little monitoring from the staff observed by the inspectors. Whilst it is acknowledged that weight loss is experienced by people with dementia for a variety of reasons there must be a robust individualised approach to providing nutrition and regular accurate monitoring. A newly arrived person was seen wandering for long periods. Her care plan was in the process of being completed. The nurse said that she needed lots of “one to one “ to help her settle but it was not clear who would provide this care or when. There was no real evidence in some of the care plans of a focus on the individual person not the dementia. For example the movement from home to an unfamiliar care environment for a person with dementia causes anguish and further confusion. There were comments that a person was “wandering” and in other peoples rooms but there was no clear plan of approach. In one file preadmission information stated that the person “liked to sleep in a chair”. This had not been transferred to the care plan. Another plan contained information about a persons aggression triggers with guidance as to how they could be managed. However in another plan the guidance for staff said simply “Needs a consistent approach. Time to be spent to build rapport and trust”. This was not signed and it was unclear who was going to be building the trust and rapport or how they were going to do it. Some personal care was clearly documented and the involvement of a relative was included. There were visits from other health professionals recorded. This person was also losing weight. One room smelled strongly of urine and contained a daily analysis chart that was not dated. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 14 Some entries into files were not signed or dated and in some the writing was illegible. At Chelston Park one person seen in her room in the afternoon had no record of fluids taken since early morning. The manager informed us that she had been downstairs in the lounge and would have had drinks there. There was evidence in the care plan for this person that her condition had improved since she came to live in the home. One person was admitted to the home with a pressure sore. Records of dressings to a pressure sore were infrequent although they did show that the area was healing. When looking at the way medicines were handled we found that a Monitored Dosage system was in use, and that the pharmacy were supplying the home with printed Medication Administration Record (MAR) charts. The medicines were taken around the home in a trolley that was locked when unattended and most medicines were seen to be stored securely and in accordance with regulations. We found that although a dedicated medicines fridge had been provided that it was not kept locked so meaning that all staff were able to access it. On looking at the MAR charts we found that there were discrepancies in the record of administration of eye drops for 3 people, where the record indicated that the drops were not being administered in accordance with the directions of the prescriber. There was also no record made in the people’s plans of care to indicate why this was happening. An immediate requirement was left to make arrangements for eye drops to be administered in accordance with the directions of the prescriber. Also on the MAR charts some records had been made using a code. However there were occasions where the code used was not defined on the chart so meaning that it was not possible to determine the reason this medicine had not been administered as no other record had been made in the daily notes. We also found that people were prescribed sedatives and analgesics to be given “when required”. For these people we could find no information with the plans of care to indicate how the decision to administer was taken, what steps were to be taken before the administration occurred, how the person was monitored after administration or what dose should be given when a variable dose was prescribed. An immediate requirement was left for the manager to develop an action plan to address these shortfalls. We also found that whilst the home have in place the correct system for the disposal of any waste medicines the policy in use indicated that they should be disposed of by an unsafe method. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 15 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 poor. The lifestyle offered does not always reflect people’s opportunity, to exercise choice, in relation to a range of social and cultural interests, including food, mealtimes and activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a care home for people with dementia the provision of a variety of activities and social opportunities requires skill and understanding. People have varying skills and preferences. It was therefore unfortunate that as the activities coordinator was on holiday during the week of the inspection the activities available and the work done by staff was not seen at its best. A piece of handwritten paper with a list that included pass the parcel and play dough was seen. Further evidence presented by the home showed that activities for other weeks were much more interesting and appropriate. People had been offered trips out and a range of art and craft activities. There was evidence that entertainers had visited the home to play music and encourage people to join in music therapy sessions. Daily records presented after the inspection showed that people had been participating in a range of activities. