CARE HOMES FOR OLDER PEOPLE
Chesham Bois Manor Amersham Road Chesham Bucks HP5 1NE
Lead Inspector Guy Horwood Announced 12 April 2005 09:30 a.m. The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chesham Bois Manor Version 1.10 Page 3 SERVICE INFORMATION
Name of service Chesham Bois Manor Address Amsersham Road, Chesham Bucks, HP5 1NE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01494 783194 B & M Investments Limited (Trading as B & M Care) Mrs Elaine Ward Care Home 48 Category(ies) of Dementia (31), Old age, not falling within any registration, with number other category (48) of places Chesham Bois Manor Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 48 residents, 31 of whom may have dementia. Date of last inspection 15 September 2004 Brief Description of the Service: Chesham Bois Manor is situated a short distance from the town centre of Chesham, a small town which provides a variety of shops and other local amenities. Chesham is served by local bus routes and has a Metropolitan Line tube station connecting it to main line services. The home is one of several run by B&M Care Limited, and provides accommodation for up to 48 elderly Residents, 31 of whom may require additional support due to dementia type illness. All Service Users are accommodated in single bedrooms, 23 of which have en-suite facilities. Communal areas consist of various lounge, dining and quiet areas. The home consists of an older building and a modern extension. The home has extensive, and well-maintained grounds, including a secure garden area where residents with dementia type illnesses can mobilise in a safe environment. A team of carers, a deputy manager, housekeeping and catering staff, support the homes manager, and access to healthcare professionals, including community nurses, is by direct contact or through General Practitioner referral. Chesham Bois Manor Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection of Chesham Bois Manor took place on the 12th April 2005, between 9.30am and 5.10pm. The lead inspector was Mr Guy Horwood, who was accompanied by Mrs Caroline Roberts, (Inspector). The inspectors were met by the homes manager, Mrs Elaine Ward, and her deputy, Mrs Patricia Andrews. The inspection consisted of meeting with Residents and staff, witnessing the serving of lunch, and viewing records relating to the running of the home and provision of care. The inspectors received the permission of residents to view some of their bedrooms, and viewed others from the doorway. Prior to the inspection 3 comment cards were received from relatives of residents accommodated at the home. Before leaving the home the inspectors reported their observations to the manager, Mrs Ward, and her deputy, Mrs Andrews. What the service does well:
The homes admissions procedure includes meeting with potential Residents and their representatives, and the information gathered from the preadmission assessment ensures appropriate placements are made into the home. Residents care plans, which are drawn up on admission are comprehensive, complete, informative and subject to regular review. Residents and their representatives are involved in the development of these care plans. The home is well equipped with pressure relieving devices and moving and handling equipment, thus enabling staff to meet specific health care needs. The home ensures a consistent approach to the storage, administration, handling and recording of medication. This is done through appropriate policies, procedures and staff training. In February 2005, the home received a “Silver Award” from the Environmental Health Officer with regards to their catering. The home consists of both old and modern buildings, with substantial grounds, and these appear well maintained and pleasantly decorated, providing a homely environment. The residents are able to choose where they spend their time during the day, and are able to furnish their bedrooms with personal belongings. The home has recently registered 11 single, en-suite bedrooms on the first floor of the dementia care unit. These are decorated to a high standard, with appropriate furnishings provided. The communal areas throughout the home are spacious, well decorated and homely in appearance. At the time of inspection staff were co-operative, polite and professional, and interaction between staff and Residents was noted as kind and caring. This was reinforced through resident’s comments.
