Inspection on 20/02/06 for Chelwood Corner Nursing Home

This inspection was carried out on 20th February 2006.

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.

Other inspections for this house

Chelwood Corner Nursing Home 29/10/08

Chelwood Corner Nursing Home 30/10/07

Chelwood Corner Nursing Home 13/06/07

Chelwood Corner Nursing Home 06/02/07

Chelwood Corner Nursing Home 21/06/06

Chelwood Corner Nursing Home 19/07/05

Chelwood Corner Nursing Home 03/11/04

Chelwood Corner Nursing Home 29/04/04

Chelwood Corner Nursing Home 04/06/03

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

Thorndene

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chelwood Corner Beaconsfield Road Nutley East Sussex TN22 3HJ Lead Inspector Niki Palmer Unannounced Inspection 20th February 2006 10:15 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 Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 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. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chelwood Corner Address Beaconsfield Road Nutley East Sussex TN22 3HJ 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) 01825-740282 01825-740282 Mr Mehrad Foroudy Mrs Jennifer Ann Foroudy Mrs Jennifer Ann Foroudy Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27), Physical disability (27), Terminally ill (2) of places Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated at any one time is twenty seven (27) That the care home provides general nursing care to older people aged sixty five (65) or over on admission and can provide care to people with a physical disability That a maximum of two (2) service users can be accommodated with a terminal illness at any one time 19th July 2005 Date of last inspection Brief Description of the Service: Chelwood Corner is a large converted manor house offering nursing care to residents who are over 65 years of age and who may have a physical disability. The home can also provide care for up to two residents who are terminally ill. The home is located on the outskirts of the village of Nutley, East Sussex. There are no local amenities within easy access for residents, or access to public transport except taxis, although car parking is available at the home. Chelwood Corner is spread out over two floors, which are accessible by a passenger shaft lift. The home comprises of 23 single and two double bedrooms. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Chelwood Corner Nursing Home will be referred to as ‘residents’. This unannounced inspection took place on Monday 20th February 2006 between 10.15am and 5.00pm and was carried out by two Inspectors. To help gather evidence on how the home is performing the Inspectors talked with a number of residents and their relatives, met with staff and had detailed discussions with the Registered and Deputy Manager. A large part of the inspection was focused around environmental concerns. A number of concerns were issued on the day of inspection and were brought to the attention of the local Fire Safety Service and Health and Safety Executive. The local Fire Safety Officer made a subsequent visit to the home, details of which are included within this report. Other records and documentation inspected included: the home’s preadmission assessment procedures, three individual plans of care, the systems in place to safeguard residents from harm and abuse, a sample of recruitment files, the home’s procedures for handling residents’ personal belongings and valuables and a number of health and safety certificates and records. 23 residents were accommodated at the time of the inspection. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection report carried out on 19th July 2006. What the service does well: What has improved since the last inspection? Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 6 Since the last inspection, the home has introduced a new medication system. All medication records were found to be up to date. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Albeit that the home has a pre-admission assessment process in place it has not been consistently applied. EVIDENCE: Three individual pre-admission assessments were seen. Whilst it was pleasing to note that detailed information relating to individuals’ needs had been obtained and recorded, two of the assessments had not been signed and dated by the person completing the form and it was noted that one resident had been admitted outside of the home’s conditions of registration. In addition one of the residents spoken with at the time of the inspection said that they had chosen Chelwood Corner as it is registered to provide nursing care to people with physical disabilities, yet on admission they were informed that the home did not have the specialist equipment required. Consequently the contract has been terminated and another home found. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. Whilst medication records and procedures are improved, the home’s care planning systems fail to identify and meet residents’ healthcare needs. EVIDENCE: The Deputy Manager stated that all care plans are devised by the Registered Nurse on duty at the time of admission. It was therefore concerning to note that the one individual who had been admitted to the home outside of the conditions of registration did not have a care plan in place. In addition, the two care plans seen were found to be difficult to understand, insufficiently detailed and outdated. Albeit that the home has risk assessments in place for nutrition, the prevention of falls and maintaining pressure area care the assessments themselves fail to identify what the level of risk is or provide detailed guidance for staff to follow in order to prevent any potential risks. A requirement has been made in respect of this. The home’s medication systems and records were viewed. Since the last inspection the home has introduced a new medication system. All medicines are now delivered to the home on a weekly basis from the GP surgery. Staff Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 10 reported that this is a far more efficient system particularly for those residents who may have frequently altered prescriptions. It was pleasing to note that all medication administration forms were accurate and signed. