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Inspection on 30/10/07 for Chelwood Corner Nursing Home

Also see our care home review for Chelwood Corner Nursing Home for more information

This inspection was carried out on 30th October 2007.

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

The home provides prospective residents and their families, with a good level of information about what services are provided at the home. Trial visits are available and one resident confirmed he had spent an afternoon at the home to meet the staff and residents before moving in. All residents, relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services one resident saying `I am very well cared for the staff are nice it`s a lovely home and has good food`, ` I think the staff have worked very hard to improve the environment and facilities`. The interaction between residents and staff was positive. The meals provided were seen to be nutritionally balanced and enjoyed by the residents. Medication practices were safe and protect the residents.

What has improved since the last inspection?

What the care home could do better:

Whilst there have been improvements to the overall care planning and accompanying risk assessments, there are some areas to be further developed to ensure the health needs of residents are met in full and residents safety is promoted. Procedures for infection control need to be reiterated to staff as poor practice was observed. The homes recruitment processes need to be reviewed before prospective staff are employed.

CARE HOMES FOR OLDER PEOPLE Chelwood Corner Nursing Home Beaconsfield Road Nutley East Sussex TN22 3HJ Lead Inspector Debbie Calveley Key Unannounced Inspection 30th October 2007 09:00 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 Chelwood Corner Nursing Home DS0000013973.V353171.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. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chelwood Corner Nursing Home 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 ccnh@hotmail.co.uk 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) of places Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 From time to time the home may admit service users whose assessed needs can be met and who are under the age of sixty-five (65) at the time of admission. 13th June 2007 3. Date of last inspection Brief Description of the Service: Chelwood Corner is a privately owned large converted manor house and is registered to provide nursing care for twenty-seven service users, who meet the registration category of elderly and service users with a physically disability. The home is located on the outskirts of the village of Nutley, East Sussex. There are no local amenities within easy access, or access to public transport except taxis, however there is ample car parking available at the home. Chelwood Corner is set within its own grounds and is spread out over two floors, which are accessible by a passenger shaft lift. The home comprises of 22 single and two double bedrooms. Eleven bedrooms have en-suite facilities of which three remain to be upgraded to comply with current standards. There are ample communal areas and this includes a newly built conservatory overlooking the grounds to the rear of the property. There is an on-going refurbishment programme, which continues to improve the facilities for the service users living in the home. Fees charged as from 1 April 2007 range from £500 to £650, which does not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers, nail painting and outside activities such as visits to the theatre. Intermediate care is not provided. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission. A copy of the home’s most recent inspection report is available on request. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 5 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 6 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 often use 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 was a key inspection that included an unannounced visit to the home and includes follow up contact with resident’s representatives and visiting health and social care professionals. The purpose of the inspection was to check that the requirements of previous inspections and Statutory Enforcement Notices had been met and inspect all other key standards. This unannounced key inspection was undertaken by two Inspectors and took place over 7 hours on the 30 October 2007. There were twenty-five residents living in the home on the day, of which five were case tracked and spoken with. During the tour of the premises eight other residents both male and female were also spoken with. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Five members of care staff, activity person and the cook were spoken with in addition to discussion with one of the Registered Providers and the senior nurse in charge. Telephone contact was made with visiting professionals following the visit and three relatives were spoken with during the inspection visit. The information received verbally has been incorporated into this report. An Annual Quality Assurance Assessment (AQAA) was received from the Manager completed in full prior to the key inspection in June 2007. The Inspectors would like to thank the residents and staff at Chelwood Corner Nursing Home for their time and hospitality. What the service does well: The home provides prospective residents and their families, with a good level of information about what services are provided at the home. Trial visits are available and one resident confirmed he had spent an afternoon at the home to meet the staff and residents before moving in. All residents, relatives, visitors and visiting professionals