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 16 There were records of how people had been participating including times when people were “not really interested” and “doing her own thing.” Church services are held in both Chelston Park and Gardens. Trips had included visits to the seaside and an animal sanctuary. There had been cream teas in the garden and a Carribean barbeque. There were notices and letters showing how relatives and friends are encouraged to join in with the life of the home. Breakfast was still being eaten late into the morning. Whilst this may well be appropriate it was clear that the food no longer appeared fresh. One person was seen being fed a solid poached egg mixed with bread and butter at 10:15am. The inspectors observed lunch being served on the ground floor. Some people sat at tables whilst others sat in armchairs or had their meals in their rooms. In one dining room two people were seen to eat very little. A carer explained that it was difficult to keep people awake. Two people were so sleepy they could not be roused to eat. Staff said that there was toast available and cheese and crackers if people did not eat their lunch. There are no records in peoples’ rooms or care plans showing what or how much food has been eaten. Records in one servery were seen but these had not been fully completed. One person identified as being at risk of malnutrition had no records made about him for three days. It was not clear how these records were incorporated into the care planning and review process. Some staff sat down and took considerable time and effort to assist people to eat. Others stood up and some were trying to complete several tasks at once. One person appeared to be in the same position in her chair throughout the day. Another person was seen to be asleep on his bed all day. There were no records that his position had been changed. In some rooms the adjustable beds were left so high that should anyone have gone back to their room they would have been unable to lie down. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 17 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 17 18 Quality in this outcome area is adequate. Staff spoken to had a good understanding of internal policies and procedures in place to protect people within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are policies and procedures in place and staff have received initial training in Safeguarding Adults. New staff seen were clear as to what action they should take within the home if they had any concerns. However managers must ensure that all staff are aware of the role of external statutory agencies in Safeguarding Procedures and contact details should be known to key staff. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 18 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 21 22 23 24 25 26 Quality in this outcome area is good. People live in a safe well-maintained environment that has been designed and adapted to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chelston Gardens is a new building adjacent to Chelston Park. It has 50 bedrooms, 25 bedrooms on each floor. This was the first opportunity to review the occupied building. There are two floors. All bedrooms measured above 16 sq m. Each bedroom includes a profiling hi lo bed, secure wardrobe, large chest of drawers, flat screen wall mounted TV with ‘freeview’, telephone, internet access, under floor heating with individual thermostat, two armchairs, bedside cabinet with lockable space, lockable main door for extra privacy, over bed table, and an en-suite shower room, with toilet and wash hand basin. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 19 An emergency call system was in place in each room and call pendants were also available. Each room was fitted with Passive Infra Red (PIR) alarms to allow staff to be alerted to anyone getting out of bed, and allowing for the lights in the room to come on was activated to help minimise falls. Fire detectors were in place. The rooms were decorated and furnished to a very high standard, and all the rooms had views over the Blackdown Hills and surrounding countryside. All windows were restricted in line with HSE guidelines and fitted with toughened safety glass. All hot water outlets were fitted with thermostatic controls, to prevent scalding. Anti-ligature curtain rails and shower curtain rails were in place to minimise any risk of suicide attempts. All rooms were accessible for persons who may use a wheelchair. En-suite doors were coloured to allow persons with dementia to orientate themselves to where the toilet was. The lights came on automatically when the door was opened. All bedroom doors are fitted with automatic fire door closures. Memory boards will be fitted to each door to allow for personalisation and orientation. Flooring throughout the home is the same and is a wood effect, MRSA resistant type. On arrival at the new build there is a pleasant reception area. There are several communal areas where service users can access and enjoy differing views of the garden and surrounding countryside. On the ground floor there are two dining rooms and serveries where service users and staff can access drinks and snacks at any time. There are large lounges including one that accesses the attractive, well-maintained pleasant garden, which surrounds the new build. On the first floor there are several other lounges, communal areas and two dining areas. One lounge has a balcony, which can be accessed as safety netting has been installed. There is an activity room and a further sitting room with excellent