Inspection on 05/09/06 for Chestfield House Nursing Home

This inspection was carried out on 5th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chestfield House Nursing Home 04/12/08

Chestfield House Nursing Home 10/05/07

Chestfield House Nursing Home 09/01/06

Chestfield House Nursing Home 17/10/05

Chestfield House Nursing Home 20/09/04

Chestfield House Nursing Home 20/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Chestfield House Nursing Home The Ridgeway Chestfield Whitstable Kent CT5 3JT Lead Inspector Mrs Susan Hall Unannounced Inspection 5th September 2006 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 Chestfield House Nursing Home DS0000026087.V300076.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. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestfield House Nursing Home Address The Ridgeway Chestfield Whitstable Kent CT5 3JT 01227 792281 01227 792281 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) Unique Help Group Limited Post Vacant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Of the 31 nursing beds 3 are registered for the admission of residential clients. PD (Physical Disability) is limited to one (1) person whose date of birth is 19.06.1942 DE(E) is limited to one (1) person whose date of birth is 17.10.1913 Date of last inspection 9th January 2006 Brief Description of the Service: Chestfield House is a large detached property, originally built as a farmhouse in 1751. It is part of the Unique Help Group of nursing homes, which was purchased by Nicholas James Care Homes Ltd. in May 2005. The group have another 4 nursing homes in the area. The home is situated in a residential area in Chestfield, near to the seaside town of Whitstable, and all its amenities. It can easily be reached via the M2 motorway, and the Thanet Way. The house has been extensively renovated and provides accommodation for 31 service users. Accommodation is situated on two floors and comprises 23 single and 4 shared bedrooms, 14 of which have en-suite facilities. The Home has a passenger lift, which provides easy access to all rooms on the first floor. There are communal areas on both floors, and gardens at the rear of the property. There is car parking available for several vehicles. The fees range from £386.98 - £550.00 per week, depending on the room, and the level of care required. This information was provided by the Acting Manager on pre-inspection documentation in August 2006. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector had not previously visited this home, and spent 7.5 hours assessing most of the National Minimum Standards. The inspection process includes information obtained prior to the visit, from completed survey forms, and from feedback from 3 relatives over the past few months. The Inspector talked with 5 service users and 1 relative during the visit, and with 6 staff, as well as the Acting Manager. The Group Manager was also present in the Home during the day, and assisted the Inspector with information. One complaint had been received by CSCI since the last inspection, and this was passed on to the Provider for investigation. Appropriate action was taken to address the matters which were raised. Another incident was referred by a care manager to the Kent County Council Adult Protection department, and was being investigated at the time of the inspection. The Inspector was informed during the following week that this had been satisfactorily concluded. The Inspector viewed all communal areas of the home, and most bedrooms. The décor was generally shabby, and the Provider has implemented a redecoration and refurbishment programme for the whole building. New carpets had been laid throughout the premises during the previous week, and service users and staff said that this was a big improvement. Further work is needed in some bathrooms, en-suite areas, and sluices, and these are itemised later in the report. The kitchen urgently needed deep cleaning, and a requirement was given to carry this out during the following week. However, the Group Manager arranged for this to be done immediately, and maintenance men had started work to steam clean the kitchen before the Inspector left the premises. Service users seemed content, and said that they were well cared for. They spoke highly of the Acting Manager. Some had less confidence in the ability of staff to carry out care effectively when the Acting Manager is not present in the home. The Inspector examined documentation for care planning, medication, maintenance records, staff recruitment and training, and some policies and procedures. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Some aspects of medication management need to be tightened up. It is important that the refurbishment programme continues until all identified areas have been improved. Sluice rooms need particular attention, as they have a foul odour which is unpleasant for staff, and for service users in adjacent rooms. Deep cleaning of the kitchen is needed on a regular basis (e.g. monthly). The cook’s training has been allowed to lapse, and further training is required. Other items are referred to in the text of the report. Chestfield House Nursing Home DS0000026087.V300076.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. Chestfield House Nursing Home DS0000026087.V300076.