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Inspection on 06/02/07 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 6th February 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 with a good level of information about the services and facilities provided. This enables prospective residents and their relatives to make an informed decision about whether or not the home is suited to their needs. The majority of residents and visitors spoken with, made positive comments in respect of living at Chelwood Corner. Visitors are made to feel welcome at the home and are able to visit at any reasonable time. The home has a comprehensive complaints procedure in place. This enables residents and their relatives to raise any concerns that they may have directly with the home. The provision of activities and food are managed well.

What has improved since the last inspection?

Two bedrooms on the ground floor have had fire doors fitted, whilst new chairs and individual tables have been purchased. Two bedrooms have been redecorated.

What the care home could do better:

A number of requirements are outstanding from the home`s previous inspection report, some of which are of serious concern: - The home`s poor pre-admission assessment and care planning procedures continue to place residents at risk of their needs not being identified and met. - Medication practices and procedures remain a serious cause for concern. - The home is continuing to employ new members of staff without satisfactory recruitment checks in place. - The overall environment is in a poor state of decorative order. Minimal effort has been made by the Providers to implement a refurbishment plan, or ensure that ongoing maintenance issues are identified and rectified in a timely manner. - It is of concern that recent inspections have identified a number of serious omissions, errors and requirements, which the service should have identified themselves through their own effective quality assurance systems. In light of these concerns, many of which have been raised during previous inspections, a Management Review Meeting was held by the CSCI on 22nd February 2007. It was agreed that a further set of Statutory Enforcement Notices would be served to the home in order to ensure that these outstanding areas are addressed within a given timescale in accordance with the regulations that underpin the National Minimum Standards. In addition to these, the CSCI will be imposing a condition of registration on the home to limit the number of residents that can be accommodated. This condition will not be removed until the CSCI considers the home to have complied with the Statutory Enforcement Notices. Should there be outstanding areas of concern following the agreed timescales for compliance, the CSCI will need to consider further enforcement action, potentially being either a prosecution for non-compliance or cancellation of the home`s registration.

CARE HOMES FOR OLDER PEOPLE Chelwood Corner Nursing Home Beaconsfield Road Nutley East Sussex TN22 3HJ Lead Inspector Niki Palmer Key Unannounced Inspection 6th February 2007 10:20 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.V330865.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.V330865.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.V330865.R01.S.doc Version 5.2 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 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. 21st June 2006 Date of last inspection Brief Description of the Service: Chelwood Corner is a privately owned large converted manor house, which offers nursing care to residents who are over 65 years of age and who may have a physical disability. 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 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. Nine single bedrooms have en-suite facilities, which were approved previously under old regulations, however these facilities would not be approved with today’s standards. The home provides nursing care and support to residents who are both privately funded and those who are funded by Social Services. The home’s fees as of 09 May 2006 range between £450 - £650 per person per week. Additional costs are charged for hairdressing (£5- £20), chiropody (£10 - £12) personal toiletries and newspapers. 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. Prospective residents know about the home through Social Services referrals, word of mouth and from living in the nearby area. Information about the home can also be obtained from the CSCI website. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 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 Tuesday 6th February 2007 between 10:20 and 5pm and was carried out by two Inspectors. The purpose of this inspection was to inspect all of the key standards and monitor the home’s compliance with the Regulations that underpin the National Minimum Standards, following the withdrawal of Statutory Enforcement Notices on 22nd June 2006. 23 residents were accommodated at the time of the inspection. The inspection began with in-depth discussions with the Registered Providers of the home in respect of progress made since the last report, followed by an inspection of all areas of the building. To help gather evidence on how the home is performing the Inspectors talked with a number of residents, their relatives and staff members on duty. Three care records were examined in some detail for the purpose of monitoring care. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, medication practices and procedures, the provision of activities and food, quality assurance systems, complaints procedure and the systems in place to safeguard residents from harm, the recruitment of staff and the provision of relevant training. What the service does well: The home provides prospective residents with a good level of information about the services and facilities provided. This enables prospective residents and their relatives to make an informed decision about whether or not the home is suited to their needs. The majority of residents and visitors spoken with, made positive comments in respect of living at Chelwood Corner. Visitors are made to feel welcome at the home and are able to visit at any reasonable time. The home has a comprehensive complaints procedure in place. This enables residents and their relatives to raise any concerns that they may have directly with the home. The provision of activities and food are managed well. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A number of requirements are outstanding from the home’s previous inspection report, some of which are of serious concern: - The home’s poor pre-admission assessment and care planning procedures continue to place residents at risk of their needs not being identified and met. - Medication practices and procedures remain a serious cause for concern. - The home is continuing to employ new members of staff without satisfactory recruitment checks in place. - The overall environment is in a poor state of decorative order. Minimal effort has been made by the Providers to implement a refurbishment plan, or ensure that ongoing maintenance issues are identified and rectified in a timely manner. - It is of concern that recent inspections have identified a number of serious omissions, errors and requirements, which the service should have identified themselves through their own effective quality assurance systems. In light of these concerns, many of which have been raised during previous inspections, a Management Review Meeting was held by the CSCI on 22nd February 2007. It was agreed that a further set of Statutory Enforcement Notices would be served to the home in order to ensure that these outstanding areas are addressed within a given timescale in accordance with the regulations that underpin the National Minimum Standards. In addition to these, the CSCI will be imposing a condition of registration on the home to limit the number of residents that can be accommodated. This condition will not be removed until the CSCI considers the home to have complied with the Statutory Enforcement Notices. Should there be outstanding areas of concern following the agreed timescales for compliance, the CSCI will need to consider further enforcement action, potentially being either a prosecution for non-compliance or cancellation of the home’s registration. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 7 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.V330865.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst sufficient information is provided to prospective residents and their relatives in order to support their decision of where to live, the home’s preadmission assessment procedures fail to identify and plan for residents’ care needs. EVIDENCE: The home has a combined Statement of Purpose and Service Users’ Guide in place, which has been updated since the last inspection. It is recommended that this be dated in order to evidence that it is current and up to date to reflect the overall provision of care. This document provides the reader with the home’s aims and objectives and philosophy of care, facilities and services, details of the Registered Manager, staffing structure and overall service provision including: the accommodation, the arrangements for residents to engage in social activities, the arrangements Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 10 for dealing with concerns or complaints and the systems for ensuring that residents’ needs are identified, met and reviewed. The Registered Manager confirmed that only Registered Nurses are able to undertake pre-admission assessments for all prospective residents. Concerns and repeated requirements have been raised regarding the home’s preadmission assessment procedures since June 2003. Despite the home reviewing the format of the assessment on several occasions since this time, a number of shortfalls were still apparent. Two recently admitted residents’ pre-admission assessments were viewed. Whilst one was reasonably detailed, a person for whom a variation of registration was applied for, another was exceptionally brief. Despite it being noted that this person had a history of falls, there was no further information regarding this, their personal circumstances or what their primary nursing needs were. In addition, there was no date of assessment or evidence to suggest who the assessment had been completed by. The Inspectors were therefore unable to determine on what basis this person had been accepted by the home. This requirement is outstanding. Intermediate care is not provided. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a risk of residents needs not being met due to care plans not being completed, updated and reflecting actual current practice. Medication procedures remain a cause for concern. EVIDENCE: Following concerns raised during a number of inspections since June 2003, three individual plans of care were inspected in some detail on the day of inspection. The Registered Manager informed the Inspectors that the home has reviewed the care planning format since the last inspection. All three plans of care were noted to be insufficiently detailed and fail to clearly identify how residents’ needs are to be met. It was not clear from individual care plans, what support residents require, particularly with eating and drinking and mobilising, concerns which have been raised in the past. In addition, not all had been updated following advice taken by the GP and/or visiting healthcare professional and in some instances not signed by the person completing them. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 12 Despite risk assessments being undertaken for pressure area care, falls and mobility, they fail to identify what the actual level of risk posed is, or the action that staff need to take in order to minimise any identified risks. A requirement has been made in respect of this. The home’s medication systems and records were viewed. All medicines are delivered to the home on a weekly basis from the GP surgery in pre-packed boxes, which are individually labelled. Registered Nurses only administer all medicines. A sample of records and medicines were spot-checked, which raised a number of concerns: • Since the last inspection, the Registered Manager has asked all nursing staff to record in a separate book, each occasion whereby a signature or reason for non-administration should appear on the medication administration record, but has been left blank. It was concerning to note that over a two week period, 12 entries had been recorded, yet no further action taken. Many residents are prescribed medicines, which are for use on an as and when required basis (PRN). These include pain relief, topical creams and emergency medication prescribed for residents with epilepsy. The home is required to ensure that clear guidance is in place for all such medicines. This remains an outstanding