views. There is a modern well-equipped hairdressing room. All communal areas have a T. Loop system and there is a portable T. Loop system available for use. There are also several seating areas at the end of corridors with views over the surrounding countryside where ‘Wireless’ systems are in place should people who are visiting, or service users need to use lap tops. Collectively the communal space adds up to: 318.07 sq m, which equates to 6.3 sq m per person in the new build. This exceeds NMS of 4.1 sq m. There are shower facilities in the en-suites in each bedroom. There are two assisted bathrooms with a hi-lo Argo Rhapsody bath in each, and a hi-lo wash hand basin and a toilet facility. There are adequate communal accessible toilet facilities near each dining area. All communal toilet facilities and en-suites have adaptations to promote mobility. All corridors are wide with handrails fitted. Colours are used as orientation queues and signage is available. Advice Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 20 has been sought for the environment from Stirling University and the Alzheimer’s Society. There is a 13-person passenger lift for service users to use to access the ground and first floors. There are also stairs, which can be accessed through doors, which are key-padded, which will disable in the event of a fire. All areas are light and airy, decorated and furnished to a very high standard with very pleasant views. The new kitchen is large and very well equipped. This is the main kitchen for the whole service to include Chelston Park. There are areas for catering staff to change and a separate toilet is available. The new laundry, also shared, is large and well equipped. There is a sluice with disinfector on each floor. All en-suites, communal toilets, bathrooms, serveries, kitchen and laundry have hand-washing facilities in place for staff. The new build meets Infection Control guidelines. All curtains, floors and kitchen walls are of a MRSA resistant type. There are domestic cupboards on each floor. There are several storage cupboards on each floor, to enable corridors to be free of equipment. The service has under floor heating throughout. Gas and electricity are supplied to the service. All windows have restrictors fitted in line with HSE guidelines. All hot water outlets are thermostatically controlled. There is a clinical room on each floor where the medications and dressings etc will be stored. Two medicine trolleys are available. New guidelines have been followed in regard to Controlled Drug storage. Mobile hoists are available and two stand aid hoists are available. There are further hoists for the assisted baths with attached weighing scales. Assessed needs will determine the use of the hoists. A range of medical equipment is in place including suction machines and equipment to monitor peoples’ physical condition. In Chelston Park the up-grading of the home continues. Some bedrooms seen had stained carpets and rooms were in some disarray due to the windows being replaced. Other rooms had had the carpets replaced by laminate wooden flooring and new en-suites installed. The dining room and main lounge functions have been exchanged. The main communal lounge is now in the conservatory area. The old lounge has had a new servery provided and makes an attractive dining room. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 21 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 adequate. People are supported and protected by the recruitment policy and procedures, Staffing levels and training programmes need to be continually reviewed to as the needs of the people using the home increase or change. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At registration proposed staffing levels appeared satisfactory. When the unit is full there will be one or two RMN’s on duty 24 hours per day or one RMN and one RGN. The designated manager (Mr Derek Lott) will be supernumerary for at least 50 of his working week. The other joint registered manager Jo Girdler is supernumerary. Each floor will have a designated trained nurse and 5 carers on duty during the day and have a trained nurse and 2 carers overnight. On the first floor there was one unit open. Staff spoke of the concerns that they had that with two more care assistants they would be caring for twice the number of people. RMN’s felt that there should be more emphasis on recruiting nurses with specialist knowledge and experience. In preparation for the opening of Chelston Gardens there was a three-day team-building programme and staff received induction training on site over a period of two weeks including mandatory training. An experienced member of staff confirmed that on arrival at Chelston Gardens there had been a good induction program. