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Inspection on 25/03/08 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 25th March 2008.

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

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

Staff make sure that they respect peoples` rights to privacy and dignity. Care was given discreetly and with sensitivity. Staff are making sure that they respect people`s rights to privacy and dignity. Care was given discreetly and with sensitivity. A programme of activities is available so that people can enjoy social and leisure events. The home is nicely decorated and comfortable. People have brought some small items with them making their own bedrooms individualised and homely. Information about the home, advocacy and events are readily available in the reception entrance. Visitors are made welcome and there are links with the local community. Relatives said they could visit at any time. The recruitment procedures are properly followed which help prevent risk to residents by making sure that the right checks are carried out before starting work. Comments from surveys included: "They look after X and keep me informed when she is off colour" "The staff have been very good in all aspects of Y`s welfare from basic needs to other health concerns" "Staff are always concerned about my health and call my GP". "Carers, nurses and manager are very caring and friendly." "They make you feel welcome at anytime". "All seems well at the time of my visit". "All the nurses and carers are very patient and understanding"

What has improved since the last inspection?

The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs Systems have been put in place to improve care plans. They now show how people`s health and personal care needs are being met. Staff have completed Safeguarding training so that the can recognise if anyone is at risk of harm. The times for meals has been changed so that people are not rushed and the main meal is served in the evening. Staff say that this is better as people are eating more and starting to put on more weight. Two shower rooms have been refurbished and other areas cleaned. The garden areas have been landscaped with help of a grant from local authority. There are more nursing beds and pressure relieving devices. And equipment throughout the home is now regularly serviced and maintained. Staff are receiving the training they need to care for people`s complex needs. And they have completed training in safe working practices including moving and assisting and fire prevention.

What the care home could do better:

The manager has made many improvements since she took up post. But there is still a lot of work to do. She knows what this work is and has a plan of action to show how these improvements are to be made. Further work is needed on the care plans so that a person centred approach to care can be demonstrated. Handwritten entries on medication charts need to be witnessed to reduce the risk of mistakes when copying complex information. The soft and pureed diets need to look attractive and appealing in order to maintain people`s appetite and nutrition. The menus must be in written or other styles to show what choices there are for each meal and snack. The redecoration must continue where there is damage from wheelchairs and trolleys. There needs to be enough bathrooms/shower rooms for people which need to be suitable for people to use. The extractor fans in toilets and bathroom need to be cleaned and clinical waste put in the proper bags. The home must make sure that there are enough staff on each shift so that everyone`s needs can be met. Comments fro surveys included: "I believe the ratio of dependency to staff should be reviewed." "More staff are needed for each shift" "Sometimes have to wait to long for attendance regarding the toilet" "It has been known that the staff have told me to wait for the night staff when I ring the buzzer""Enough staff Monday to Friday. Weekends never" "There is a general lack of carers especially at weekends" "The home has difficulties in recruiting staff and retaining their present staff. This has a detrimental effect on residents and their families. Managers remain in post on average twelve months only."

