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Inspection on 22/08/06 for Chichester Court Nursing Home

Also see our care home review for Chichester Court Nursing Home for more information

This inspection was carried out on 22nd August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is well decorated, bright and airy so that residents have a pleasant environment to live in. The home has a centre courtyard that provides a seating area outside for residents and their visitors. People can enter this area easily from both sides of the home. The residents have been included in choosing pot plants and flowers and some residents are proud to show `their` garden.

What has improved since the last inspection?

The financial administration of residents` personal monies has improved. There is a robust, safe system in place so that residents can be sure that their monies are safely looked after. The home has increased staffing levels through some areas of the home so that staff can respond more quickly to residents who need assistance.

What the care home could do better:

Five statutory requirements were issued to the home during the last inspection, three of which have still not been met. These include ensuring that care plans reflect the needs of residents so that staff know how to look after them effectively, ensuring that medication is safely handled and also that staff receive training to enable them to improve work practices. The home has not yet shown improvement in these areas.

CARE HOMES FOR OLDER PEOPLE Chichester Court Nursing Home Chichester Road South Shields Tyne And Wear NE33 4HE Lead Inspector Sheila Head Key Unannounced Inspection 10:00 22nd August 2006 & 5 September 2006 th 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 Chichester Court Nursing Home DS0000000272.V308580.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. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chichester Court Nursing Home Address Chichester Road South Shields Tyne And Wear NE33 4HE 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) 0191 454 5882 0191 454 6455 chichester.court@fshc.co.uk Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Care Home 52 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (52), of places Physical disability (15) Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: Chichester Court Nursing Home was purpose designed and built in 1997. It is registered to accommodate up to 52 older people with personal care and nursing needs. The building is single storey with wide corridors and doors providing good access for people with mobility difficulties, or wheelchair users. All bedrooms have en-suite toilet facilities. A variety of lounges and sitting areas are available, also two dining rooms, and two internal courtyards that provide outdoor seating areas. An additional, paved outdoor seating area is provided at the top end of the home. The home is located close to public transport facilities including the Metro railway system, and buses, and is within easy reach of local shops and amenities, and the town centre. Local parks and the seacoast are approximately two miles away. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced and carried out by one inspector over two days, spending thirteen hours in total. During the inspection a number of documents were examined including care files, staff files, maintenance logs and medication records. The inspector toured the building looking at bedrooms, communal lounges, dining rooms and service areas such as the treatment room, laundry and kitchen. The breakfast and teatime experience for residents was observed and the inspector shared a lunchtime meal with residents and visitors. During the time spent in the home the inspector spoke with residents, visitors and staff. A new manager has been appointed since the last inspection and has been in post for six weeks. She was present throughout the inspection. The Commission has received her application to become the Registered Manager. What the service does well: What has improved since the last inspection? What they could do better: Five statutory requirements were issued to the home during the last inspection, three of which have still not been met. These include ensuring that care plans reflect the needs of residents so that staff know how to look after them effectively, ensuring that medication is safely handled and also that staff receive training to enable them to improve work practices. The home has not yet shown improvement in these areas. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 6 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. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 7 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 Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 8 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): 3 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The admissions process does not always ensure that residents’ needs are assessed prior to care being offered so that residents cannot be sure they will receive the right type of care. There is no evidence to confirm if residents are encouraged to have a look round the home so that they can decide to live there. Standard 6 was not inspected as there were no service users receiving intermediate care. EVIDENCE: Information about the residents assessed needs is supplied to the home, usually by a care manager from Social Services before the person comes to live in the home so that staff have some information to start development of an individual care plan. However there is no consistency in quality of information gathered by the home. The inspector examined six care files. In one file the resident had been transferred from another home and there was Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 9 no evidence to show that Chichester Court had gathered their own information about this resident to ensure that they could meet their needs. Another file showed an assessment completed after the resident had come to live in the home. Detail was poor, for example in the section headed ‘hobbies’ the written information said ‘likes to go to the dining room for lunch’. No information was gathered about this residents’ hobbies and what they liked to do so that staff would not know how to meet that persons social needs. Two files did not have any information about residents before they were admitted and two files contained some information but were not dated, did not indicate where the assessment took place, or if family or friends were present to help give information so that staff could look after them effectively. The home does have documentation that has been developed for use by staff to carry out pre admission assessments but this is not used to good effect. It is important that a pre admission assessment is carried out so that the information can be used as a basis for developing care plans. Also so that the resident can be sure that the home can provide the care they need before choosing to live in the home. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9 and 10 Quality in this outcome is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents do have care plans however they are poorly developed and do not contain detailed information or risk assessments. Residents’ needs are not clearly identified so that staff have no clear instruction about how to look after them safely and residents cannot be sure that their needs will be met. Medication practices are poor and do not safeguard residents so that they are potentially at risk. Residents’ privacy is not always maintained and their dignity is not always respected. EVIDENCE: Plans are required to be clear so that staff can look after residents in the correct way once their needs have been assessed. In all the plans examined there was a theme of incomplete assessment and recorded information that Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 11 had not generated necessary risk assessment or interventions. For example, one plan identified a resident as very high risk after a nutritional assessment had been carried out. However, although this risk had been identified the resident had not been weighed regularly, when they were weighed no action was taken, even though their weight was reducing. This means that the resident was put at risk as no supplement drinks or high protein diet was introduced. The dietician had not been asked to review the resident and no assessment was documented as to the residents’ capability to eat. In another care file staff had written in the daily record ‘dressing renewed to sacrum’ but there was no care plan to instruct staff how to do the dressing or what type was needed. This means that the resident was put at risk, as there was no clear direction as to how this wound was progressing or how to manage the treatment. Another care plan showed an entry of ‘very aggressive and abusive towards staff, physically and verbally’ but again there was no plan of care or risk assessment to indicate to staff how to look after this resident so that both resident and staff were left at risk. Care plans also do not demonstrate the support given by the staff so that continuity of care is compromised for the residents. Care plans need to be developed by staff so that residents can be looked after correctly and safely. The home uses a pre-dispensed system for administration of medicines. This means that the majority of medicines arrive at the home in blister packs with the medication already measured by the pharmacist. The blister packs are named and the medicine is packaged in individual doses with the time to be given clearly marked. This system is used to reduce risk to the residents of receiving incorrect doses or incorrect medication. The person that is giving out the medicine then records on a pre printed form that the medicine has been given or, if it hasn’t been given, the reason why. On examination of this record of administration it was found that there were gaps in recording so that it was not clear if the resident had received their medication, if it had not been given for any other reason, or if the medication had been destroyed. The records include a list of alphabetical codes to be used to identify what has happened to the medication but on many occasions this was not correctly used and the record was incomplete. This means that there is not an accurate record of administration of medicines so that the residents are potentially at risk. For example, a resident was prescribed a daily injection yet six hours later than the time stated it had to be given there was no written record of this injection having been given. Two nurses confirmed verbally that it had been given but had not completed the record. That resident was put at risk as another nurse may have thought that the resident had not had their injection and given it again. There is a strict legal procedure for handling and storage of Controlled Drugs. Qualified nurses are responsible for the storage, recording and administration of these drugs. On receiving controlled drugs from the pharmacy, these must be counted and checked they are correct by two qualified nurses and then the totals must be entered in the controlled drug book and on the medication record. Boxes containing controlled drug patches had not been opened and the Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 12 amounts counted, yet amounts had been entered in the controlled drug book and signed as correct. Certain types of drugs must be locked in a cupboard within a cupboard to ensure safety however some bottles of controlled medicine were incorrectly stored. The inspector observed two qualified nurses administering a controlled drug. The medicine was measured into a cup, one nurse signed the controlled drug register to confirm that this drug had been given and the other nurse signed to say she had witnessed the drug being given. One nurse then took the medicine to presumably give it to the resident. This was unsafe practice and put the resident at potential risk. The register should only be signed after the medication has been witnessed that it has been given safely to the correct resident. Both qualified nurses did not act in accordance with Nursing and Midwifery Council guidelines or within the policies and procedures issued by the home. The inspector also observed unsafe practice that put a resident at risk. A controlled drug had been hand written onto the medication record indicating the strength and dose to be given and at what time. The start date of the medication had not been entered. During the audit the nurse then advised the inspector that the prescription needed to be amended as she had received a call that morning halving the dose. This had not been entered onto the prescription sheet at the time, which means that the resident was at risk of being given the incorrect amount of medication. The actual audit count of controlled medication was found to be correct. The fridges for storing