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 22 The company trainer confirmed that staff continue to have two days induction with her. Topics covered included Safeguarding adults, Manual Handling, Health and Safety, Infection Control and Fire training. There is a supervision meeting that takes place three months after employment commences. Four recruitment files were examined. Staff have been recruited in line with Regulation 19 for the protection of vulnerable adults. All staff had recruitment checks completed correctly. Staff had not commenced employment before the receipt of an enhanced CRB check. All had signed rehabilitation of offenders declarations. There were full employment histories completed. The recording of training and supervision in the files was variable. In file 1 a staff-training matrix present but this was blank. In file 2 supervision record and training records were present until 05/11/2007 when it would appear the member of staff moved from Chelston Park to Gardens. In file 3 there was a record of a 2-day induction recorded for 04 and 05/02/08. Manual Handling and Abuse training had been recorded. There were no further supervision or training records present. There is a date for a for a 13 week review but none is recorded. File 4 indicates that Basic induction; Manual Handling, Fire, Abuse and Nurse Call were all completed on 17 and 18/03. The 13-week review has not been completed. There were no records of systematic Dementia Care training and evaluation of peoples’ performance following induction available at inspection. There are some experienced RMN’s in the home and they need opportunities for clinical supervision and planned professional up dating planned. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 23 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 36 38 Quality in this outcome area is adequate. Systems to manage and monitor staff are currently being developed. H&S monitoring systems are in place and policy and procedure documentation is in line with current legislation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Derek Lott has been appointed to manage Chelston Gardens. He is experienced and very well qualified. At the time of the inspection the systems to manage and supervise staff were still being developed. Mr Lott stated that “at present they are not done individually and the only record is of issues raised in staff meetings”. Precautions have been taken to protect the health and safety of people who live in the home and staff. The home was built in line with HSE guidelines, EVH and Fire Safety Regulations. All Fire safety risk assessments are in place. The Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 24 service meets the Building Control Regulations. A final certificate was received 8th November 2007 by fax. Fire safety equipment is in place throughout the home. Fire extinguishers are sited throughout the corridors. Fire alarms were being tested throughout the day at the time of this visit. Each bedroom has a smoke alarm and sounder fitted. All doors are fitted with automatic door closures and shut when the alarms sound. All fire escapes are key padded and are released when the fire alarm sounds. Signage to escape routes was fitted and clear. Emergency lighting is fitted throughout the home in a domestic style type light, in the communal areas, to fit in with the other lighting. A nurse call system is fitted and available in all private and communal areas, and call pendants are also available. All gas appliances have been tested and certificates given to the RRI. All electrical hard wiring and appliances have been tested and certificates given to the RRI. Employers and buildings insurance is in place. Policies and Procedures are in place in line with current legislation, for the safety and well being of service users and staff. There has recently been a joint quality monitoring survey undertaken. Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 25 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 1 X 3 Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1) Requirement Arrangements must be made to ensure that people are only admitted to the home after an assessment has been made and the home has confirmed that they are able to meet the assessed needs. Arrangements must be made to ensure that service user plans are kept under review, are robust and reflect the assessed needs of the individual. There must be clear action taken in response to peoples’ weight loss. There must be a record of nutrition and hydration maintained. A letter of serious concern was sent on 4th July 2008 Arrangements must be in place to ensure that guidelines are available to staff to determine how and when “when required” medicines are to be given and the expected outcomes from the intervention. A serious concerns letter was sent on 4th July 2008. Arrangements must be made to DS0000003249.V362521.R01.S.doc Timescale for action 03/09/08 2 OP7 15 03/09/08 3 OP8 14(1) (2) 17(1)(a) Schedule 3 25/07/08 4 OP9 13(2) 03/08/08 5 OP9 13(2) 05/07/08 Page 27 Chelston Park Nursing Home Version 5.2 6 OP12 16 (2) 7 OP15 16(2) 8 OP27 18(1) 9 OP30 12(1) ensure that eye drops are administered in accordance with the directions of the prescriber. A serious concerns letter was sent regarding this requirement on 4th July 2008. There must be opportunities for stimulation through leisure and recreational activities in and outside the home that suit peoples needs, preferences and abilities. The registered manager must review the provision of food to ensure therapeutic diets are available when needed and that all staff are aware of peoples individual nutritional needs. This includes ensuring that snacks are offered and recorded when appropriate. The manager must review the staffing levels in the home in line with the dependency levels of people. The staff-training programme must be developed to promote the specialist skills required to meet the needs of people in the home. 03/08/08 03/08/08 11/08/08 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chelston Park Nursing Home DS0000003249.V362521.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 © 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 DS0000003249.V362521.R01.S.doc Version 5.2 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. 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