Inspection on 20/01/09 for Cheswardine Hall Nursing and Residential Home

This inspection was carried out on 20th January 2009.

CSCI found this care home to be providing an Good service.

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

Cheswardine Hall Nursing and... 30/01/07

Cheswardine Hall Nursing and... 24/01/06

Cheswardine Hall Nursing and... 18/10/05

Cheswardine Hall Nursing and... 02/02/05

Cheswardine Hall Nursing and... 07/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cheswardine Hall Nursing And Residential Home Cheswardine Hall Nursing And Residential Home Cheswardine Market Drayton Shropshire TF9 2RJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joy Hoelzel     Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Cheswardine Hall Nursing And Residential Home Cheswardine Hall Nursing And Residential Home Cheswardine Market Drayton Shropshire TF9 2RJ 01630661316 01630661316 stephen@cheswardinehall.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Anne Poole RN,Mr Stephen George Poole Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 48 Number of places (if applicable): Under 65 Over 65 0 26 0 dementia old age, not falling within any other category physical disability Additional conditions: 1 0 21 The home may accommodate a maximum of 48 service users, of whom up to 48 may be Older Persons, 21 may be persons with a Physical Disability, and 1 may be suffering from Dementia. The home must comply with the Staffing Notice as issued by the Shropshire Area Health Authority dated 18th August 1994. Date of last inspection Brief description of the care home Cheswardine Hall was built about 1880 in the style of a large country house, set in beautiful private grounds with a small lake. The Home provides residential and nursing care for a maximum of 48 older people. It is owned and managed by Stephen and Care Homes for Older People Page 4 of 26 Brief description of the care home Anne Poole, both of whom take an active part in the daily operation of the Home. The Homes furniture, decor, fixtures and fittings reflect the character and opulence of the house. Information on the service is available in the form of a statement of purpose and a residents guide. Both documents are kept up to date with the latest information, are easy to read and can be available in other formats if required. The weekly fees for the service are included and range from £375.00 - £703.00. Further information on the fees can be obtained directly from the home. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection was conducted on 30th January 2007 with an annual service review 14th January 2008. On this occasion the home did not know that we would be visiting to conduct a full inspection of the service. We conducted a short follow up random inspection 10th February 2009, again the home were unaware that we would be visiting. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the Care Homes for Older People Page 6 of 26 home. Some people were unable to fully comment about their experience of life at the home. Observations were made of how they spent the day and of the interactions offered by staff in an attempt to obtain an overview of how they may be feeling. An Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion prior to the annual service review being completed. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us the areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. A member of the management team completed this document and returned it the commission. Comments from the AQAA were included in the annual service review and reference is made to the document in this report. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the care home can meet their individual care needs. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. Evidence: Information on the service is available for people who are thinking of moving into a social care setting. The documents produced are informative and comprehensive; they are in large print format and can be available in other formats and languages if required. The residents guide specifies the weekly fees for the service, and what is and what is not included in the fee. This information ensures that people can decide whether the care home can meet their support and accommodation needs. The case file of the person who recently moved into the home was looked at to see if Care Homes for Older People Page 10 of 26 Evidence: information had been sought regarding this persons needs prior to moving in. Information had been gathered from the previous health care setting and an assessment was completed by the service very soon after the person arrived at the home. The provider explained that this person arrived at the home at short notice at the request of the previous placement. The provider explained the admission process and stated that if at all possible people are visited in their place of residence but it is preferable for the person and their relatives to visit the service, so that they can get a feel of the home. Many people staying permanently have had previous respite care and short stays so are familiar with the home, staff and other people. One person spoken with stated that they had previous short stays at the home and was now making the decision to move in permanently. They went on express a satisfaction with all aspects of the home and service. The home does not provide an intermediate care service. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. Evidence: All people living at the home have a plan of care that is discussed and agreed with them or their representative whenever possible. We looked at the care records of four people who had been at the home for varying lengths of time. The plans mainly contained assessments relating to clinical needs and were not particularly individually focused or person centred. Discussions with the person and observation of staff working practice evidenced that people are receiving a service that meets their needs, preferences and expectations. For example one person experiences episodes of anxiety and distress due to a specific condition. A care plan has been developed with details for staff of what the possible triggers are to these periods and the action needed to reduce the distress. Staff discussed the care needs and described the way they helped this person. Another plan indicated that a person required regular interventions by the nursing staff, this was documented in the care plan and monitored using the daily Care Homes for Older People Page 12 of 26 Evidence: evaluation document. The information was also noted on the information board in the treatment room. There were some gaps in the recording of the interventions and it was not always possible to establish the exact care provided on observation of the documents. Currently the providers are looking at different systems and documentation for planning and recording a persons care needs and a complete review and revision is imminent. This will ensure that the care needs identified are recorded and gives an accurate reflection of the care being provided. Medication is administered to people by the registered nurses using boxes and bottles of medicines. The procedures were looked at; staff explained the processes and all evidence points to good arrangements being in place for the safe administration of medications. Staff were observed throughout the day to be assisting people with care needs in a discreet and sensitive way. People spoken with confirmed that staff were very respectful with the way they spoke to them and when they required help. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. People have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: People spoke of the activities that are organised by the home and stated that there is always something going on, and that they are able to decide to join in or not. A programme of the weekly events is displayed and includes activities arranged by the staff and from people in the community. There is a well-stocked library, numerous board games and other pastime equipment for people to use. Two ladies spoke of the recent game of scrabble, which they stated they thoroughly enjoyed as it helped to keep their brains active. Religious observance is arranged at regular times during the month with various denominations visiting, people commented of how important this was to them. The main front door is kept locked for security reasons staff answer the door and allow entry. No other doors around the building are locked with the exception of storage Care Homes for Older People Page 14 of 26 Evidence: cupboards and the treatment room. People can have free access to all areas if they so wish. The bedrooms are all very different and personal to the person residing in the room with people encouraged to bring with them their own possessions. The dining areas are prepared in advance of meals with people being encouraged to sit at the table, but people are able to have their meals in their preferred place. Menus for the day are available in the dining areas and detail the choices on offer. People spoken with stated that they enjoyed the meals provided, had plenty to eat and a very good variety. Staff were observed to be sitting with people who required help to eat and drink and were very patient, discreet and encouraging. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and others involved with the service say that they are satisfied with the service provided and know what action to take if they have concerns. Evidence: The residents guide includes the details of how to raise a concern or complaint about the service. Several people spoken with stated that they would see the providers, the person in charge or their relatives if they had any concerns or worries and they were certain that it would be sorted out. Staff described the actions they would take if they had any issues relating the protection of vulnerable adults. Some of the staff have received training in abuse awareness during 2008. The providers confirmed that no concerns, complaints have been raised with them since the last key inspection. We, the commission have not received any correspondence in this area. One referral has been made to the safeguarding adults team following some concerns raised regarding a person living at the home. This investigation is ongoing and has yet to reach a conclusion. The providers of the service are aware of the referral and have offered their cooperation with the process. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. Transactions are recorded on individual balance sheets with regular audits of the account conducted. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. Evidence: Cheswardine Hall is a large country house set in its own grounds offering a high standard of accommodation. All areas of the home are very well furnished and decorated and there is a programme for ensuring the upkeep of the premises remains at a high standard. The providers discussed the recent refurbishment of the main kitchen. They discussed the plans of the laundry receiving attention and for the installation of a conservatory. People spoken with expressed a great satisfaction with their accommodation with one person stating It couldnt be better, I am very happy to be here. All areas of the home were spotlessly clean; the staff responsible for the household cleaning must be commended on maintaining such high standards. People living at the home also commented on the cleanliness and stated that their rooms were cleaned very regularly. Good systems are in place for the control of the spread of any infections and suitable hand wash facilities are provided in all areas. Staff discussed the actions they take on a daily basis and their working practices to ensure people are as safe as they can be. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has plentiful staff available at all times to support the needs, activities and aspirations of the people in residence. Evidence: A duty rota is maintained on a weekly basis to identify the members of staff in the home at any one time. During the morning of the inspection the providers confirmed that twenty two people were in residence and were being cared for by a staff team consisting of a registered nurse, five care staff and ancillary personnel. People living at the home stated that the staff are very good, and staff are kind and help me when I need help. People who were unable to comment or declined to do so appeared well groomed, comfortable and relaxed. General observations and discussion with staff confirmed that staffing numbers and skill mix are suitable and sufficient to meet the care needs of the people living at the home. Care staff spoken with confirmed that they were offered the opportunity for training at National Vocational Qualification (NVQ) in care levels 2&3. Both stated that they found the courses useful. The Annual Quality Assurance Assessment indicates that 70 of care staff hold an NVQ qualification level 2 in care with 40 acquiring level 3. Three staff files were selected for inspection, each contained details of the checks Care Homes for Older People Page 20 of 26 Evidence: necessary to ensure that suitable people are employed by the service. A training matrix is under development to identify the training needs of all staff and will be a useful reference tool. The matrix indicates that some staff received training in the mandatory subjects for example fire safety awareness, health and safety in a care setting, abuse awareness and moving and handling. Specialist subject areas for example wound care, nutrition and other topics relevant to the client group are outstanding. The provider discussed the difficulties met with accessing training in some specialist subject areas but has plans to deal with this. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the care home because it is led and managed appropriately. Evidence: Mr and Mrs Poole are the joint providers and both are very involved in providing a social care service. Throughout this inspection Mr and Mrs Poole offered a clear understanding of the key principles and focus of the service, discussed the improvements made recently and the plans for the future. People living and working at the home offered positive comments about the management arrangements and commented that they would have no hesitation but to see either Mr or Mrs Poole if they felt unhappy about anything. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to residents. The home demonstrates a high level of self-awareness and recognises the Care Homes for Older People Page 22 of 26 Evidence: areas that it still needs to improve, and has clearly detailed the ways in which they are planning to do this. The service has an effective quality assurance and monitoring system that makes certain the home is operating as it states it does and meets its stated aims and objectives. Satisfaction surveys are sent to residents and their families, staff and to other health care professionals that are involved with the home. The results of the surveys are then considered and actioned. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this were seen. Transactions are recorded on individual balance sheets with regular audits of the account conducted. Records, documents and certificates are available for inspection to ensure that the weekly, monthly and annual health and safety checks are being carried out. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 Health care needs should be assessed and fully documented with the actions required, this will ensure the needs of people are met. Staff should be trained in the core and specialist topic areas relating to the service to ensure that staff are competent to do their job. 2 30 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!