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 Chestfield House Nursing Home DS0000026087.V300076.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Suitable documentation is provided to enable service users to make an informed choice about staying in the home. Detailed pre-admission assessments are carried out prior to admission. EVIDENCE: The Statement of Purpose and the Service Users’ Guide are set out clearly, and provide detailed information about the running of the home. The Service Users’ Guide is produced in large print for easier reading. The complaints procedure is included, and contained up to date names and addresses for contacts. Registration is for 31 service users, but some rooms previously used for sharing were being used as single rooms. There were 24 service users on the Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 10 day of the inspection visit. The home is registered to take up to 3 service users requiring residential care, but there were none in the home at this time. Pre-admission assessments are carried out by the Acting Manager. The Inspector read 4 of these, and they were appropriately detailed, and had been well completed. They included assessments for all aspects of daily living – e.g. communication needs, mobility, pressure relief, diet and social needs. Any specialist equipment needed had been identified, and was in place in the home prior to admission. This included items such as pressure-relieving mattresses, bed rails, and hoisting facilities. The Inspector viewed contracts for 2 service users. These showed details of room number, the room size, and a breakdown of the fees. They had been properly completed and signed by both parties. Service users are admitted for a trial period of 4 weeks, with a review at the end of this time to check the suitability of the placement. Chestfield House Nursing Home DS0000026087.V300076.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Health and personal care needs are mostly met adequately, but attention is needed for accurate completion of care plans. Improvements are needed with the management of medication. EVIDENCE: The Inspector examined 5 care plans – 2 completely, and a further 3 with specific reference to wound care and nursing needs. The Acting Manager was in the process of putting care plans into a new format, and the Inspector read one of these first. The new format was found to be far easier to follow, and more comprehensive than the old one. Care plans are set out in individual A4 folders. The nursing staff carry out assessments for different aspects of daily living, and care plans are written in conjunction with these. There were good risk assessments for such items as use of call bell (e.g. does the service user have Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 12 the physical agility and the mental capacity to use a call bell); equipment needed (such as bed rails, hoist); and if the service user has any confusion. Consent forms were included for use of bed rails, use of wheelchair belt, and taking photographs. These were signed by the next of kin where the service user lacked capacity. Communication risk assessments (e.g. re hearing, vision, speech, ability to understand) were well completed, and dependency scores are assessed. A “family tree” gives details of the service user’s previous family and working history. Other care plans included management of personal hygiene needs, eating and drinking, moving and handling, prevention of pressure sores, and continence. These were appropriately detailed, and included directions such as “brush finger nails daily”, and “ensure feet are washed each day.” Eating and drinking risk assessments are accompanied by nutritional screening assessments, monthly weights, and Body Mass Index (BMI) calculation. Moving and handling care plans recorded transfer details such as a handling belt and 2 carers, or 2 care staff for all hoist transfers. The moving and handling assessments itemised which slings and hoists to use. Care plans included the service user’s preferred time to get up/go to bed, and if they like breakfast in bed. Prevention of pressure sores includes a risk assessment, the use of moving and handling procedures, “Waterlow” dependency scores, nutritional scores, and any history of skin breakdown. Fluid balance charts are maintained where indicated. Plans specified if a pressure-relieving mattress was in use, and 2 -3 hourly positional changes. Care plans were being reviewed monthly, but some were unsigned and undated by the nurses who had written them. The Acting Manager audits care plans, and indicates clearly where plans have not been properly completed. Wound assessments were not always clear on admission, and had not been identified before transfer to hospital. However, wounds were being evaluated and recorded at each dressing change. The Inspector saw 2 pre-admission assessments where wounds had been documented, but these had not been entered on to care plans. If these had been healed prior to admission, this should still be clearly documented, so a clear pathway can be seen for what has happened. Daily records are written by the nurses, and separate reports are written by care staff. These include daily care needs, elimination, activities, visitors etc. Some of these records were poorly written (i.e. showing a poor grasp of English), and this was discussed