contacted as part of the inspection process confirmed a satisfaction with the home and its services Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 7 one resident saying ‘I am very well cared for the staff are nice it’s a lovely home and has good food’, ‘ I think the staff have worked very hard to improve the environment and facilities’. The interaction between residents and staff was positive. The meals provided were seen to be nutritionally balanced and enjoyed by the residents. Medication practices were safe and protect the residents. What has improved since the last inspection? What they could do better: Whilst there have been improvements to the overall care planning and accompanying risk assessments, there are some areas to be further developed to ensure the health needs of residents are met in full and residents safety is promoted. Procedures for infection control need to be reiterated to staff as poor practice was observed. The homes recruitment processes need to be reviewed before prospective staff are employed. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 8 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. Chelwood Corner Nursing Home DS0000013973.V353171.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 Chelwood Corner Nursing Home DS0000013973.V353171.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): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. EVIDENCE: There is a range of well-documented information about the home and the services it provides. The home has a combined Statement of Purpose and Service Users Guide and a copy of this is available along with the last inspection report and a copy of the homes terms and conditions of residency are available on request. It would benefit residents if they all had a copy of their own to refer to. Relatives and relatives spoken to were clear on the service provided by the home and costs involved. One resident confirmed that Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 11 whilst he had not visited the home prior to his admission, his family had, and they had been provided with details of the home. The registration certificate is clearly displayed and was found to be accurate. The most recent admissions to the home were identified and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide a clear assessment of prospective residents care needs. These are completed by one of the senior nurses or the manager and discussion with the senior nurse in charge confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. The register of admissions was found completed in full. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. Social care professionals spoken to confirm that pre admission assessments are always completed and that these were completed promptly and efficiently. A very recent admission to the home confirmed that he had visited the home prior to admission to meet the staff and other residents, which gave him the opportunity to be involved in his move to the home. It was however noted that the home does not confirm with the prospective resident the outcome of the assessment and that the home can meet the assessed needs of the prospective resident. This was discussed with the senior nurse who was advised that this should be completed in writing in accordance with the required documentation. Intermediate or rehabilitative care is not provided at Chelwood Corner. Chelwood Corner Nursing Home DS0000013973.V353171.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 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care, it needs to be further developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. The home’s practices ensure resident’s medicines are stored and administered safely and residents are treated with respect and have their privacy and dignity maintained. EVIDENCE: The care documentation pertaining to five residents was reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments, personal histories and risk assessments. On the whole the care documentation demonstrated that the care was reviewed and evaluated. However it was noted that not all the plans of care highlighted all the needs of residents. For example one resident who has communication problems did not have any guidance in the documentation to facilitate this vital need, one Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 13 identified unstable blood sugars over a period of time and there was no follow up with G.P or a review of her diet. Communication care plans need to be further developed to include guidance for staff to follow. It was discussed that to ensure residents’ confidentiality, the files in their entirety include some personal and sensitive information and should be separated, leaving the care plans with the guidance for staff to follow. Risk assessments for health needs and residents’ safety are included in the care planning format used by the home and all risk assessments were found to be completed, but not all followed through with an appropriate plan of action when identified as required. E.G The weights of the residents are not consistently recorded at present and evidenced quite a number of variable weights for individual residents. These need to be assessed alongside their nutritional diaries to ensure there is not a dietary problem. The air mattresses in two residents’ rooms were not functioning properly and had alarm lights illuminated. Restraint risk assessments were in place for zimmer frames and this could impact on restricting residents from being independent. Not all residents had access to a call bell facility whilst in the lounge area and this needs to be risk assessed. These were discussed in full with senior staff and it was discussed that further training in risk assessments would be beneficial for staff. It is acknowledged that a lot of hard work has been undertaken by the staff to improve the records and documentation. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation that is kept in the residents’ bedrooms. They felt that their views were taken into account when planning resident’s care. The home operates a key worker system. Relatives spoken with were satisfied with the care provided at the home, one saying that the home ‘should be congratulated for its care’, ‘my relative receives good nursing care and care workers are kind, considerate and supportive of her every need’ and ‘Staff are efficient, courteous and very kind’. Residents spoken to were also satisfied, comments included ‘they look after me very well’, ‘I have my own room and the staff are kind ’ and ‘ it’s my home’. A relative stated ‘ I have found the standard of care and consideration to be excellent, the staff are all involved with their patient care, well motivated and cheerful’. Records indicated that local Doctors are called regularly and are involved in the care of residents. The senior nurse confirmed that specialist external advice is sought as necessary and included the Dietician and regular visits from a privately employed Tissue Viability Nurse. A senior Registered General Nurse is the link with the Tissue Viability Nurse and takes the clinical lead for wound care in the home. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 14 Staff were observed when administering medicines and they were seen to be working safely. The records seen were found to be accurate and the storage areas were found to be appropriate and well managed. Staff were seen to be kind and pleasant to residents and a good rapport was noted between them, one staff member said’ she thought of many of the residents as friends’ and one resident said ‘Staff are good to me and I am very happy here’. The residents spoken with confirmed that they felt that their privacy and dignity was respected. Chelwood Corner Nursing Home DS0000013973.V353171.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 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ lifestyle within the home is their own choice and most residents are provided with sufficient stimulation to fulfil their interests and needs. Residents are offered a choice in meals to ensure preferences and nutritional value is catered for. EVIDENCE: Residents spoken with confirmed that their lifestyle within the home is their choice and they are able to choose their own routines of daily living such as when they get up or go to bed, where they wish to eat etc. The activities person commenced employment in January 2007. She confirmed that some days are structured in relation to activities and the other days are structured depending on residents’ choice and preference. The activities person confirmed that outside entertainment visit the home. This includes: a keyboard player, music for health every second week and pantomimes. Other activities provided at the home include: bingo every second week, films on a Friday, arts and crafts, reminiscence, games and one to one sessions. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 16 The activities person confirmed that she does not visit those residents who may remain in bed and leave staff to care for these residents. She said that she thought it may be disruptive/unsettling for these residents to meet ‘another stranger’. The Inspector queried if she was a permanent member of staff and has been at the home for so long, why haven’t introductions been made. The activities person confirmed that she hadn’t thought about getting to know them. It was suggested that this be discussed with the senior staff/Registered Manager if this would benefit the individual residents. It was confirmed there is a care plan in place for residents regarding activities and a list of social contacts are kept. The activities person informed the Inspector that they are currently arranging a Link Relative system where it has been discussed with relatives/representative that visit the home regularly, if they have time would they like to visit another resident at the home that may not receive visitors. It was confirmed that there has been a positive response to this. Some residents visit the local community with friends/family. The activities person confirmed that residents have not been provided with an outing since her commencement of employment. She confirmed that they would need to hire a mini bus and some residents don’t want to go out. It was confirmed that money restrictions can hinder the provision of activities. Visitors are welcomed and encouraged to visit the home. All relative/visitors spoken with confirmed that there were no time restrictions for visitors and were always made to feel welcome. Of the residents that were asked, all confirmed that they could receive visitors in private. Twelve residents were eating lunch in the dining room. Staff confirmed that two residents were eating in the conservatory, one resident had gone out with family/friends and the other residents were in their rooms. Residents are able to choose where they eat. The Inspectors joined residents for lunch. One had fish pie and the other had lamb casserole. The food was very tasty and residents were observed to be enjoying their meal. Two residents who an Inspector ate with were complimentary about the food at the home and confirmed they are provided with choice. Discussions were had with the cook. He confirmed that he orders the food and there are no restrictions with this. His food and hygiene is up to date. There is a four-week rolling menu. He devises the menus and consults residents about their preferences during this process. He has been provided with a list of residents’ likes/dislikes/allergies or any specialist diets. E.g. diabetes. He confirmed that the menu is also in picture format to assist residents to make a choice. He confirmed that all meals are cooked from fresh. It was confirmed that the Environmental Health Department inspected the home in March/April this year. This report was not viewed but the cook confirmed that any shortfalls noted have been addressed. There is another cook working at Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 17 the home when the full time cook has his days off. It was noted that the home has information and using the safer food better business documentation. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 18 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 and 18. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a formal complaints system with evidence that residents feel that their views are listened to and acted upon. Staff receive training to protect residents from abuse. EVIDENCE: The home has a written complaints procedure and this is displayed in the home and provided within the service users guide. The procedure followed on receipt of a complaint clearly records the process and provides an audit trail of how the home has responded to the complaint. All records are clear and kept in a way that promotes peoples confidentiality. A complaint has been dealt with by the home and has been resolved; the records seen included an outcome and action. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised. One relative said ‘I have always found that if I had a problem or a concern it is dealt with immediately’. Residents’ spoken with confirmed that if they had any concerns or complaints they would not hesitate in talking to either manager or a member of the staff. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 19 Although the home has the local guidelines on safeguarding vulnerable adults there is a need to ensure staff are aware of the homes’ policy and procedure and this needs to be easily assessable and supported with appropriate training on this subject for all staff working in the home. Two staff members were unsure of the homes procedure. Records demonstrate that staff have training in safeguarding adults and the home has a whistle blowing procedure. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 20 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 & 26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Work is continuing to be done to ensure that residents live in a clean and homely environment and are provided with comfortable indoor and outdoor communal facilities. Residents will be better protected if staff follow infection control procedures. EVIDENCE: The home is located on the outskirts of Nutley. There is no access to public transport nearby, only taxis. Residents spoken with confirmed that they were happy with their rooms and are able to personalise them. Individual rooms and communal areas viewed demonstrated that work has been done and is continuing to be done to improve the standard. There is a maintenance programme in place that evidenced future work to be undertaken and had timescales within the home anticipate to reach these by. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 21 There is a good-sized conservatory area that provides residents with a nice view over the forest. There is a good-sized garden at the rear of the home. Work is being done on the ramp to assist is providing easier access for residents to the garden area. Some rooms on the upper floor have doors that open out onto a low walled balcony. One of these doors was noted to be unlocked. A registered provider confirmed that there are risk assessments in place for these. The content of these were not viewed. There is work continuing to install en suites into some rooms and work to up date the previous en suite facilities that were unsuitable and would not be approved under the National Minimum Standards. Some of these new en suites did not have any form of ventilation in them and the maintenance man and registered provider confirmed that this would be put in place in the near future. Ongoing maintenance work is not reflected as an outstanding requirement as there is evidence that the home has and is continuing to address the maintenance within the home. There is also a written maintenance programme in place with identified timescales that the providers have set themselves. Although there are window restrictors in place, albeit these could be easily overridden. The home needs to assess these and ensure that they are appropriate for use in all of the areas requiring restrictors and suits the purpose for the residents residing at the home. There was a strong smell of urine confined to one area within the home. It was smelt in the corridor outside two rooms, however appeared to be permeating from one room. The room appeared of good décor, however a very strong offensive smell of urine was present. The registered provider felt that this was due to the lid of the bin being not placed on properly. This bin is kept within the room where used continence pads are disposed of and emptied regularly. The storage for contaminated waste was viewed and it was noted that clinical waste bins remained overflowing, despite some bins remaining only half full. The registered provider confirmed that he has reiterated this to staff and feel that they are too lazy to walk an extra step to use the bins that are not full. He addressed this on the day. Following his actions, all bins appeared full and the waste disposal people were not due until Thursday. The registered provider confirmed that they had increased the contract with the clinical waste disposal company to have collections every week, instead of every two weeks as was previously being done. This has not been reflected as an outstanding requirement, however a new requirement has been introduced asking the registered providers to monitor and review the disposal of clinical waste and address immediately when bins become overflowing. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 22 Procedures for infection control need to be reiterated to staff as it was observed that they were walking through the home in the morning with gloves and aprons on. A staff member was observed to walk from one resident’s room into another resident’s room and back again whilst still wearing the same apron and gloves. The staff member confirmed that she was in the process of assisting with personal care. Staff were also observed to be going to the clean linen closet without taking aprons or gloves off. Cleaners/staff need to ensure that attention is given to cleaning wheelchairs and base of bedside table. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 23 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, 29 & 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being met with the number of staff on duty. Residents will be better safeguarded if robust recruitment procedures were followed. EVIDENCE: Residents were complimentary about the staff working at the home. The majority of people spoken with felt there were sufficient numbers of staff on duty. Those residents who expressed they felt at times there were insufficient numbers on duty confirmed that someone was always available if they needed assistance. The staff rota viewed demonstrated that there is one registered nurse and one carer working at night. Forms in place identified that the dependency levels of residents were last reviewed in January 2007. No requirement has been made in relation to this, however management must ensure that dependency levels and staffing numbers are regularly reviewed to ensure staffing numbers meet the assessed needs of residents. It was observed that the Registered Manager hours had been reflected on the staff rota as required at the last inspection, however this had not been done for the two weeks prior to the inspection. There was reasoning behind this that was evident to the Inspectors so no outstanding requirement has been made in relation to this, however the Registered Manager must ensure this is updated at the earliest possible convenience. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 24 Although a key standard, the number of staff with National Vocation Qualification (NVQ) level 2 or above was not assessed on this occasion due to the Registered Manager not being present at the home to speak to. Staff files were viewed, however there had been no new staff employed since the last inspection. A Criminal Record Bureau (CRB) check had been obtained for the maintenance person. Files for staff that have not yet commenced employment were viewed. These demonstrated that further work and information is required to be undertaken before these people commence employment. References obtained for some of these individuals were from people not reflected on the application form so it was difficult to ascertain what procedures were in place for obtaining references e.g. Previous/current employers, what capacity the referee knew them in etc. Recruitment remains an outstanding requirement, as it could not be assessed if improvements have been made. Shortfalls for current staff have not been addressed. This outstanding requirement is not based on the information viewed on prospective staff as these people have not commenced employment yet and the home may address the shortfalls identified. No new staff have commenced employment so it could not be assessed what induction procedures are in place. In one current staff members file there was evidence that there is a basic induction implemented by the home. Information was located at the home on the Skills for Care Common Induction Standards. Management must ensure that new staff undertake the appropriate induction. Training records viewed demonstrated that staff are provided with mandatory training, albeit some of these certificates were out of date. There was evidence that training sessions are being arranged for the near future to address this. Other training records observed that other training provided were epilepsy, diabetes and dementia etc. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36, 37 and 38. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The overall management of this home has improved and now demonstrates that there suitable quality monitoring systems in place. However practice issues identified do not ensure that the welfare of the residents are appropriately safeguarded. EVIDENCE: The Registered manager is also one of the Registered providers and they have owned the home for twenty years. She is a Registered Nurse and has the experience and qualifications to manage the home. There has been some concern regarding the effective management of the home and this inspection has confirmed that they are following their improvement plan and continuing to improve. The staff spoken with said that they felt supported by the Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 26 management structure of the home. Residents were aware of whom the manager is and of her role in the home. Relatives and visitors state that the home has improved the service and facilities and that they felt they could approach the management at any time. There has been significant improvement in the formation of care planning and risk assessments, and this needs to be maintained. As stated previously it was not possible to assess recruitment procedures in full and there were some shortfalls identified in the initial stages of recruitment and therefore this standard 31 is not yet met in full. The quality assurance systems in the home include questionnaires being sent out to residents, families and health professionals and internal audits of all areas that had been identified as needing improvement, these include preadmission assessments, care plans, medication, activities and the environment. The introduction of these formal quality assurance and quality monitoring systems is enabling the management to objectively evaluate the service and ensure it is run in the residents best interests. At present however they are still collating the audit results and need to be actioned. Therefore this requirement will remain outstanding. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. Staff supervision was discussed and staff supervision has been commenced. Staff spoken with confirmed that they receive supervision and a plan of the year’s supervision sessions seen. A file viewed showed that a staff member had received supervision every couple of months. The senior nurse in charge confirmed that all staff are appropriately supervised until they have received the necessary training and induction. The accident book was viewed, and was found completed appropriately, however there is evidence of some residents having regular falls and skin tears. It was discussed that expert advice be sought and action plans devised regarding those residents that have recurrent falls and those that have skin tears. Good practice was observed throughout the inspection in respect of promoting the safety and well being of the residents whilst being moved around the building. However specialist advice is to be sought regarding the appropriateness of their wheelchair for their individual physical disability. There are references to other areas of promoting the health and safety of the residents under Health and Personal Care and Environment sections of the report. Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 27 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 28 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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 2 2 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation Requirement Timescale for action 01/04/08 13(4)(a-c) That the registered person ensures that all care plans accurately reflect all the identified needs of the service users. This is to include communication, sight and hearing and those identified with weight discrepancies and unstable blood sugars. 13(4)(a-c) That the registered person ensures that there are appropriate risk assessments and action plans in place to safeguard the health and safety of service users, in respect of: • Falls and skin tears, • Moving and handling/wheelchairs. • Pressure mattresses and the checks in place to ensure they are in working order. • Weights of residents. • Diabetes and blood sugars. • Restraint. 23 (2) That the registered person ensures that the refurbishment and maintenance put in place by DS0000013973.V353171.R01.S.doc 2. OP8 OP38 01/12/07 3. OP19 01/02/08 Chelwood Corner Nursing Home Version 5.2 Page 30 4. OP26 16(2)(k) themselves with timescales is adhered to: this includes • Ventilation in the ensuite bathrooms. That the registered person 01/12/07 ensures that staff follow the homes policies and procedures in respect of infection control measures: Including: • • • Appropriate use of gloves and aprons. Disposal of continence pads. That the home continue to review and monitor the disposal clinical waste That the registered person ensures that all areas of the home are free of offensive odours and that systems for the cleaning of hoists and bedside side tables are introduced and monitored. 5. OP29 19 & Sch 2 The registered person must ensure That no person is employed to work in the home without satisfactory recruitment checks including: • • • A completed application form; Proof of identification; Two written references one of which must be from their previous employer; Receipt of a CRB/PoVA First check. Clear and accurate records must be maintained in respect of this and made available for inspection. Version 5.2 Page 31 01/12/07 • • Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc 6. OP30 18 (a) 7. OP31 12 (1) 8. OP33 24(1)(a) (b)(2)(3 9. OP38 17 (1) (a) [Outstanding from last three inspection reports]. That the registered person ensures that all new staff receive an induction programme in line with the ‘Skills for Care’. That the registered person ensures that the home is run effectively and meets its stated purpose, aims and objectives. That the registered provider ensures that a robust quality assurance system is fully introduced to identify key areas which require action from the Providers and staff, to ensure all aspects of the home are managed well in order to meet the needs of residents. [Outstanding from last three inspection reports]. That the registered person ensures; • That the accident book is completed in full and states action taken by staff to prevent further occurrences of falls and skin tears. • That specialist advice be sought regarding footplates on wheelchairs. • That call bells are in reach of residents in lounge areas. • That existing window restrictors are reviewed for safety. 01/04/08 01/04/08 01/04/08 01/12/07 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 32 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 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Chelwood Corner Nursing Home DS0000013973.V353171.R01.S.doc Version 5.2 Page 34 - 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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