CARE HOMES FOR OLDER PEOPLE Chichester Court Nursing Home Chichester Road South Shields Tyne And Wear NE33 4HE Lead Inspector Irene Bowater Key Unannounced Inspection 11:00a 25 and 26th March 2008 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.V361892.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.V361892.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) Elizabeth Margaret McCaffery 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.V361892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26th February 2007 Brief Description of the Service: Chichester Court was 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. Fee rates vary as follows: Local Authority rates vary from £349 with the free nursing care contribution added. That contribution is set nationally. Private fee rates for personal and social care is £441.00 Private nursing care fees are £513 with the free nursing care contribution added. Toiletries, hairdressing, chiropody, clothing, newspapers and magazines are not included in fee rates. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on 26 February and 1 March 2007. • How the service dealt with any complaints and concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives, staff and other professionals The Visit: An unannounced visit was made on 25 and 26 March 2008. During the visit we: • Talked with people who use the service, relatives, staff, the manager and visitors • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last inspection. • We told the manager what we found. What the service does well: Staff make sure that they respect peoples’ rights to privacy and dignity. Care was given discreetly and with sensitivity. Staff are making sure that they respect people’s rights to privacy and dignity. Care was given discreetly and with sensitivity. A programme of activities is available so that people can enjoy social and leisure events. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 6 The home is nicely decorated and comfortable. People have brought some small items with them making their own bedrooms individualised and homely. Information about the home, advocacy and events are readily available in the reception entrance. Visitors are made welcome and there are links with the local community. Relatives said they could visit at any time. The recruitment procedures are properly followed which help prevent risk to residents by making sure that the right checks are carried out before starting work. Comments from surveys included: “They look after X and keep me informed when she is off colour” “The staff have been very good in all aspects of Y’s welfare from basic needs to other health concerns” “Staff are always concerned about my health and call my GP”. “Carers, nurses and manager are very caring and friendly.” “They make you feel welcome at anytime”. “All seems well at the time of my visit”. “All the nurses and carers are very patient and understanding” What has improved since the last inspection? The staff collect information together about the person before anyone moves into the home to make sure they can meet their needs Systems have been put in place to improve care plans. They now show how people’s health and personal care needs are being met. Staff have completed Safeguarding training so that the can recognise if anyone is at risk of harm. The times for meals has been changed so that people are not rushed and the main meal is served in the evening. Staff say that this is better as people are eating more and starting to put on more weight. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 7 Two shower rooms have been refurbished and other areas cleaned. The garden areas have been landscaped with help of a grant from local authority. There are more nursing beds and pressure relieving devices. And equipment throughout the home is now regularly serviced and maintained. Staff are receiving the training they need to care for people’s complex needs. And they have completed training in safe working practices including moving and assisting and fire prevention. What they could do better: The manager has made many improvements since she took up post. But there is still a lot of work to do. She knows what this work is and has a plan of action to show how these improvements are to be made. Further work is needed on the care plans so that a person centred approach to care can be demonstrated. Handwritten entries on medication charts need to be witnessed to reduce the risk of mistakes when copying complex information. The soft and pureed diets need to look attractive and appealing in order to maintain people’s appetite and nutrition. The menus must be in written or other styles to show what choices there are for each meal and snack. The redecoration must continue where there is damage from wheelchairs and trolleys. There needs to be enough bathrooms/shower rooms for people which need to be suitable for people to use. The extractor fans in toilets and bathroom need to be cleaned and clinical waste put in the proper bags. The home must make sure that there are enough staff on each shift so that everyone’s needs can be met. Comments fro surveys included: “I believe the ratio of dependency to staff should be reviewed.” “More staff are needed for each shift” “Sometimes have to wait to long for attendance regarding the toilet” “It has been known that the staff have told me to wait for the night staff when I ring the buzzer” Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 8 “Enough staff Monday to Friday. Weekends never” “There is a general lack of carers especially at weekends” “The home has difficulties in recruiting staff and retaining their present staff. This has a detrimental effect on residents and their families. Managers remain in post on average twelve months only.” Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 9 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.V361892.