with the Acting Manager. Separate records are retained for input from health professionals (visits or phone calls). GPs are called out as needed, and there were good follow up Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 13 details for blood and urine tests, and wound swabs. Other health professional visits included dentist, optician, dietician, chiropodist, speech and language therapy and Out-patient departments. Service users were observed as being treated with privacy and dignity. An allegation had been made some time ago about service users being left without call bells. This had been investigated by the company at that time. Service users were seen to have access to their call bells at this visit, and said that they are well cared for. One said “everyone here is very good to me”, and another said she “couldn’t ask for better.” There are care plans in place for “death and dying” indicating if the service user is anxious and wishes to discuss this, if relatives are aware of the service user’s specific choices, and if the service user may like to be visited by a religious leader. Medication is stored in a small clinical room, which is barely adequate. The room temperature sometimes reaches 25 degrees, and an air-conditioning unit is in place to help control this. Most medication is dispensed via Boots Pharmacy at Herne Bay, but the home has good arrangements with a nearby pharmacy for items prescribed out of hours or at weekends. Contracts are in place for the disposal of unused medication, and management of sharps boxes. The drug fridge had satisfactory contents, and the fridge temperature is recorded daily. There are 2 small, controlled drugs cupboards, and one of these contained items which had been prescribed over a year ago, but which had not been needed. These should be reviewed with the GP, and disposed of if not required. The numbers of fentanyl patches recorded in the CD register were incorrect, and unused patches were stored with used ones which is bad practice. There were 4 extra patches to those recorded in the register. A requirement was given for this to be investigated. As there were too many, this did not indicate theft of drugs, but it did indicate poor recording and auditing procedures. A homely remedy was found to be out of date, and the expiry date was for 2003, so these had not been checked for a considerable amount of time. Boxes of tablets –mostly for analgesia – had the tops torn off. This is bad practice, as it indicates that nurses do not routinely take the box out of the trolley and check the name label each time. There were no drug audits in place, and this is recommended. Medication Administration Records (MAR charts) showed drugs are receipted in from the pharmacy. Handwritten entries had been signed by 2 nurses. The Inspector found that one MAR chart had sticky pharmacy labels added to it, and informed the Acting Manager that this is unacceptable practice, as the labels can come off. This was dealt with immediately. Pain assessments were in place to assess if the medication given has the desired effect. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 14 Chestfield House Nursing Home DS0000026087.V300076.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home has recently improved the range of activities, and these could be further improved by more opportunity for one to one care. Food is satisfactory, but could be improved with better systems at teatimes. EVIDENCE: Activities had recently been increased by employing an Activities Organiser for 2 days per week (Mondays and Fridays). This is appreciated by the service users, but could still be further improved by more input during the week. Some service users are able to take part in minibus trips, and these are carried out between the group homes, and usually take place on Thursdays. The activities organiser keeps an individual record for the likes and dislikes of each service user, and accompanying risk assessments. The records are well compiled. Activities include crafts, film afternoons and manicures, and the hairdresser visits the home on Wednesdays. A singer was carrying out musical entertainment on the day of the visit, and this was being combined with a buffet tea during the programme. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 16 Church representatives are made welcome, and a communion service is held in the home every month. Visitors are welcome at any time, so long as it is the service user’s wish. Service users are encouraged to maintain their own financial affairs if possible, and are able to personalise their rooms according to their liking. A trolley shop is taken round once per week to enable service users to have the opportunity of choosing their own purchases. The kitchen is quite small, but fairly well organised. There is a dry food storage cupboard included in the kitchen area. Ventilation is provided by an open doorway and 2 windows, both covered with fly netting. The room was still very hot. Menus are decided weekly, and there is always a choice of 2 dishes for each course. The cook visits the service users quite often, so that she gets their feedback, and gets to know their preferences. Additional items are prepared for service users who request this, and the cook had made several extra dishes that day. The service users said that when the cook is on