Chesham Bois Manor Version 1.10 Page 6 The management structure within the home provides a good role model for care staff and their provision of care. The manager and her deputy were open, co-operative and courteous throughout the visit. All records required for inspection purposes were readily available, well maintained and up to date. The Inspectors had the opportunity to speak with a number of residents during the visit, and comments received included: “I have no complaints”, “the staff are charming and nice”, “The kitchen staff are wonderful”, “I feel extremely fortunate to be at Chesham Bois Manor”, “It’s a lovely place” and “the food is good”. Comments received from relatives of Residents included: The staff are “..always so positive...and the care is just terrific”, “the home is very clean…we are very content with the care.” What has improved since the last inspection? What they could do better:
Tissue viability assessments are evident within care plans, however these did not detail the action required by staff as to how they should ensure skin integrity. A programme of cleaning is required to ensure that all areas within rooms are cleaned to a satisfactory standard. The typed notices for the attention of staff that are displayed in various areas within the home should be removed and their content shared with staff through more appropriate communication. Where food is delivered to the home fresh, written guidelines must be sought from the supplier and held within the home should the catering staff freeze this food. Prescription creams, lotions, and latex gloves must be stored appropriately and with regard to the category of Residents accommodated. Chesham Bois Manor Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chesham Bois Manor Version 1.10 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chesham Bois Manor Version 1.10 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The admissions procedure appears consistent, and the pre-admission assessment detailed. This allows the home to make an informed decision as to whether they can meet a residents needs, and as a consequence, residents appear to be placed appropriately. EVIDENCE: The home has an admissions procedure, which includes meeting with potential residents and/or their representative prior to admission. The records for the 2 most recent admissions were viewed and were found to be completed. Preadmission visits are conducted by the manager, her deputy and/or care staff. Chesham Bois Manor Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Care plans are working documents, are up to date and subject to regular review. This ensures residents identified needs are known to staff to enable them to provide the appropriate care. The staff have a good understanding of the residents support needs, which enables them to provide individualised care. Staff have developed positive relationships with residents, which allows Residents to be open in expressing their thoughts, feelings and needs. Medication appears to be received, stored, administered and disposed of in a satisfactory manner, and residents appear to receive their medication as prescribed. EVIDENCE: Individual plans of care are available, and seven were viewed. All were well completed with relevant information relating to identified health, personal and social care needs, and how the home was to meet these needs. Each plan of care contained an up to date risk assessment, weight monitoring chart and moving and handling assessment, which were subject to regular
Chesham Bois Manor Version 1.10 Page 11 review. Tissue viability assessments were evident within the care plans, however these did not lead to a plan of care to address this issue. There was evidence of residents and their family’s involvement in the completion and agreement of the plan of care. The home has equipment for the provision of specific health care needs. This includes pressure relieving devices, moving and handling equipment, weighing scales and nutritional supplements. Care plans included records detailing visits by healthcare professionals. Medication records were complete, maintained and subject to review. Records of medication entering and leaving the home were appropriately documented and retained. Medication was seen to be stored securely. With a recently admitted Resident, discrepancies had been noted by care staff between instructions printed on medication packaging and information provided within the pre-admission documents. Whereas the care staff had identified these discrepancies, they had not sought advice to clarify the actual medication dose from an external source. Personal care was observed as being conducted within resident’s own bedrooms. Staff were seen to knock at residents doors before entering. Residents frequently commented that staff were kind, caring and considerate, and this was observed throughout the visit. Chesham Bois Manor Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 15 The home enables open visiting, which enables Residents to maintain contact with family and friends as they wish. The dietary needs of Residents appeared adequately catered for with a balanced and varied selection of food and drinks available that meets Residents tastes and choices. EVIDENCE: The home has open visiting. This was observed throughout the visit, and confirmed through discussion with Residents. Evidence was seen of visits to the home by local schools and voluntary groups. The lunch served appeared adequate, although it was not witnessed that Residents were offered second helpings. No choice of main meal was witnessed, although the manager stated, and menus reflected, that alternative dishes were available should they be requested. Care staff were witnessed to assist Residents with meals in a sensitive and dignified manner. The homes menus were viewed and appeared to offer variety. A choice of hot and cold drinks were noted to be provided throughout the visit. Chesham Bois Manor Version 1.10 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system, ensuring that Residents views are listened to and acted upon. EVIDENCE: The home has a complaints procedure, which is accessible to residents and their representatives. A record of all complaints is maintained, and this was viewed. This record detailed the investigation and outcomes of complaints raised. Residents spoken to were able to confirm that the complaints procedure was accessible, user friendly and that their views had been listened to where it had been used. Chesham Bois Manor Version 1.10 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,25 and 26 The home is well maintained, pleasantly decorated and furnished to meet the needs of frail elderly residents. This provides residents with an attractive, safe and homely place to live. In places there were unpleasant odours and dust, which detract from an otherwise pleasant environment. EVIDENCE: Residents