Inspection on 16/01/07 for Chiltern Court Care Home

This inspection was carried out on 16th January 2007.

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

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

Other inspections for this house

Chiltern Court Care Home 12/06/08

Chiltern Court Care Home 22/06/07

Chiltern Court Care Home 06/04/06

Chiltern Court Care Home 08/11/05

Chiltern Court Care Home 17/08/05

Chiltern Court Care Home 13/12/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Chiltern Court Care Home Wendover Road Aylesbury Buckinghamshire HP22 6BD Lead Inspector Christine Sidwell Unannounced Inspection 16th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chiltern Court Care Home DS0000062822.V322773.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. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiltern Court Care Home Address Wendover Road Aylesbury Buckinghamshire HP22 6BD 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) 01296 625503 01296 624482 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Including 3 service users of Forty (40) years or over Bedroom 26a is to be used as a respite room, able to offer flexible accommodation: for example for husband, wife or siblings. The maximum number of service users to be accommodated shall not exceed fifty-three (53). That as of the 24th of October the home is registered to provide Nursing Care for 53 (fifty-three) service users with Physical Frailties. 22nd August 2006 Date of last inspection Brief Description of the Service: Chiltern Court is a care home that provides care for up to fifty-three older people. The home is located on the outskirts of Wendover, adjacent to a large garden centre with a coffee shop and a variety of shopping outlets. Public transport is not easily accessible. The home is a large detached property consisting of a Victorian house with a more recent extension to the rear and has two floors. There is a passenger and stair lift to the first floor. Forty-three bedrooms are single and five are double. Twenty-four single bedrooms and four double bedrooms have en suite facilities. The home has a pleasant garden, which is well maintained. The current scale of charges at the time of writing this report ranged from £472.15- £717.00 weekly. Information about the home can be obtained by visiting or contacting the home Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted over the course of three days and included an unannounced visit to the service. The key standards for older people’s services were covered. Information received about the home since the last inspection was also taken into account in the planning of the visit. Prior to the visit, a questionnaire was sent to the manager with comment cards for distribution to service users, relatives and visiting professionals. Two responses were received. Service users and families were also spoken to on the day of the unannounced visit and a number of phone calls were made to families during the course of the inspection. Discussions took place with the manager, operations manager, nursing and care staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. At the end of the inspection feedback was given to the manager and the operational manager. An immediate requirement was made that the lounge and dining areas be better supervised. Some requirements from previous inspections have not been addressed, causing concern about how the home is run and overseen. Revised timescales are given within the report. In addition the Commission will look at whether further action is necessary, such as enforcement action, to ensure that regulations are complied with. What the service does well: Residents needs are assessed before they move to the home and care managers reports are incorporated where necessary to ensure that the home can meet residents needs. The staff were observed to be kind and caring towards residents. One resident said that on the whole staff are very caring (emotionally) and friendly and supportive. The standard of food is good and the nutritional needs of those who are able to eat independently are met. Residents rooms are homely and they are encouraged to bring some items of furniture and their ornaments with them when they move to the home. Recruitment procedures are thorough ensuring that residents are protected from unsuitable staff. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Information is available to residents in the service users guide although it was not evident that all service users had received a copy. The home should ensure that all residents and their families or representatives have an up to date copy of the statement of purpose and service users guide. The organisation should also be proactive in contacting care managers when care management reviews are due. The registered person must ensure that the changed needs of residents are reflected in the care plan, with up-to-date assessments undertaken to support staff to meet the needs of individuals. Southern Cross Healthcare should review the use of the pressure damage risk assessment tools and the dependency assessment tool to ensure that they work together and staff have a full understanding of both. The registered person must ensure that sufficient staff are available to assist residents with their meals. The registered person must also ensure that residents with swallowing difficulties are supervised when eating and drinking. The lounge/dining areas should not be left unsupervised when residents are in them. The registered person must ensure that bathing facilities are available to residents and if these require upgrading that this is done in a timely way and alternative facilities are made available to residents. Medication is managed safely although the registered nurses were not able to administer medication in a timely way. Medicine rounds took several hours and the mid day round was seen to commence at 14:00 and be completed an hour and half later. Staffing levels are such that residents are not able to exercise their choice as to how they spend their day. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 7 The registered person should ensure that complaints are responded to promptly and the issues raised are dealt with reliably. The registered person must ensure that staff have training in safeguarding vulnerable people with annual updates as necessary. The home as a whole would benefit from a systematic approach to upgrading the facilities if they are to be brought to the standard of the Southern Cross Group as a whole. Control of infection practices must be improved to protect residents from the risk of acquired infection. The staffing levels are poor and staff have had insufficient training to ensure that they have the knowledge and skills necessary to meet the needs of residents. The staffing levels and training should both be improved. However it is not clear that Southern Cross have an overall development plan for the home, which identifies clear targets for improvement of both the environment and the service offered to residents. This should be shared with the Commission for Social care Inspection 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. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to residents in the service users guide although it was not evident that all service users had received a copy. Residents needs are assessed before they move to the home and care managers reports are incorporated where necessary to ensure that the home can meet residents needs. EVIDENCE: Information about the home is held in the statement of purpose, which has been updated. There is a service users guide, a copy of which is in the main entrance. The care of five residents was case tracked. Each care file has a section where the fact that residents had received a copy of the service users guide is to be recorded. This was recorded in three of the files seen. Two residents had a copy in their rooms. Three of the families phoned could not Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 10 remember having seen either a copy of the statement of purpose or the service users guide. The files of the residents who were case tracked had evidence that their needs had been assessed prior to their moving to the home. There was also evidence that care managers reports were available in some but not all files. Not all residents had been reviewed by their care manager on an annual basis and it is recommended that the home is proactive in this matter and contact care managers when reviews are due. It was not checked at this inspection whether the home had written to all service users to confirm that they could meet their needs. This will be checked at the next inspection. In the meantime it is recommended that the home ensure that this is done. The home does not offer intermediate care. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents personal and healthcare needs are not met in full. The care plans have improved since the last inspection but they do not yet contain the detail necessary to ensure that staff have all the information they need to care for residents. Although the standard of the cooking is good, residents nutritional needs are not met due to a lack of staff at key times during the day to assist them. Medication management has improved and residents receive their medication in a safe but not necessarily timely way. EVIDENCE: In general residents were helped with their hygiene needs. Both bathrooms on the top floor had been unusable for several months and most residents had not been bathed or showered in that time. One resident said that she had not had a bath for weeks saying that the carers are very good and give me a good wash in bed although it is not as good as a bath or shower. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 12 On the first day of the inspection the manager said that she had been given permission to upgrade one bathroom although by the second day of the inspection she was told that one bathroom could be converted into a shower room and the other would be upgraded to take a hoist. Both bathrooms were being repaired on the second day of the inspection. The care plans recorded that most residents had had a wash in bed or in their rooms and had not had a bath or shower for several weeks. Where key facilities require upgrading Southern Cross Healthcare must ensure that this is done in a timely way and alternative facilities are provided in the meantime. The residents whose care was tracked had care plans which in general were detailed and contained information about residents care needs. All those seen had had risk assessments undertaken to assess their risk of developing pressure damage, nutritional problems and risk of falling. Moving and handling needs and continence needs had been assessed. Although the needs had been assessed the assessment did not always appear to reflect the residents real level of need. One lady had been assessed as not requiring help with eating and drinking. She was observed at lunch when her meal was placed in front of her. She took no interest in it and at one stage put her glass on the plate. After 30 minutes the meal was taken away and a pudding given. She was then given a glass of ensure, meal replacement drink. No help was given at any stage. Nothing had been recorded on the intake monitoring chart since the day before. The staff spoken to said that nine people in the ground floor lounge needed help with eating and three in rooms on the ground floor. At the time of the inspection there were only three members of staff available to do this. The lounge dining rooms were observed to be left unattended at times when residents had food and drink in front of them. Several