duty the food is very good. There is a weekly meat delivery, and fruit and vegetables are delivered 3-4 times per week. Most food is home-cooked; this includes soup, which is offered every lunch time as a starter. The cook and a kitchen assistant give out breakfasts, and service users can have a cooked breakfast if they wish. There is usually a hot dish at teatimes, but not always. Teas are usually prepared by a carer – but they do not carry out care on the same shift. Service users said that some care staff do not cook as well as others, and do not have the same commitment to preparing different dishes and presentation of food. Some do not cook well at all, and service users are not sure of the quality they will get at teatimes. Snacks are always available, including night times. There was no hot water urn/dispenser in place, and the cook said this had broken some time previously and had not been replaced. Two kettles were being used to heat hot water for drinks, and the boiling water is then poured into flasks. This is an ineffective and time-consuming method, and increases the risk of scalding. The kitchen needed deep cleaning, and this is addressed in standard 19. The cook’s basic food hygiene training had run out during the previous year. Basic food hygiene training must be updated as soon as possible, and the cook should have further qualifications for managing a kitchen for vulnerable service users. Intermediate or Advanced training is recommended. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users know who to make complaints to, and complaints are appropriately followed through. Training in the protection of vulnerable adults has been increased in response to a complaint which was made. EVIDENCE: The complaints procedure is on display, and contains all the required information. The home had received 2 complaints since the last inspection, and records showed that these had been dealt with appropriately. One complaint was made to the CSCI Inspector, who asked the Provider to investigate. This complaint was thoroughly investigated, and was partially substantiated. Action was taken in response, and this included the following: A policy review of moving and handling practices, with clear instructions to staff to ensure they adhere to the policy; Further adult protection training and close monitoring to ensure service users are not left without a call bell; A revised induction programme regarding the Protection of Vulnerable Adults, (POVA) and the attitude of staff towards service users. A recent referral had been made to the Social Services Adult Protection department regarding a service user who had sustained a skin tear during a Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 18 moving and handling incident. This alert was being investigated at the time of the inspection. The Inspector was informed that this had been concluded during the following week. Increased POVA training was evident in the home. Staff recruitment files showed that staff have POVA checks before commencing work. Contractual employment is not confirmed until a satisfactory Criminal Record Bureau (CRB) check has been received. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The quality for this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home requires maintenance in many areas to bring it up to a satisfactory standard. The Provider has started to implement this. EVIDENCE: There is a programme of ongoing maintenance in the home, and this was evident on the day of the visit. New carpets had been laid throughout the home during the previous week, and looked very smart. These had not been stuck down, as redecorating was still needed throughout the premises, and this enables them to be lifted for painting skirting boards etc. it would have been better if decorating could have been completed first, but the carpets were of such poor quality that replacing them had become a priority. The company were mindful of health and safety measures, and carpets were not rucked or obviously loose in any areas. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 20 Maintenance men had commenced redecorating – starting with vacant bedrooms. One of these was decorated on the day of the inspection. The Acting Manager said that the Provider had left the choice of several colours for décor up to the staff and service users. This was to enable some choice of décor for service users for their bedrooms. The premises are an old building with shabby décor, so this should improve the whole appearance of the building in due course. The kitchen was seen to have large grease spots on the ceiling, and the fly screens were dirty. The floor was very dirty underneath the sink unit, fat fryer and cooker. The cook said she is unable to pull out heavy equipment for proper cleaning. A requirement was given for deep cleaning to be carried out within one week. However, this was already being done when the Inspector left the home. A broken tile by the door needs replacing. The Inspector viewed communal areas, most bedrooms, and toilet and bathroom facilities. There are 2 lounge area on the ground floor which are adjacent to each other, with an archway between them. Armchairs are put back to back in the archway, so as to make 2 smaller areas, rather than one large one. There is a large dining room on the ground floor, and this