drugs were found to be unlocked and only one had temperature readings recorded. The fridges were not clean and contained inappropriate contents such as food supplements. A pot of unidentified substance was found on the bench and a 500 ml bottle of liquid paracetamol was found on a bench instead of being stored securely. Residents comments include ‘the staff try hard’ and ‘the staff are usually very kind’. However sometimes privacy for residents was not promoted. The inspectors observed one resident in a state of undress with the bedroom door open and although staff knocked on doors the majority were held open by doorgaurd mechanisms. Some staff made comments to residents in what they thought was a jocular manner however some residents took this to heart and were worried and concerned. One resident was heard encouraging another to complain about the way they were spoken to. The inspector had difficulty identifying some residents who were in their rooms due to lack of nameplates on bedroom doors. When asking a member of staff a residents’ surname the reply was ‘I forget. There’s so many of them.’ This lack of basic knowledge does not promote resident dignity, as staff need to address residents using their names and their chosen form of what they wish to be called so that residents feel respected and valued. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome is poor. This judgement has been made from evidence gathered both during and before the visit to this service. There are activities arranged in the home but these do not appear to be structured so that residents are not aware of the programme. The home supports visiting at any time so that residents can see friends and family at any time. Meal times are poorly managed and menu choices are limited so that residents are not provided with a positive dining experience that contributes to their well-being. EVIDENCE: Visitors were observed coming and going into and from the home throughout the course of the day. Chichester Court allows visiting at any time so that residents are able to have visitors whenever they wish to maintain contact with their family and friends. There is an activities co-ordinator employed by the home that supports residents in their social interests and needs. They work as part of the care staff Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 14 team for part of the morning then promote activities during the rest of the day. As the residents’ needs are not clearly identified in the care planning process activities are ad hoc and appeared to be targeted at a certain group of residents. Evidence was not available on an individual basis to confirm who received encouragement in which leisure activities. The programme for activities is being developed and is not available to residents as yet so residents are unclear as to what is on offer everyday. Individual support appears to be limited and leisure time appeared to be spent in groups. ‘ I don’t know if we will be doing anything’ and ‘I think there was talk of a quiz this afternoon but I’m not sure’ were some comments from the residents. However the inspector did see some photographs of a recent trip to a local wildlife park that some residents enjoyed. ‘It was a lovely trip out’ and ‘It is so nice to get out once in a while’ said two residents who had been on the trip. These trips out are limited to a few residents due to minibus capacity and staff helpers so many residents do not get the opportunity to go out from the home. The inspector arrived early in the morning so was able to observe the residents having breakfast. The dining room being used for breakfast has recently been decorated in cool beige and on the day of inspection the room still was to be finished as there were no homely touches such as pictures or ornaments. Breakfast is served at 8.45 a.m. and the dining room was full of residents. The tables were covered with tablecloths and condiments were available on the tables. There was no menu available so that residents were unable to make an informed choice about what they would like to eat. Most residents appeared to have had some sort of cereal by the time the inspector arrived in the dining room. The choice of cereal appeared to be limited though some residents had porridge. One carer was in the dining room giving assistance to some residents who needed help. Porridge was served in individual bowls and placed on the tables so that the second or third resident were given cool porridge. Staff must ensure the residents receive freshly served food at all times so that residents are offered hot, appetising meals. The atmosphere in the dining room was subdued. One carer who was assisting a resident to eat their breakfast was asked by another for some tea. The response was ‘I’m feeding, I can’t do everything’. The resident continued asking for tea for fifteen minutes. Residents were observed raising their hands to attract attention when a second carer entered the room. Kitchen staff served the second course of breakfast. The residents were ‘advised’ what they liked or given what they usually had such as ‘You are having brown bread and marmalade’ which was served as one slice of bread rolled over in half, not cut with a knife or presented in a pleasing, more manageable manner. One member of staff was observed repeatedly teasing a resident telling them ‘You aren’t getting any today’. Another resident did not understand and took these comments literally and became very upset. ‘You must speak up and demand your breakfast’ was the comment from the upset resident. The dining room was not managed and breakfast was a slow, subdued experience for the residents so that some became agitated and upset. Staff did not observe infection control procedures so that residents were potentially at risk. Staff must ensure that they wear Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 15 aprons when handling food after giving residents personal care to control and limit the risk of infection. One resident was given a large handled spoon to help them eat their cereal so that independence was promoted however a plate guard was not fitted to the plate so that the resident could not eat satisfactorily and with dignity. The choice of meal for lunch was Somerset casserole with fresh vegetables or sausage and onion pie. The alternate choice was a salad. Desert offered was apple crumble and cream, yoghurt, banana or ice cream. At teatime residents were offered pasties or sausage rolls with baked beans, sandwiches and assorted cakes. Comments from residents at lunch varied. ‘That was nice but not very hot’ to ‘that was alright’ and ‘You always get enough’. Lunch time followed the same pattern as breakfast but as more residents were up and able to go to the table a second dining room was also used so that some residents were given more space. One resident was given a cup of tea by a carer and started to choke. Another carer then gave the resident assistance and said ‘This resident must have thickener in his tea’ Some thickening agent was found and the resident was offered another cup of tea. Staff must have information of residents dietary requirements so that residents are protected from harm. Thought must be given by senior staff to how mealtimes are supervised and conducted so that residents can be confident that they are not at risk from harm through lack of knowledge by staff. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a procedure for dealing with complaints, however this procedure is not always adhered to so that complainants may not receive a satisfactory resolution to their concerns Some staff have not received training in Protection of Vulnerable Adults so residents are potentially at risk, however there are guidelines available in the home to help staff in recognising suspected or actual abuse. EVIDENCE: The complaints procedure is available in the main entrance for all visitors to see. Residents knew who to talk to if they had a concern. ‘I would ask to see one of the nurses’ was one comment; another said ‘I would ask one of the staff to get me the Boss’. There are complaints recorded in the complaints register and these have been dealt with in the required timescales and sorted out by either a letter or a verbal solution. Talking to one relative revealed that not all complaints are recorded. ‘I complained to one of the staff about the food last week, but nothing happened’ said one visitor. This would indicate that not all complaints are taken seriously and passed to the manager for action, or that staff are not aware that all concerns must be reported so that remedial action can be taken ensuring residents views are taken into account. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 17 Training records show that under half of the staff group have received training in Protection of Vulnerable Adults, however some of this training was not recent. The home does have information available to staff for guidance in how to recognise abuse and what action to take if they suspect potential or actual abusive situations. More training of more staff needs to take place before residents can feel confident that they are protected. The home does have a whistle blowing policy for staff to use if they are aware of any abusive situations relating to staff, residents or visitors. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 18 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 and 26 Quality in this outcome is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides a recently decorated, comfortable environment for residents to live in. Unsafe working practices from some staff were observed so that residents cannot be confident that their safety is protected. EVIDENCE: The home has recently had many areas redecorated, both communal and their bedrooms. The design of the home enables residents to sit outside in an inner courtyard that is well maintained with seats and flowering shrubs. There was an odour present in one part of the home but staff and visitors confirmed that this was not usually the case. Two visitors confirmed that ‘The home is very clean and rarely is it unpleasant, sometimes things happen that can’t be helped.’ Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 19 The manager has implemented a system for ensuring necessary any repairs are dealt with quickly. Any member of staff who notices any area that is in need of repair or attention completes a request in the maintenance book. The manager checks the book daily to monitor that repairs have been completed promptly so that the residents’ environment is maintained in a safe condition. Water temperatures around the home had been checked recently however the record showed that although bedrooms were checked, bathrooms and shower areas were not. All baths, showers and taps need to be checked so that residents are protected from harm and results recorded. The home was unable to provide evidence of recent fire checks or weekly fire alarm testing so that residents are put at potential risk. The training of staff in fire safety matters is not up to date so that again residents are placed t potential risk. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 20 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): 27,28,29 and 30 Quality in this outcome is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The numbers of staff employed is sufficient to meet the needs of residents, however staff have not received sufficient training to ensure those needs are met in a satisfactory way. The recruitment procedure for new staff is robust so that residents can be confident that they are protected from potential harm. EVIDENCE: Staff files included necessary documentation such as two references; Criminal Record Bureau enhanced disclosures, contract, application form and latterly interview information records. The files are easy to look through and information is clearly marked. One staff file relating to one of the qualified nurses had not been updated on expiry of nurse registration, however on checking, the nurse had renewed her registration when it expired in July but had not brought the evidence to the home for recording. The home must develop a system that alerts the manager when registration renewal is expected so that residents are looked after by currently registered nurses. Some staff have not received up to date training in mandatory requirements such as fire safety, health and safety, moving and assisting, food hygiene and infection control. Documentation is poor and although staff told the inspector they had taken part in training records were not available to evidence this. The company have a robust matrix system for recording training and alerting the manager if mandatory training is due that needs to be implemented. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome is adequate. This judgement has been gathered both during and before the visit to this service. The manager is not yet registered with the Commission but holds the necessary qualifications and has extensive experience to manage the home so that residents can be confident that their home is run well. The home has a robust quality assurance system in place however this has not been fully completed so that it is difficult to identify if the home is run in the best interests of the residents. Appropriate systems are in place to safeguard personal finances so that residents can feel confident their financial interests are protected. Staff do not always follow safe working practice to ensure the health and safety of residents, visitors and staff. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 22 EVIDENCE: The manager is new to the home having only been in post for five weeks. She is not yet registered with the Commission but has submitted completed application forms. She has lengthy experience of managing care homes and through conversations with the inspector has shown awareness of the need to improve areas of concern so that the quality of living in Chichester Court improves for the residents. The company has a robust quality assurance system that is available to the manager, which will determine the standard of care the residents and visitors receive from the home. This includes a monitoring system to audit medication, maintenance, care planning, complaints, catering and domestic services. The manager will also be able use a proven process for supervision and appraisal of staff. Due to the manager recently coming to work in the home this system has not been developed or used effectively as yet so that the inspector is unable to assess if the home is run in the best interests of residents. There is a meeting for residents to be held during the next week so that they will be able to express their views about living in the home. The company has introduced a thorough, robust system for ensuring residents personal allowances are safeguarded. Each resident is allocated an individual balance sheet where credit and withdrawal activity is recorded. Residents receive receipts for money deposited into their account and two signatures are required for withdrawal of funds. There is both a paper copy and a computerised record. Every week totals are balanced and checked, then audited via email by the central finance department of the company. At present there is one dedicated non-interest bank account that holds all resident monies, however there are plans to support individual accounts. Residents can be confident that the home looks after their money safely and securely. Training for staff in health and safety, infection control, fire awareness, food hygiene, first aid and handling and assisting, has fallen behind required renewal and updating timescales. Many staff have not received supervision that would enable them to identify training needs Many staff have not received basic food hygiene training yet help serve meals and assist residents who need help to eat. Health and safety practices around the home are inconsistent. Some areas that stored potentially hazardous items were unlocked and locating keys was difficult. This practice is potentially harmful to residents. The laundry was unlocked even though fitted with a keypad mechanism whilst unattended and was found to be dirty. Lint and combustible materials were found behind washing machines and dryers. This was remedied throughout the day after being reported to the manager by the inspector. The dirty utility room was full of equipment such as wheelchairs and a hoist that there was no clear way to disposal unit causing a hazard to staff. The hot trolley that is used Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 23 to transport food from the kitchen to the dining room was dirty with old food debris, fat and spillages. Poor working practices must be identified and corrected so that residents’ health, safety and welfare are protected and so that they can feel confident that they will not come to any harm. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 24 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 X X 1 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The Home must ensure that all information provided in the care plans identifies all service users’ needs, including changed needs and how they are met. Previous timescales of 28/2/06 not met The Home must ensure the safe handling, storage, administration and recording of medicines at all times. Previous timescales of 14/12/05 not met Staff training in health and safety must be up to date and practices and procedures must ensure that all matters of health and safety are upheld. Previous timescales of 14/12/05 not met. The door to the laundry must be kept locked at all times when the laundry is unattended All staff must receive supervision at least six times a year and a programme developed and DS0000000272.V308580.R01.S.doc Timescale for action 30/09/06 2. OP9 13(2) 30/09/06 3. OP38 18(1) 13(40) 23(4) 30/09/06 4. 5. OP38 OP36 12(1)(a) 18(2) 30/09/06 31/10/06 Chichester Court Nursing Home Version 5.2 Page 26 6. OP15 12(4)(a) 16(2)(g) 18 12(4)(a) 15 7. OP15 8. OP12 16(2)(n) 9. OP38 17(1) (a) 10. 11. OP7 OP37 OP8 12(3) 12(4) 12(1) 13(10 12. OP18 13(6)18(1 )© (i) records maintained All staff must be made aware of the correct methods for feeding residents, in particular relation to upholding their dignity and respect. Residents preferences must be made known to all staff to ensure they can offer the resident appropriate choices and support them in a manner which upholds their dignity Adequate social activities must be provided to meet the assessed social needs of each resident. A planned programme of leisure interests needs to be developed. Accident records must contain an account of the action taken and also the outcome account of the action taken Staff must accurately describe incidents and events in service users records. Service users health needs must be closely monitored and appropriate medical intervention must be promptly arranged as soon as it is required All staff must receive updated training in the protection of vulnerable adults 31/10/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 30/09/06 Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations The Manager should submit an application to become Registered Manager, to the Commission. Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Chichester Court Nursing Home DS0000000272.V308580.R01.S.doc Version 5.2 Page 29 - 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. 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