requirement. One person had been prescribed a medication, which is to be administered via injection. There was no guidance recorded to state the dose or frequency of this. Nursing staff were unaware of this. One person was prescribed oral medication, which was to be administered three times daily, but had not been given for the past three weeks. There was no record as to the reasons why, or under whose instructions. One person had had their medication altered from daily to PRN. There was no record as to the reasons why, or under whose instructions. New guidance under legislation regarding the safe disposal of waste medicines from nursing homes was given to the home at the last inspection as the home were returning all unused and discarded/omitted medicines to the GP practice. Despite assurance at the previous inspection that the appropriate disposal methods would be implemented, no further action has been taken by the home. • • • • • Whilst most staff were observed to treat residents with respect and dignity and knock on bedroom doors prior to entering, one of the Inspectors observed a resident who clearly appeared uncomfortable whilst seated in the lounge area. When the Inspector brought this to the attention of a member of staff, the staff member replied: “she likes sitting like that”. This was addressed with the member of staff at that time and with the Registered Manager during feedback. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A variety of daily activities are planned. Relatives and visitors are made to feel welcome at the home. The provision of food is good. EVIDENCE: A new activities organiser had been employed by the home approximately two weeks prior to the inspection. Prior to her arrival there had been a period of time when there had been no one to provide activities on a daily basis. On the day of the inspection, residents were observed to take part in an exercise group, which had been organised by the home. Residents commented that this was arranged on a two weekly basis. One person commented: “The entertainment is good”. The organiser was very keen and had begun to record what activities she has done, who took part and which residents she had spent time with individually, which is good. She is beginning to discover who takes part in the group-based activities and who prefers to spend time on their own. There is a need for this person’s work to be developed and for her to find out from residents their interests in order that she can meet individual needs. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 14 From discussions with the Providers, relatives and others, visitors are welcome to visit the home and the residents. One relative was seen during the inspection. Their relative had been at the care home a matter of weeks. They reported that they visit at least twice weekly alongside other members of the family. They commented that they are made to feel welcome and kept informed of how their relative is and whenever they have asked about aspects of their relative’s care, the home has responded well. The Providers explained that residents are offered choice whenever this is possible. For example, whether residents go to the lounge or stay in their bedrooms. Choice is available at lunchtime and this was observed on the day of the inspection. Residents were asked by care staff at the dining table, which of the two options they would prefer. When one resident was given the wrong choice of food, he raised this with staff and was promptly given the food he had requested. The home has recently employed a new chef, who is responsible for the devising of menus in consultation with residents. All weekly provisions are currently purchased by the Providers from a nearby supermarket. Residents commented that the standard of food is good whilst specialist diets e.g. vegetarian and low sugar alternatives are available. There was a choice of menu on the day of the inspection. One resident said, “The fish is good”. One resident requires his food pureed and the staff explained the reason for this to him. On the day of the inspection, fourteen of the residents ate their food in the dining room. Although the only fruit and vegetable evident in the home were bananas and potatoes, the chef assured the Inspectors that fresh fruit and vegetables are brought into the home each morning by the owners. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has sufficient systems in place to ensure that all complaints are dealt with appropriately. Residents will be better safeguarded from potential harm, neglect and abuse once all staff fully understand their roles and responsibilities for the protection of vulnerable adults. EVIDENCE: The home has a detailed complaints procedure in place, which is included within the home’s combined Statement of Purpose and Service Users’ Guide. It gives clear guidance with regards to how a complaint can be made and how the complainant can expect it to be dealt with. Residents and relatives spoken with said that they would feel confident in raising concerns directly with the Manager of the home. No complaints have been received by either the home or the CSCI since the last inspection. Albeit that the home has a policy and procedure in place for the protection of vulnerable adults and all staff have undertaken the appropriate training, it was concerning to note that the Registered Manager was unclear of the home’s roles and responsibilities in recognising and reporting suspected abuse. For example, the owner stated that she would carry out a preliminary investigation before reporting a potential adult protection matter to the local Social Services Department, when the policy and procedure should be that the matter will be reported immediately. This was discussed in detail and a requirement made. No alerts have been raised since the last inspection. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Chelwood Corner is in poor decorative order with many areas in need of refurbishment and modernisation. There is a need for a refurbishment programme to be established. EVIDENCE: A tour of the premises was undertaken by one of the Inspectors with one of the Providers. Most areas were seen, although a few bedrooms were not entered, as residents were asleep in them. A number of significant matters were identified. These included; • • • Ceilings in two bedrooms were stained and needed repainting. Skirting boards and other paintwork, particularly in the corridors, were badly scratched and in need of repairing and repainting. Paper on the ceiling of the dining room was falling apart and coming loose. DS0000013973.V330865.R01.S.doc Version 5.2 Page 17 Chelwood Corner Nursing Home • • • • • Wallpaper was torn and ripped in the lounge. There was no hot water in the shower facility in two bedrooms. The carpet between the lounge and the rear section of the building was loose and posed a trip hazard. One external door in a bedroom was ill fitting and therefore was very draughty. One room smelled very strongly of urine. There was evidence of two bedrooms being redecorated. One had recently been redecorated, whilst another was being redecorated at the time of the inspection. Since the last inspection two bedrooms have had new fire doors fitted. This has resulted in one bedroom having minimal natural ventilation, as there is no window in the room. There are occasions when the door has to be left open to the outside to ventilate the room. This needs investigating and resolving. New chairs and individual tables have been purchased for the lounge area. A requirement was made at the last inspection for a redecoration and refurbishment programme be devised and sent to the CSCI. Although a programme was sent, this was inadequate. It was dated 1st August 2006 and gave a timescale for completion of certain key areas. Some of these have passed. For example, a six month timescale was given for “internal redecoration including carpeting of the Nursing home”. Most of the programme is concerned with external work that is required to such areas as the roof, lead work, gutters, tiling and windows. None of this has begun, although the Providers stated that quotes had been obtained for the roof and windows and anticipated that this work will be carried out in the spring/summer. The environment has been deteriorating for many years with little investment, resulting in the level of internal decoration being poor. It is of concern that this has not been addressed or a clear programme of work, including clear timescales, established. This provides no faith to the CSCI that the work will be completed in a timely way. Although a maintenance log was introduced in January 2007, there were still twelve items on the list to be completed including the hot water regulator in two rooms identified as not working. The reason given by the Providers was that the maintenance person had been off work for a couple of weeks. The home provides one bathroom, one shower room and six toilets, however it must be noted that none of these facilities are accessible on the first floor. Albeit that nine single bedrooms have en-suite facilities, which were approved previously under old regulations, these would not be approved under the National Minimum Standards today. They are cubicles separated by a curtain, which fail to promote individuals’ privacy and dignity. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s poor recruitment procedures, discrepancies between records and inadequate induction processes, fail to promote the health, safety and welfare of residents and ensure that residents are well supported and their needs are met. EVIDENCE: Since the last inspection, the home has had several long-term key members of staff leave, including the Deputy Manager, one Registered Nurse, two senior carers, chef / housekeeper and activities coordinator. However, new staff have been recruited to fill these posts, with the exception of the Deputy Manager. The Registered Manager explained that she has resumed her role as the lead in clinical care. The home is approved by a University to employ four adaptation nurses from overseas. No staff are currently undertaking this course at this time. All staff spoken with confirmed that a good level of staff training is provided by the home both internally and externally. Examples of recent training include: first aid, moving and handling and COSHH. Staff spoken with and rotas seen confirmed that there is usually a total of six staff on duty in the daytime: two Registered Nurses and four care staff. At the Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 19 beginning of each shift, staff are allocated to work on either the ground or the first floor to support residents. There is always one Registered Nurse and a minimum of one carer working at night. Four newly appointed staff recruitment files were seen on the day of inspection, which raised a number of concerns: There was some discrepancy between the start dates of all four employees, completion of their (brief) application forms and receipt of their Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (PoVA) First checks. It was noted in one person’s file that they had commenced employment following satisfactory police checks, however the Inspectors found a handwritten letter from the Registered Manager stating: “CRB checks take so long, so start before”. In addition, discussions with both of the Registered Providers indicated that there were two separate records being maintained in respect of persons’ start dates, in which there was a period of between six to eight weeks difference. There were some areas of concern in relation to references. Not all persons had references in place from their previous employer (care homes) and a number were noted to be from friends/ex-colleagues/acquaintances. In addition, it was noted that one member of staff who had left some months previously, who was then re-appointed without any additional recruitment checks in place. When each of these concerns were raised with the Providers, the Manager commented: “But I know them”. As similar concerns were raised during the home’s previous inspection in June 2006. These will be addressed with the Providers separately from this inspection. The home’s policies and procedures state that all staff are expected to undertake a thorough induction to the home within the first six weeks of employment. It was concerning to note that only one person’s file, had documentary evidence in place to show that they had received an induction to the home, although all areas had been signed on the employees first day. This indicates that the home’s induction procedures are brief and fails to equip newly appointed staff to meet the assessed needs of residents. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Albeit that the Registered Manager has the relevant experience and qualifications to manage the home, evidence gathered during this and previous inspections indicate that the home is not being managed effectively and in the best interests of residents. EVIDENCE: Following the last inspection, the Deputy Manager left and withdrew her application to become registered with the CSCI as the Manager. One of the Providers of the home continues to be the Registered Manager at this time. She has been running the home for the past 20 years and is a Registered General Nurse with a background in midwifery and neonate nursing. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 21 The Providers have obtained a quality assurance and auditing system, which was introduced in January 2007. This is very much in its infancy and most has not yet been introduced. For example, although the Providers stated that there was a development plan, this consisted simply of a statement that the en-suite facilities would be improved, by them being fully enclosed. The development plan included no other issues and gave no timescale for action. It was therefore completely inadequate. It is of concern that recent inspections have identified a number of serious omissions, errors and requirements, which the service should have identified themselves through their own effective quality assurance systems including: The home’s pre-admission assessment and care planning procedures Medication practices and procedures The recruitment of staff Maintaining a safe environment It is of concern that due to these failings in the care home, and the failure of the Providers to identify and rectify key issues, that enforcement action must be considered. The providers stated that they are involved in the financial affairs of two residents only. Records are maintained to provide an audit trail in relation to how these monies are managed. One set of records were clear, whilst the other needed further work to clearly identify how the person is receiving their weekly personal allowance. Each month, £5 is added to the invoice, or deducted from residents’ monies, to pay for toiletries. Although the Providers stated that relatives have signed to agree to this, there was no evidence to support this statement. Where additions are made to the fees, this should be made clear in the contract and signed as agreed by the resident or their representative. Evidence seen within the home’s maintenance records identified that all equipment is well-maintained and regularly serviced including: fire equipment, electrical appliances, gas installation, emergency lighting and adaptations and equipment. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 22 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 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 1 X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 3 Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 23 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-d) 14(2)(a) (b) Requirement That residents’ primary nursing needs are clearly recorded within the home’s pre-admission assessment record. This must include the action that is to be taken in order to prevent the risk of falls [Outstanding]. That all care plans provide clear and specific guidance for staff to follow in relation to meeting individuals’ assessed needs. This must include eating and drinking and mobility [Outstanding]. 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 safe procedures for the handling of medicines are adhered to at all times: All medication administration records must contain either a signature or reason for nonChelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 24 Timescale for action 06/02/07 2. OP7 OP8 15(1)(2) (a-d) 30/04/07 3. OP7 OP8 13(4)(c) 30/04/07 4. OP9 13(2) & Sch 2 06/02/07 administration. Clear and accurate records must be maintained on the MARS if there is a change in the prescription. That clear guidance is in place for all medicines that are prescribed on a PRN basis [Outstanding]. All unused, omitted and/or discarded medicines must be disposed of through a licensed waste disposal company. 6. OP12 16(2)(m) That sustained activities are provided to residents based on individual needs and choices, in order to provide a stimulating environment. That all staff have a clear understanding of their roles and responsibilities in recognising and reporting suspected harm, neglect and abuse. 30/04/07 5. OP9 13(2) & Sch 2 30/04/07 7. OP18 13(6) 30/04/07 8. OP19 23(2)(d) That ongoing maintenance issues 06/02/07 identified by the home are rectified speedily in order to provide a safe environment. That a full refurbishment programme be established and forwarded to the CSCI, including clear timescales for action on each area, in order to ensure that the long standing issues regarding the poor environment are rectified [Outstanding]. That the ventilation in one bedroom is investigated and resolved. 30/04/07 9. OP19 23(2)(b) 10. OP20 OP26 23(2)(p) 30/04/07 Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 25 11. 12. 13. OP20 OP21 OP29 23(2)(b) 23(2)(j) 19 & Sch 2 That the carpet in the lounge is checked and made safe. That hot water is available to all shower facilities. That no member of staff 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. [Outstanding]. 09/03/07 09/03/07 09/03/07 14. OP30 18(1)(c) (i) That all new members of staff receive a structured induction programme within the first six weeks of employment. Records must be maintained. 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. That a clearer system is introduced regarding on residents’ monies, in order to provide a clear audit trail. DS0000013973.V330865.R01.S.doc 30/04/07 15. OP33 24(1)(a) (b) 24(2)(3) 30/04/07 16. OP35 17(2) & Sch 4 (9)(a)(b) 30/04/07 Chelwood Corner Nursing Home Version 5.2 Page 26 17. OP35 17(2) & Sch 4 (9)(a)(b) That a clear system for obtaining agreement to additional fees is introduced. This must be available for inspection. 30/04/07 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 OP1 Good Practice Recommendations That the combined Statement of Purpose and Service Users’ Guide be dated in order to evidence that it has been reviewed and reflects the current provision of care. Chelwood Corner Nursing Home DS0000013973.V330865.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Kent and Medway Area Office The Oast Hermitage Court Hermitage Lane Maidstone Kent 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.V330865.R01.S.doc Version 5.2 Page 28 - 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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