was used as a venue for singing entertainment during the afternoon. There is a small quiet lounge on the first floor, and a flat roof area which was being re-fitted as a secure decking area for service users to sit outside. Bedrooms were seen to be personalised. Most of these needed redecorating and refurbishment. New bedroom furniture had been ordered for some rooms. One of the service users looks after the home’s cat in her room, which is her wish. The pet food is kept in here, and the Acting Manager said that this had been risk assessed. All rooms have locks on the doors, and a lockable facility in the room. Radiator guards and window restrictors have been fitted. There is a separate small room for the hairdresser to use, and wheelchairs are stored here when she is not in. There is a large ground floor bathroom with an assisted bath, which was in satisfactory condition. A large shower room had tiles missing, and needs attention. The home has 2 sluice rooms – one on each floor. Both of these rooms were extremely smelly and offensive, indicating a problem somewhere which must be rectified. The ground floor sluice room does not have any noticeable ventilation, and there is poor ventilation in the first floor room. The Acting manager said that the sluicing disinfectors are quite old, and did not seem to have been serviced for years. Action must be taken for the sake of staff and service users. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 21 The home is equipped with a passenger lift, and with 4 mobile hoists (2 on each floor). Grab rails were seen, and toilet surrounds and commode chairs. Some new nursing beds had been ordered. The laundry room is small, but was well organised. There is one large commercial washing machine, and one large tumble-dryer. The laundry assistant said that these were just adequate. Dirty washing is taken straight from laundry sacks into the machine, and soiled items are put into red alginate sacks and washed last. The laundry assistant checks that clothes have been properly marked when service users are admitted. The laundry is equipped with hand washing facilities. Clean items are put into individual baskets, and taken straight to service users’ rooms – except for clothes which are for ironing. The home has a good sized garden to the rear. The grass had been cut, but otherwise this needed attention to borders and flower beds to make it into an attractive area for service users. A gardener had been recently employed by the home. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing levels and s recruitment procedures are satisfactory. There is an increased programme of staff training in place. The home is still below the target for the percentage of care staff with NVQ 2 training. EVIDENCE: Staffing rotas showed consistent levels of care staffing. The numbers of care staff on duty had been increased to meet dependency levels. There are usually 5 care staff in the mornings, 4 in the afternoons and evenings, and 2 at night. There is always one nurse on duty, and often 2 nurses during the mornings, which is the busiest time. The Acting Manager covers as a second nurse at times, but has some dedicated time for management. Ancillary staff include a cook and kitchen assistant during the day, and an extra carer working in the kitchen in the evenings. There are usually 2 cleaning staff on duty on weekday mornings and 1 at weekends. Care staff assist with laundry duties when the laundry assistant is not on duty. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 23 Numbers for care staff with NVQ 2 training are currently below 50 . There are 5 care staff with level 2, and this comprises 35 . Another carer was enrolled to start NVQ 2, and 3 others are due to commence level 3. The percentage will be nearly 50 when these have completed training. Staff recruitment procedures were found to be satisfactory. 3 staff files were examined, and were in good order. They contained a photograph, completed application form, health questionnaire, 2 proofs of identity, confirmation of POVA first, 2 written references, confirmation of CRB checks, and training certificates. Police clearance from abroad had been obtained for overseas staff, and work permits where applicable. Nurses PIN numbers had been checked prior to commencing employment. Staff had signed a confidentiality statement, and interview records are retained. The home uses the Skills for Care induction programme (“Learn to Care”), and some of the induction booklets were seen to have been commenced. The Acting Manager and trained staff work together to mentor care staff. There is also an external tutor to check inductions. All care staff were currently completing the induction course as a refresher course. A staff training matrix showed that mandatory training is carried out for all staff. There is a continuous ongoing programme of POVA training. The Acting Manager is a moving and handling trainer. Care staff had completed a food hygiene awareness course. This is satisfactory for the general handling of foods, but care staff working in the kitchen should have the Basic Food Hygiene course. The Acting Manager was booking training courses for nursing staff to help them to keep their training updated. This includes care planning, first aid, health and safety, supervision, medicines, and pressure sore prevention. Two representatives had been invited in to discuss wound care and new products. The Acting Manager was also trying to access wound care training via specialist support nurses. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, 35-38. The quality for this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The Acting Manager is carrying out management duties effectively. EVIDENCE: The Acting Manager has been overseeing the running of the home since the previous manager left several months ago. She is a level 2 nurse, with a history of nursing and management experience in this home. She has completed the Registered Managers’ Award, and intends to apply for the post of Registered Manager. The company are supporting her in this by looking to appoint a level 1 nurse as Head of Care, so that clinical supervision for level 1 nurses can be carried out by a nurse at the same training level. There is a recommendation for the Acting Manager to put in her application. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 25 Staff meetings are held occasionally and the Acting Manager said that she intended to increase the frequency of staff meetings. Informal meetings are held at handover times, and the Acting Manager has an open door policy, and is accessible to staff and service users. Quality assurance processes were being implemented with the introduction of service user surveys. Another manager from a home in the same group comes into the home to talk with service users, and find out their opinions on how the home is running. The Group Manager carries out monthly (Regulation 26) visits, and sends these in to CSCI. The company are also preparing survey forms to send out to GPs and health professionals. The home does not look after any service users’ finances, except for “pocket monies”. These are kept in a secure place, and all transactions are recorded and signed by 2 senior staff and/ or the service user or relative. Receipts are numbered and retained. Staff supervision is mostly carried out buy the Acting Manager, and evidence of this was seen on staff files. One to one supervision is usually carried out every 2 months. Policies and procedures had been implemented in 2005, and some had been reviewed in 2006. It is good practice to review these every year. Other records were satisfactorily maintained. Care plans are in the process of being put into a new format. Mandatory training needs are being met. Fire training had last been carried out in March 2006, and had been well attended. Maintenance records were included in pre-inspection documentation sent to the Inspector, and these were up to date. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 26 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 2 2 2 3 2 3 1 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 2 3 Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 (2) Requirement To ensure that controlled drugs are correctly recorded at all times; and to inform the Inspector of the outcome of the investigation regarding one identified drug. To ensure that homely remedies do not go out of date. To review the level of training and ability for care staff who have additional duties for preparing meals, ensuring that they are capable of preparing food to a good standard. To ensure that the cook(s) have suitable training for the job they are to perform. To ensure that kitchen equipment is suitable for the tasks (e.g. to provide hot water for drinks). To complete the ongoing programme of redecorating and refurbishment for communal DS0000026087.V300076.R01.S.doc Timescale for action 05/10/06 2 3 OP9 OP15 13 (2) 18 (1) (c) (i) 05/10/06 05/11/06 4 OP15 18 (1) (c) (i) 16 (2) (g) 05/12/06 5 OP15 05/11/06 6 OP19 23 (2) (b,d) 05/03/07 Chestfield House Nursing Home Version 5.2 Page 28 7 OP19 23 (2) (d) areas and bedrooms. To implement a deep cleaning programme for the kitchen on a regular basis (e.g. monthly). To ensure that the gardens are brought up to a reasonable standard, and have a programme of ongoing maintenance. To review the standard of bathroom and shower facilities, and provide the Inspector with an action plan for their refurbishment. To investigate the offensive odour in both sluice rooms, and provide the Inspector with an action plan for addressing this situation. 05/10/06 8 OP19 23 (2) (o) 05/11/06 9 OP21 23 (1) (a) and (2) (b,j) 05/11/06 10 OP26 16 (2) (j,k) 05/11/06 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 Refer to Standard OP7 Good Practice Recommendations To ensure that care plans are all completed into the new format. To ensure that skin integrity and any wounds or sores are clearly documented on admission to the home, and on any transfers to hospital or the community. To stop the poor practice of nurses who are tearing box tops off boxes of medication; and ensure sticky labels are not put on to MAR charts. To implement drug audits on a regular basis (e.g. DS0000026087.V300076.R01.S.doc Version 5.2 Page 29 OP8 3 OP9 4 OP9 Chestfield House Nursing Home monthly). 5 6 OP31 OP37 To put forward a candidate to CSCI for the post of Registered Manager. To review policies and procedures on a yearly basis. Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chestfield House Nursing Home DS0000026087.V300076.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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