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive comprehensive assessments of need which helps them make the right decision about using the service. EVIDENCE: Before anyone is admitted to the home a full needs assessment is undertaken by a Care Manager and the Home Manager. The pre-admission assessments were detailed providing information about people’s health and personal care. The preadmission assessments are used as the basis of the care planning process for each person. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 11 Previously there were instances where the proper pressure care equipment was not available for people on admission. The home has put this right and spare equipment is now available should anyone need it. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although care planning, and access to health care services are good, lack of detail about social care needs means that the home cannot demonstrate that people’s needs are being fully met. EVIDENCE: Each resident has a plan of care based on the admission carried out by care managers, the home manager and where necessary nurse assessors. Staff complete pressure sore risk, dependency, moving and handling, nutritional assessments using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. These tools help the staff understand the level of risk each person and helps them complete a care plan. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 13 Care plans are regularly reviewed and updated according to changes in personal and health care needs. Those who have reduced appetite or low weights are regularly weighed and intervention sought from dieticians. Their recommendations are acted upon and the care plans updated as necessary. Up to date information regarding changes in wound care is documented and regular reviews take place to make sure the home is still meeting their needs. Daily progress records are being completed in more detail regarding daily personal care and activities. However there are still some unclear records. For example, “settled day”, “unable to retain complex information” and “at risk of social isolation”, doesn’t show how staff are giving support and sometimescomplex nursing care to residents. The social care assessments are not detailed and social care plans are not completed. This means that people’s likes, dislikes and previous lifestyles are not always taken into account when planning care. The activities person records what activities people have participated in or otherwise in a separate file and these details are not part of the care planning process. Staff still need to develop care plans to show how peoples previous history and lifestyle affects their current needs and aspirations. Decisions on how care is given are based on health care needs and not on a person centred approach. Everyone has access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. Appropriate pressure relieving devices are available. Several people have air cell mattresses and cushions to prevent pressure damage. Advice is sought from, occupational therapists, speech therapists and continence advisors. Visits from the multi disciplinary team are recorded in individual care plans. The home has comprehensive medication policies and procedures for staff to use. Records are in place for all medicines received, administered and disposed of. An audit of Controlled Drugs and the Medicine Administration Records (M.A.R.) showed no discrepancies. When staff are handwriting directions on the M.A.R. sheets there are not two witness signatures. This would show that the correct directions had been carried out and would reduce the possibility of error. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 14 Comments from surveys included: “They look after X and keep me informed when she is off colour” “The staff have been very good in all aspects of Y’s welfare from basic needs to other health concerns” “Staff are always concerned about my health and call my GP”. Chichester Court Nursing Home DS0000000272.V361892.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are restricted by staffing levels. The menus are only adequately organised and do not show the full choice and variety of food provision. This prevents people from leading full and active lives. EVIDENCE: The home has an activities organiser and activities are planned on a four-week programme. There is also pictorial evidence of events that have taken place both inside and out of the home. These activities include armchair basketball, film nights, and sing longs, reminiscence and one to one. People have also been able to enjoy special events such as Valentines Day and St Patrick’s Day. The activities person records what people have participated in or not in a separate file and these details are not part of the care planning process. Staff still need to develop care plans to show how peoples previous history and lifestyle affects their current needs and aspirations. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 16 Good information about activities and events are displayed in the entrance to the home. None of this is readily displayed in the communal areas so that people can see at a glance what is happening on different days. And information about advocacy is available in the home. Visitors said that they are always welcomed in the home and can share in the care of their relatives. Since the last visit changes have been made to the mealtimes. Breakfasts are now mainly served to people in their bedrooms although a few still like to go to the dining room. Lunch is now a snack with the main meal served in the evening. Staff said this is much better as most people have a full breakfast and prefer a lighter lunch. They also said that now there was very little wastage and people were enjoying their food more and putting on weight. The manager confirmed that the current menus are being changed as they do not provide choices and many of the meals are repeated. They are displayed but are not in a picture style or large print. Nor do they show what alternatives are available. They also do not reflect what people are going to eat, as lunch is dinner and vice versa. The chef keeps records of the meals provided and was able to discuss how food would be fortified for those who have poor appetite or losing weight. None of this provision is recorded anywhere. People who have difficulties swallowing have soft or liquidised food. Some of these meals looked unappetising as the food was blended into a brown mush. The manager and the chef are looking at better ways to present this food. Chichester Court Nursing Home DS0000000272.V361892.