are accommodated in single rooms, some of which have en-suite facilities. The organisation provides maintenance and gardening staff, and these were observed to be working at the home at the time of the visit. Residents confirmed that these maintenance staff frequently visited the home. The grounds appeared accessible to Residents, were well maintained and provide a secure area for the safety of the residents in the dementia care unit. Chesham Bois Manor Version 1.10 Page 15 The home has a variety of lounges, all of which are a good size and are decorated in a homely style. Furnishings are domestic in character and meet the needs of individual Residents. This was confirmed through discussion with Residents. Individual bedrooms contained personal belongings reflecting the character of the occupant. The home has disabled bathing facilities in addition to en-suites, however on the day of the inspection 3 bath hoists were out of order. The manager said that these had been reported for repair. Toilets and bathrooms appeared clean and free from unpleasant odours. It was noted that carpeting outside of bathroom 1 had come away from it’s gripper, and presents as a trip hazard. The carpeting must be repaired. The home was found to be generally clean and tidy, although it was observed that behind furniture and in corners it was very dusty. Several areas had an unpleasant odour, which was discussed with the manager. Following previous inspections, the home has taken action to eliminate unpleasant odours through the instalment of air freshening devices, the provision of cleaning staff and the use of appropriate flooring. The laundry was of an adequate size, with suitable equipment provided. The laundry assistant said that she had sufficient time to perform her duties. Typed notices for the attention of staff were present in various areas of the home. This detracts from the homely environment of the home, and it is recommended that these be removed. Chesham Bois Manor Version 1.10 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Staffing levels appear sufficient and therefore meet the current identified needs of residents. Vetting and recruitment practices of the home appear adequate, ensuring the safety of residents. EVIDENCE: The staffing rotas were viewed, and these identified that 8 care staff were to be on duty through the working day. Observation during the visit, and discussion with staff, evidenced that the home ensures adequate staffing to meet the identified needs of residents. The home has 4 waking night staff. Residents spoken with said that staff were always willing to help and did not rush them. The recruitment files of two recently appointed members of staff were viewed, and these contained the required information. Chesham Bois Manor Version 1.10 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,37 and 38 The management of the home appears to promote Resident focused care, which ensures Residents health, personal and social needs are catered for. Systems are in place for the maintenance of the premises and equipment, with appropriate records kept, this provides Residents with a safe and homely place to live. The home is not being pro-active in ensuring that potentially harmful items are stored appropriately, which potentially places Residents at risk of significant harm. EVIDENCE: The manager appears competent and sufficiently experienced to manage the home, and is currently undertaking her registered managers award. The management structure within the home provides a good role model for care staff and their provision of care. The manager and her deputy were open, coChesham Bois Manor Version 1.10 Page 18 operative and courteous throughout the visit, and this was also the case with all staff spoken with. The manager said she conducts unannounced visits, including out of hours, in order to monitor staff working practices, with records kept. The manager was able to provide all records that were required for the inspection. These were well maintained, up to date and generally subject to review. Records were stored securely where required. Moving and handling equipment was present, and this appeared to have received regular servicing, however at the time of the inspection 3 hoists were out of order, and were awaiting repair. Window restrictors were fitted to all first floor windows. The kitchen was found to be clean and tidy, with all food in the kitchen stored appropriately. The freezer storage area was clean and tidy, however the practice of freezing produce supplied to the home needs further clarification and the development of procedures pertaining to this. The home has achieved a Silver Food Hygiene Award from the Environmental Health Officer in February 2005. During the tour of the premises, prescription creams and latex gloves were found in bathrooms and en-suites. Due to the category of Residents accommodated by the home, it is not safe for these items to be on display. The homes staff room was noted to contain electrical appliances, including a fridge, microwave and kettle. It was uncertain as to whether the door to this room met with current fire safety standards, (i.e., it did not have an intumescent strip and was not fitted with a self closing mechanism.) The homes accident reports were viewed. These were appropriately documented. Chesham Bois Manor Version 1.10 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 2 x x 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 3 x x x x 3 2 Chesham Bois Manor Version 1.10 Page 20 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 13(4)(a) and (c) and 23 (4)(c)(i) 13(4)(a) and (c) 13(4)(a) and (c) 13(3) and 16(2)(k) Requirement The staff room must be fitted with a self closing fire door. Prescription creams, lotions and latex gloves must be stored appropriately. The carpet at the doorway to bathroom 1 must be repaired or replaced. The manager must review cleaning schedules to ensure the home is free from offensive odours. Timescale for action 02.05.2005 2. 3. 4. 38 38 26 12.04.2005 02.05.2005 02.05.2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 7 9 15 19 Good Practice Recommendations Review the use of the tissue viability tool, ensuring it details actions required by staff. Seek advice from General Practitioner and/or pharmacy where queries arise pertaining to medication. Seek clarification from food suppliers as to correct storage of produce. The typed notices for the attention of staff, that are
Version 1.10 Page 21 Chesham Bois Manor 5. 38 displayed in various areas within the home, should be removed and their content shared with staff through more appropriate communication. Provide lockable bathroom cabinets throughout the home for the appropriate storage of toiletries, creams and other items. Chesham Bois Manor Version 1.10 Page 22 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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