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14. Residents are encouraged to remain in close contact with friends and relatives and are supported to make decisions and choices in most areas of their lives. EVIDENCE: All residents spoken with said that their friends and relatives are made to feel welcome by the home when visiting, and that there are no restrictions placed on visiting times. Relatives who were visiting during the inspection confirmed that this is the case. Most times they visit unannounced, yet are always made to feel welcome. Residents confirmed that the home encourages them as much as possible to make their own decisions and choices in relation to many aspects of their lives. For example, when to go to bed and get up in the morning, whether to have their meals in the dining area or in the quietness of their own rooms and whether to participate or not, in daily activities. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. This home has adequate systems in place to ensure that residents are protected from harm, neglect or abuse. EVIDENCE: The home has a detailed adult protection policy/procedure and whistle-blowing policy in place in accordance with local multi-agency guidelines. Two senior members of staff have recently attended Adult Protection training and a ‘train the trainers’ course. It is anticipated that up to date information, policies and procedures will be cascaded to all staff over the next couple of months. No alerts have been raised since the last inspection. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26. Chelwood Corner is in a poor decorative order with many areas in need of refurbishment and modernisation. The homes environment is, in a number of areas, dangerous and is therefore placing residents and staff alike at risk. The homes monitoring systems for ensuring the health and safety of residents, staff and visitors to the home are inconsistent and in need of urgent attention. EVIDENCE: Concerns have been raised during previous inspections that the homes environment is in need of general modernisation and redecoration. In particular, it has been highlighted that the poor environmental standards and practices at the home place residents and others at risk of harm. It is therefore concerning to have found that many of the previous environmental requirements have yet to be addressed and to find that essential health and safety standards continue to be unmet. During a tour of the building a hot water tap in a resident’s bedroom was noted to deliver water at 54oC, above the required level of 43oC. A communal Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 14 shower was found to be fitted with two taps marked hot of which only one worked and this only delivered hot water to 46oC without any option to introduce cold water. A number of corridors were found to have thin metal guards fitted to corners, where seemingly the walls had been damaged by wheelchair use etc, several of these stuck out at an angle and had rough edges. These pose a considerable risk to others. The majority of residents’ bedrooms were viewed and many were found to have electrical extension leads in use, whilst one contained a portable electrical perfume-riser that did not have a label confirming it had been tested and was safe to use. A number of bedrooms and corridors were seen to have a number of electrical plugs sockets that were loose fitting or hanging off. The fire alarm was activated during the inspection as a result of staff cooking in their accommodation on the top floor of the nursing home (staff spoken with commented that this happens on a regular basis). It was concerning to find that several magnetic and sound activated doors did either not release or close properly following the fire alarm being activated. In addition a window in a fire door, which opened to the outside, was found to have a substantial crack running across it. Most concerning of all was a fire door, situated in a resident’s bedroom, that could not be opened by the Inspector. On closer inspection it was found that the door had had masking tape placed around it’s edges thus stopping it from being functional. Following the inspection, a Fire Safety Officer visited the home to assess the environment in respect of fire safety. It was identified that the fire exit mentioned above does not have to be a fire door and could therefore be closed off, however taping it shut with masking tape when it was clearly marked as a fire exit route is unacceptable. In addition concerns were raised in respect of two bedrooms that need to have appropriate fire exits/routes fitted, fire routes that were blocked by combustible materials, a hole in a fire door in the upstairs staff accommodation and inadequate fire and health and safety risk assessments. A number of requirements were made at this time and will be followed up by the Fire Safety Officer. In general the premises were found to be in need of general modernisation and upgrading, with the overall appearance of the building, including many resident’s bedrooms, being one of tired and worn décor, furnishings and fittings. The cleanliness of the home was found to be somewhat inconsistent with several bedrooms found to have clutter under their beds. Whilst hygiene in the home was found to be generally reasonable, several bedrooms were found Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 15 to have unpleasant odours, as did a downstairs storage cupboard outside of a bathroom. Although suitable equipment is provided in individual bedrooms throughout the home for the care of residents with Methicillin Resistant Staphylococcus Aureus (MRSA) it was concerning to note that the Inspectors were not informed about which rooms were affected during a guided tour of the premises. The home must ensure that the risks of cross infection between residents, visitors and staff is minimised and that safe working practices are in place and followed at all times. The Registered Manager stated that the home employs a full time maintenance person and produced evidence of a ‘works book’ that all staff can complete when damage or repairs are noticed. It was explained that the book is subsequently read by the maintenance person who then carries out the work and dates and signs his section when completed. The Registered Manager informed the Inspectors that she and her Deputy have recently introduced a system whereby they both ‘walk-around’ the home on a regular basis to check for health and safety issues, concerns or damages and to risk assess the building, however no written record of this could be found. Similarly no records of water temperature checks were available. The Registered Manager stated that the maintenance person keeps an environmental checklist and risk assessment book for the premises. However these records were not available for inspection. A number of files required for health and safety recording were viewed. These confirmed that regular fire equipment checks are carried out via a registered contractor, whilst fire alarm, emergency lighting and fire door closure checks are regularly carried out by the proprietor or the maintenance person. As previously noted several fire doors did not close following release or when the alarm bells were activated. There was evidence of staff attending fire lectures/training, however no records regarding fire drills or evacuations could be found. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30. A team of adequately recruited and suitably trained staff meet residents’ needs. EVIDENCE: Three staff recruitment files were seen on the day of inspection. It was pleasing to note that all files contained proof of a PoVA First and Criminal Record Bureau police check (CRB), written references, proof of identification and a full history of employment. Staff spoken with and records confirmed that since the last inspection a great deal of in-house training has taken place in the following areas: pneumonia, safe handling, falls and maintaining residents’ privacy and dignity. Staff spoken with said that they found in-house training to be ‘useful’ and ‘worthwhile’. Supervision structures are in place within the home and records confirmed that this is happening on a regular basis. The majority of residents and visitors spoken with spoke very highly of the nursing and care staff at the home. Their comments included ‘staff are very nice’, ‘I’m treated very well’ and ‘very friendly and kind’. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38. Albeit that residents express satisfaction with the quality of their lives at Chelwood Corner, there is little evidence that their interests are safeguarded in respect of the management approach towards health and safety. EVIDENCE: Small amounts of residents’ monies are kept securely in the home, for purchases such as hairdressing, toiletries and outings. Only designated people have access to these. Clear written records for each transaction are kept including receipts. The home is currently in the process of reviewing the monthly charges for toiletries. This will be followed up at subsequent inspections. The Registered Manager has been running the home for the last 18 years. She is a Registered General Nurse with a background in midwifery and neonate Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 18 nursing. She is currently undertaking the required NVQ level 4 in Care and Management. Whilst residents and visitors to the home commented that the home is well run and organised, the findings of this and previous inspections indicate that overlooked health and safety aspects continue to place residents, staff and visitors to the home at risk [see environment]. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 1 X X X 1 1 1 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 X X 1 Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes. 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)(a) Requirement That the homes pre-admission assessment document is signed and dated by the person completing the assessment [OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT] That in line with the home’s Statement of Purpose, residents are not admitted outside of the home’s conditions of registration. That all residents are provided with a detailed plan of care. This should be drawn up with the involvement of the resident and regularly updated. That risk assessments identify any potential risks. Staff need to be aware of the action that they need to take in order to reduce any potential risks. That all metal guards fitted in corridors are suitably affixed to the walls and must not stick out or have rough edges. That all showers have a cold water source, whilst taps must be marked accurately. That all hot water outlets have thermostatic valves fitted to DS0000013973.V281951.R01.S.doc Timescale for action 06/03/06 2. OP3 14(1)(a) (c) 15(1) 06/03/06 3. OP7 06/03/06 4. OP8 13(4)(c) 06/03/06 5. OP19& OP20 OP19 OP25 13(4)(a) & 23(2)(b) 13(4)(c) 13(4)(c) 06/03/06 6. 7. 06/03/06 20/03/06 Chelwood Corner Version 5.1 Page 21 8. OP19 & OP24 13(4)(a) (c) 9. OP26 23(2)(d) & 16(2) 13(3) & 16(2)(j) 10. OP26 11. OP19& OP38 OP19& OP38 OP19& OP38 17(2) 12. 23(4)(e) 13. 23(4) 14. OP19& OP38 23(4)(b) 15. OP31 23(2)(a) (b) ensure hot water temperatures do not exceed 43oC [OUTSTANDING FROM THE THREE PREVIOUS INSPECTION REPORTS]. That all electrical fittings and sockets are installed securely and safely, whilst all portable electrical equipment must be PAT tested. That all areas of the home are kept clean, hygienic and free from unpleasant odours and smells. That good procedures are in place and followed at all times to minimise the risks of cross infection between residents, staff and visitors [IMMEDIATE REQUIREMENT]. That all records relating to the health and safety of the home are accurately maintained and made available for inspection. That regular fire drills including evacuations, take place. Records must be kept and made available for inspection. That all fire doors close securely when door guards are released [IMMEDIATE REQUIREMENT OUTSTANDING FROM THE TWO PREVIOUS INSPECTION REPORTS]. That fire doors are never obstructed or prevented from opening [IMMEDIATE REQUIREMENT OUTSTANDING FROM THE TWO PREVIOUS INSPECTION REPORTS]. That adequate, safe and responsible management and administration systems are followed to ensure the health and safety of residents, staff and visitors. 06/03/06 20/02/06 20/02/06 20/02/06 20/02/06 20/02/06 20/02/06 20/03/06 Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 22 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 OP7 Good Practice Recommendations That the current care planning format be reviewed in order to make it easy to read and understand. Chelwood Corner DS0000013973.V281951.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. 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