Inspection on 25/11/08 for Chichester Court Nursing Home

This inspection was carried out on 25th November 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.

Other inspections for this house

Chichester Court Nursing Home 25/03/08

Chichester Court Nursing Home 26/02/07

Chichester Court Nursing Home 22/08/06

Chichester Court Nursing Home 14/12/05

Chichester Court Nursing Home 20/07/05

Chichester Court Nursing Home 22/02/05

Chichester Court Nursing Home 09/08/04

Similar services:

The Highlands

Turret Villa Retirement Home

Moor House

Blenheim House

1 Lanark Close

Mendip House

Beaconsfield Court Care Home

Ann Charlton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

CARE HOMES FOR OLDER PEOPLE Chichester Court Nursing Home Chichester Road South Shields Tyne And Wear NE33 4HE Lead Inspector Irene Bowater Unannounced Inspection 25th November 2008 08:15 25/11/08 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.V373105.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.V373105.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) Manager post vacant 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.V373105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th March 2008 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.V373105.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 visits on 25 March and 24 April 2008. 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. Annual Quality Assurance Assessment (AQAA). The AQAA gives CSCI evidence to support what the home says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Visit: An unannounced visit was made on the 25 November 2008. This visit was carried out by one Inspector and took eight and quarter hours to complete. During the visit we: Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 6 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 a sample of 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 visit We told the manager what we found. What the service does well: The staff collects information together about the person before anyone moves into the home to make sure they can meet their needs. Staff talk with a range of healthcare professionals to make sure that the health and well being of people living in the home is regularly assessed to make sure their needs are being met. Staff are respectful and sensitive with people when helping them or when speaking to them. Visitors are always welcomed and there are links with the local community. A programme of activities is available so that people can enjoy social and leisure events. 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. 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. Staff have completed Safeguarding training so that the can recognise if anyone is at risk of harm. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 7 There are more nursing beds and pressure relieving devices. And equipment throughout the home is 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. Comments from surveys included: “Staff listen and there are always activities that I can take part in” What has improved since the last inspection? What they could do better: The quality of the care planning needs further improvement and all additional records need to be completed in detail. Care plans need to be reviewed and brought up to date. Information about peoples past lifestyles and choices need to be written down so that staff can continue to support them or help them access help from others. Medication policies and procedures need to be followed so that people receive their medicines safely. Mealtimes need to be reviewed so that people can have their meals at a convenient time to them. This will also make sure that individual’s nutritional needs are being met. Comments from surveys included: “Prefer main meal in the evening”. “They provide alternatives.” Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 8 The manager should develop strategies so that people living in the home and their relatives feel that their views are always taken seriously. There needs to be a redecoration programme to make sure damage to walls and paintwork throughout the home is put right. Some of the lounge chairs and recliner chairs need to be replaced. The bedroom carpets, which are stained, need to be replaced. The home must make sure that there are enough staff on each shift so that everyone’s needs can be met. Comments from surveys included: “Staffing levels need to be improved.” “Staff shortages at weekends.” “Usually have to wait a long time for help.” There needs to be a stable consistent management so that staff feel confident that they will be able to meet people’s needs in a professional manner, taking the principles of a person centred approach to care into account. The new manager should progress with her application to become registered with CSCI. 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.V373105.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.V373105.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.Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive clear information about the service and good assessments of need before admission. This helps them make the right decision about using the service. EVIDENCE: The Company have a Dependency Assessment Rating Tool (DART) assessment document that includes areas specifically about the needs of people who have dementia, challenging behaviours, learning disabilities, physical disability and other complex health care needs. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 11 Before anyone is admitted to the manager or senior nurse completes a full needs assessment and also makes sure that a care plan from the Care Manager and nurse assessor is available. These assessments are used as the basis of the care planning process for each person. Care plans showed that these were completed in detail and information from other professionals used so that the staff can start to complete care plans based on individual needs and wishes. Chichester Court Nursing Home DS0000000272.V373105.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. Access to health care is satisfactory, but lack of detailed care planning and other recording does not demonstrate that peoples’ needs are being fully met. EVIDENCE: Each person has a plan of care based on the admission assessment which has been carried out by care managers, the home manager and where necessary nurse assessors. Staff completes pressure ulcer 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. The care plans examined were completed to different standards. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 13 One care plan written in May 2007 had not been updated monthy. It states that “can walk short distances” then “needs stand aid and sling “and further details state, “none weight bearing”. Comments are for this person to reach “optimum level of mobility”. The plan has not been updated since the catheter was taken out. However records show good catheter care history. The continence assessment was last completed in January 2008. This person is at risk of weight loss and dehydration and the care plan does stress the importance of maintaining a stable weight. There is information about providing Fortisips, Crèmes and stage one thickened fluids. This person’s weight had not been recorded since August 2008 and progress records were not detailed about food and fluid intake, for example, “prompted and encouraged to eat”. Another care plan showed that a full assessment and initial care plan had been completed. This persons weight is increasing but care plan does not include the details about fortified foods provided. Good wound care records with body maps and input from the TVN are recorded in the care plans. Staff 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. Care plans were not in place to show how staff how they should support and manage behaviours that may be difficult. For example one person was “told not to do it again” and another plan states “re orientate as there are difficulties with memory comprehension” Daily progress records are being completed regarding daily personal care and activities. However there are still some unclear records. For example, “settled day”, “unable to retain complex information”, “maintain optimum level of mobility” and “at risk of social isolation”. This information doesn’t show how staff are giving support and sometimescomplex nursing care to the people living in the home. Many people have food and fluid charts to record their daily intake but they are not completed at the time food and drink was offered. If staff do not accurately record what people have had to eat and drink there is no guarantee that individual nutritional needs are being met. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 14 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, Speech and Language Therapists (SALT), Psycologists.Occupational Therapists, (OT) Tissue Viability Nurses (TVN) dentists, opticians and chiropody services. Appropriate pressure relieving devices are available. Several people have profiling beds, air cell mattresses and cushions to prevent pressure damage. Advice is sought from other professionals and this information is recorded in the 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 showed no discrepancies but there were some gaps on the Medicine Administration Records (M.A.R.) Although there was no excess stock of medication there was a huge stock of Thick and Easy, Forticreme’s and puddings 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. The staff worked very hard to make sure everyone was treated with respect and their rights to privacy and dignity maintained. Chichester Court Nursing Home DS0000000272.V373105.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 still restricted by staffing levels and mealtimes are only adequately organised. 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 Halloween and are looking forward to the planned Christmas activities. 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 Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 16 still need to develop care to show how peoples previous history and lifestyle affects their current needs and aspirations. Good information about activities and events are displayed in the entrance to the home. And information about advocacy is readily available. People have been encouraged to bring small items with them. This makes individual bedrooms personalised and reflective of their lifestyles. The timing of meals have again been looked at and changed. At the last visit breakfast was being served in individual’s rooms, lunch was a light meal and the main meal was in the evening. They have now gone back to providing the main meal at lunchtime with the lighter meal in the evening. On the day of the visit people were having a full English breakfast between 9am and 10:30 am. They then had hot drinks and biscuits before being provided with lunch consisting of choices of liver and onions or mince cobbler with cauliflower, broccoli and potatoes followed by bread and butter pudding and custard or fruit salad. There was lot of wastage as people were still full after the breakfast meal. Menus are being reviewed but generally no one knew what was available for the any of the meals. Staff were working extremely hard to make sure everyone was given support and assistance. Some people had to wait for help, as there was not enough staff available to give individual support. Comments from surveys included: “Less dinners with chips.” “Prefer main meal in the evening”. “Sometimes cold or dry and tasteless.” “Staff do try to provide alternatives.” Chichester Court Nursing Home DS0000000272.V373105.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 and effectively followed to ensure that people and their relatives are listened to and protected from harm. EVIDENCE: The Company has a comprehensive complaints procedure, which is displayed in all areas of the home. It is also available in the Service User Guide, which is available in reception. There is a complaints book which shows that all complaints and concerns are taken seriously and there is written evidence of investigations and outcomes. There have been three complaints since the last visit to the home. The majority of the complaints were about individual people’s care. They were recorded in detail and demonstrated thorough investigation and responses to people’s concerns. There was evidence of follow up action being taken by the management of the home as a result of complaints being upheld. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 18 Comments from surveys include: “I know how to complain but it falls on deaf ears.” “Staff listen to what I say.” “Some don’t seem to care.” The Commission for Social Care Inspection are aware of three Safeguarding alerts that have been investigated by the Company and the Local Authority. These have now been resolved. Staff have completed safeguarding training which links into the Local Authority Framework. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22.24.26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable and safe but further investment is needed to make sure it remains an attractive and homely place to live. 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.V373105.R01.S.doc Version 5.2 Page 20 There is some damage to walls and paintwork throughout the home from the constant use of wheelchairs and trolleys. The communal areas are generally well kept, however the lounge chairs are grubby and some have drink spillage, which had not been cleaned up. There is also damage to some of the chairs that are split. There is a designated smoking room for people living in the home to use. This was generally messy with ash on the carpet, cigarette burns and stale smell from cigarettes. Since the last visit the extractor fans have been cleaned and bathrooms and showers repaired. One bathroom is to be converted into a shower room. 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, and en-suite toilets. Some of the bedroom carpets are stained, have an odour and it was confirmed that these are due to be replaced with flooring that is easier to maintain. The laundry is separate from all communal areas. There is sufficient equipment that is in working order. Sluices were kept locked and were free from any odour. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 21 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 and selection of staff are satisfactory but staffing levels only adequately meet the range of needs of the people using the service. This means that people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: The home has had several managers over the last few years. The registered manager had been in post for a year and then transferred to another home within the Company. The deputy manager was completing her notice period. A new manager has been appointed and she has only been in post since August 2008. On the day of the visit there were forty-three people living in the home. There were three nurses on duty with four carers. One carer had phoned in sick that morning. Overnight there is one nurse and four care staff on duty. The off duty showed that there are often staff shortages due to people either phoning in sick at the last moment or just not turning up for their allocated duty. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 22 The manager is supernumerary and ancillary staff includes domestic, laundress, administrator, maintenance, cook, kitchen assistants and activity organiser. During the visit it was evident that the focus was to make sure people’s basic care needs were met. Qualified nurses spent the majority of their time giving out medication leaving care staff to assist people from their bedrooms to dining rooms for breakfast then back to toilets, bedrooms and lounges for the rest of the morning. Many people had to wait some considerable time to be made comfortable, as most people require two staff to transfer them using a hoist and appropriate sling. This task was then repeated for the lunchtime meal. Staff said it was difficult to find time to sit and talk to anyone and visitors said it was “always very busy” and staff are “run off their feet”. Comments from the surveys included: “If the full staff are on you get better care but usually short staffed.” “Due to staff shortages you have to go looking for them.” “Staffing levels need to be improved.” “Staff shortages at weekends.” “Usually have to wait a long time for help.” Recruitment procedures are correctly followed to minimise the risks to those living in the home. 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. New staff 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. Mandatory training includes, moving and assisting, food hygiene, infection control, first aid and fire prevention. Specialist training has included Dementia Care, Swallowing difficulties, wound care, nutrition and care planning. Chichester Court Nursing Home DS0000000272.V373105.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. Without consistent management there is a lack of leadership and guidance, which means there is only adequate quality assurance systems in place and people may be placed at risk. EVIDENCE: This home has had problems retaining managers. The previous manager worked at the home for a year before transferring to another home within the Company. Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 24 The constant changes in senior staff result in staff being unsure what is expected of them and then doing what they think is right. This means the focus is on the task, getting the job done without looking at the individual needs of those using the service. A new manager was appointed in August 2008.She is a first level RGN with many years experience as a nurse and in management. Since coming into post she has started to improve communication between people living in the home, their relatives and all of the staff team. Meetings are being held and the manager has introduced an “open door” policy where people can go and discuss any concerns that they may have. She is also aware of the previous issues especially about staffing attitude, numbers and providing a “person centred approach” to care. And she has stared to audit all aspects of the service so that improvements can be made. It gave a reasonable picture of the service and information about how it plans to develop over the next year. Personal monies are held in one joint non- interest making account. 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. Records show that the required monthly and weekly checks for water temperatures, Legionella, nurse call system, emergency lighting and fire checks have been completed. External maintenance contracts are up to date. Chichester Court Nursing Home DS0000000272.V373105.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 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Chichester Court Nursing Home DS0000000272.V373105.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 15 Requirement The registered persons must ensure that all care plans are brought up to date and updated to reflect the changing needs of individuals. This includes social care plans. This will mean that staff have the right information to provide individual care and support to the people living in the home. The registered persons must ensure that they maintain people’s health. People’s psychological and nutritional health status must be monitored and any changes recorded and updated in care plans. Fluid balance and food charts must be completed in detail to evidence practice. This will mean that people are kept properly hydrated and their nutritional health maintained. The registered persons must ensure that excess stock of fortified prescription medication is returned to the pharmacy. Handwritten entries on medication charts must be witnessed to reduce the risk of DS0000000272.V373105.R01.S.doc Timescale for action 01/02/09 2 OP8 14,17 01/02/09 3 OP9 13,17 01/02/09 Chichester Court Nursing Home Version 5.2 Page 27 4 OP15 12,16 5 OP19 23 6 OP20 16,23 7 OP21 23 8 OP24 16,23 9 OP27 18 10 OP33 24 mistakes when copying complex information. This will also make sure medications are stored properly. The registered persons must ensure that people living in the home receive a balanced diet that is suited to individual need at times convenient to them. The registered persons must ensure that there is a routine programme for the renewal and redecoration of the home. The registered persons must replace the torn reclining chairs and redecorate and clean the smoking room. The registered persons must ensure that the damage to walls and paintwork in bathrooms, toilets and en suites is repaired and redecorated. The registered persons must ensure that the stained smelly carpets in bedrooms are replaced. The registered persons must ensure that at all times suitably qualified, competent and experienced persons at working at the care home in such numbers as are appropriate for the health, safety and welfare of people living in the home. Timescale of 25/03/08 not met. The registered persons must maintain and develop systems of evaluating all aspects of the service and take the views of people using the service into account. 01/02/09 01/04/09 01/05/09 01/06/09 01/06/09 01/01/09 01/04/09 Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP15 OP16 OP31 Good Practice Recommendations Menus should offer choices of all meals, which are readily available and written in a style understood by the people living in the home. The manager should develop strategies so that people living in the home and their relatives feel that their views are always taken seriously. The manager should progress with an application to become registered with CSCI Chichester Court Nursing Home DS0000000272.V373105.R01.S.doc Version 5.2 Page 29 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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