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good complaints and protection procedures are in place to ensure that people and their relatives are listened to and protected from abuse. EVIDENCE: There are detailed complaints procedures available in the home, which show how to make a complaint. Records showed that all complaints are taken seriously and are investigated within 28-day time scales. There were complaints and safeguarding alerts raised in the summer of 2007. This resulted in CSCI completing two random inspections and the Company working with the Local Authority Safeguarding Team to put things right. The Company produced an action plan and have resolved the problems. Since then there have been no safeguarding alerts. The manager has received two complaints one of which is resolved and the other is being investigated at home level. Staff have completed safeguarding training with the Local Authority. Chichester Court Nursing Home DS0000000272.V361892.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers a comfortable and well maintained environment for people to live in but some practices could result in an infection control risk. EVIDENCE: The home is a single storey purpose built home, which is close to all local facilities and the sea front. Wide corridors and level access throughout the home make getting around easy for people using wheelchairs. There are several lounges and two dining rooms, which are close to all bedrooms. Inner courtyards offer safe external areas, which are well maintained with seats, and shrubs. The gardens have been improved with the help of a Local Authority grant. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 19 The home was generally clean, tidy and well maintained. All of the bedrooms have an en-suite facility and there are sufficient bathrooms and toilets close to all communal areas. There is wheelchair damage to the walls in the bedrooms, corridors and en-suite toilets. The extractor fans in the majority of bathrooms, shower rooms and toilets were very noisy and have not been cleaned for some time. This means that air is not exchanged within areas such as en-suites and toilets and could increase the risk of cross-infection. The bath panels are broken in the bathroom opposite room 28 and the door does not fit properly. Two shower rooms have been refurbished since the last visit. One bathroom is used as a storage room and contained wheelchairs mattresses, Zimmer frames and other equipment that could not be used. The manager said that one of the bathing areas was to be changed into a store area. This would reduce the required numbers of bathrooms in the home and would therefore, fail to meet national minimum standards to ensure enough bathing facilities are provided in the home. The laundry is opposite the kitchen and separate from bedrooms and communal areas. The home has sufficient laundry equipment all of which was in working order. Laundry staff said they have completed COSSH and Infection control training Some used incontinence pads were not being disposed of in the correct clinical waste bins. This caused odours in some parts of the home. Chichester Court Nursing Home DS0000000272.V361892.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems around recruitment, selection and training of staff are satisfactory but the staffing levels are not sufficient to address the full range of needs of people living in the home. This means that people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: The registered manager is supernumerary and a deputy manager has been employed since the last inspection. Ancillary staff includes domestic, laundress, administrator, maintenance, chef, kitchen assistants and activity organiser. There are two qualified nurses on duty over twenty-four hours with six care staff during the day and three care staff overnight. The majority of the people who live in the home need two staff to support and help them in all aspects of their care. During the two days of the site visit to was evident that the focus of the day was making sure basic needs were met. Two staff had to spend most of one morning helping one person and the other staff were spending the majority of Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 21 their time taking people to and from bedrooms, lounges, dining rooms and toilets. People had to wait some considerable time to be taken to the lounge after lunch and breakfast. The reason for this is people need two staff to be transferred from wheelchair to their destination. Twenty nine people need two staff to help them with all of their care needs whist seventeen need support with their meals. Staff said that it was difficult to find the time to sit and talk to people. Visitors agreed saying it was difficult to find any staff and sometimes their relative had to wait when they needed assistance. More than one relative said there had been problems with staffing due to carers phoning in sick or just not turning up for work especially at the weekends. Comments from the surveys included: “I believe the ratio of dependency to staff should be reviewed.” “More staff are needed for each shift”. “Sometimes have to wait to long for attendance regarding the toilet”. “It has been known that the staff have told me to wait for the night staff when I ring the buzzer”. “Enough staff Monday to Friday. Weekends never”. “There is a general lack of carers especially at weekends”. “The home has difficulties in recruiting staff and retaining their present staff. This has a detrimental effect on residents and their families. Managers remain in post on average twelve months only.” Recruitment procedures are correctly followed to minimise the risks to residents by ensuring proper checks are carried out. There was evidence of completed application forms, two written references, Criminal Record Bureau checks and proof of identity. Personal Identification Numbers (P.I.N.) numbers of qualified nurses are checked with the Nursing and Midwifery Council to make sure nurses are registered. The staff are completing NVQ level 2 training and the 50 target has been reached. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 22 New staff have an induction period, which is over twelve weeks and follows the “Common Induction Standards” from Skills for Care. They are given a “Staff Handbook” which covers all aspects of employment matters and care practice. It also covers areas of equality and diversity and valuing that everyone has a contribution to bring to the home. Staff training has improved with all staff completing Safeguarding training with the local authority. Other training includes moving and assisting, food hygiene, infection control, first aid and fire prevention. Specialist training includes Dementia Care, Swallowing difficulties, wound care, nutrition and care planning. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced to manager the home . Quality assurance and monitoring systems need to be developed so that the home is always run in the best interests of the people using the service. EVIDENCE: The manager has become registered with the Commission. She is a qualified first level nurse who has considerable experience working with older people. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 24 She is very aware of the issues raised in the last reports and from the Safeguarding alerts of 2007.She is working hard to improve the quality of life for the people who live in the home. Staff are being trained to understand a person centred approach to care delivery and this has started to change the culture in the home. Further work is needed to make sure that the views of the people who use the service are listened to and acted upon. The quality monitoring systems are being put in place both externally and internally. Monitoring includes training, medication care planning, and health and safety. At the last relative meeting only one person attended. The Company has put a quality monitoring system in place and the results are collated nationally. The external customer survey comments about the lack of staff. The AQQA was completed and the information gave a reasonable picture of what was happening in the home. Further detail would show how they plan to improve over the next year. Personal monies are held in one joint non- interest making account. A couple of the people have a lot of money and they need to have a personal account so that they can gain interest on their own money. There are individual records for each individual and accounts are reconciled weekly. The home holds a float and two staff signatures are provided for all entries. Accidents are recorded and the manager completes monthly accident analysis to examine and track any trends. Records show that staff have completed training in moving and assisting, infection control, fire prevention, food hygiene and first aid The manager has completed a risk assessment for the laundry and the environment and the fire risk assessment was completed in November 2007. Regular checks are carried out including checks on water temperatures, nurse call and emergency lights. External service contracts are available and up to date Following an Environmental Health Inspection the extractor fans in the kitchen have been cleaned and a new deep fat fryer provided. Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 2 X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 X 3 X X 3 Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 26 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 14,15 Requirement The registered persons must ensure that the care plans set out details of peoples social care needs so that staff can deliver a person centred approach to care. The registered persons must ensure that handwritten entries on medication charts are witnessed to reduce the risk of mistakes when copying complex information. The registered persons must continue with the redecoration programme where there is damage from wheelchairs and trolleys. The registered persons must ensure that the bathrooms are suitable for people to use. There must be a ratio of 1:8 working assisted bathing facilities available in the home. The bath opposite room 28 must be repaired. The registered persons must ensure that the extractor fans in toilets and bathroom are properly maintained. This is to ensure that the air in these areas DS0000000272.V361892.R01.S.doc Timescale for action 01/06/08 2 OP9 13 01/06/08 3 OP20 23 01/09/08 4 OP21 23 01/06/08 5 OP26 13,23 01/06/08 Chichester Court Nursing Home Version 5.2 Page 27 6 OP26 13,23 7 OP27 18 is exchanged reducing the risk of cross infection. The registered persons must ensure that appropriate yellow bags are always used for clinical waste. The registered persons must provide sufficient numbers of staff at all times to meet the needs of individuals living in the home. 01/06/08 01/06/08 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 OP15 Good Practice Recommendations The registered persons must ensure that the catering team provides soft and pureed diets that appear attractive and appealing in order to maintain appetite and nutrition. The menus must show in written or other formats what choices there are for each meal and snack. The registered persons must continue to give clear direction and leadership to the staff so that the home can fully develop. 2 OP32 Chichester Court Nursing Home DS0000000272.V361892.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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