had swallowing difficulties. This places residents at risk of choking and an immediate requirement was made that residents are supervised at all times when they are eating and drinking. One resident whose care was tracked had a chest infection and had been prescribed antibiotics. These had been commenced promptly. His care plan had not been updated to reflect this although the staff were aware of his condition. He had had a nutritional assessment which showed he was at high risk of nutritional deficiency. A plan of care had been written. However the daily entries indicated that he had eaten little and had lost 4.2 kgs over 5 months. The care plan was not updated to reflect this. Residents risk of developing pressure damage is measured. Southern Cross Healthcare have implemented a new tool and the staff had not been trained in its use. There was some confusion as to the relevance of the grading, which is different from the most commonly used tools. The overall dependency tool had not been amended to reflect the scores generated by the new tool and therefore an inaccurate picture of residents dependency needs and risk of developing pressure damage is given. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 13 There was evidence to show that residents are seen by a doctor regularly and that the chiropodist and optician visit the home regularly. The qualified nurses spoken to had a good understanding of residents needs but were seen to be very busy throughout both days of the inspection, particularly on the ground floor. The staff were seen to be speaking politely and respectfully to residents. Residents were wearing their own clothes, which were in a good state of repair. Medication was managed satisfactorily. There are policies and procedures in place. The staff said that no medication is administered covertly and that if a resident refused medication that was considered essential the doctor and family would be informed and a way forward agreed as a multidisciplinary team. Records were kept of medication entering and leaving the home. The medication administration charts were correctly completed. Controlled drugs are stored correctly and the records were checked and found to be accurate. There was evidence to show that the home manager audits medication administration on a monthly basis and that the audit had shown an improvement in medication management. However the time taken to complete the medication rounds meant that residents were not always receiving their medication in a timely way. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are such that residents are not able to exercise their choice as to how they spend their day. The standard of food is good and the nutritional needs of those who are able to eat independently are met. They may not be met for those who require assistance. EVIDENCE: The home has not had an activities coordinator since October 2006. A new activities coordinator was starting on the day of the inspection and was undertaking her induction. She had spent sometime with the activities coordinator of another local home. The residents spoken to said that there was little to do although they had enjoyed the Christmas activities. The activity coordinator had plans to introduce a range of activities for groups and individuals. Leisure interests were recorded in some care plans but not all. The service users spoken to said that they did not really have a choice as to when they went to bed or got up as the staff were so busy. One resident said that she didn’t dare say no as if she did the staff would be long time before they were able to return to her. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 15 The statement of purpose and service users guide makes it clear that relatives and friends are welcome at any time and the relatives who were spoken to confirmed this. The meals were of a high standard although staffing levels at meal times meant that some residents were not able to take advantage of this. This is discussed in the health and personal care section of this report. Those residents who were able to eat independently said that they enjoyed their food. The chef was spoken to. She has a varied menu and was aware of resident’s preferences and was able to provide meals to meet resident’s cultural and religious needs. Chiltern Court Care Home DS0000062822.V322773.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The complaints procedures are not implemented within the timescales set by the company, issues are not always resolved and families feel that their concerns are not always addressed. Residents would be better protected if all staff were to have training in protection of vulnerable people with regular updates. EVIDENCE: There are complaints, whistle blowing and protection of vulnerable adult policies and procedures in place. Southern Cross Healthcare has investigated a number of complaints although their own response timescales were not met. Complaints have also been made that the stair lift leading to a small annex with three rooms was not working and residents were sometimes trapped in their rooms. Although the complaint had been responded to it was not responded to within the timescales. On the day of the inspection the lift was working although one footplate had broken making it difficult to get wheelchairs and trolleys on and off. One family member spoken to said that whilst the manager and staff were very helpful it was difficult to get other managers in Southern Cross Healthcare to understand the problems. One family member said that s/he had complained about the lack of staff and had occasion to intervene to prevent an elderly gentleman from falling in the day room. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 17 The staff spoken to said that they have had Protection of Vulnerable Adult training. The training records showed that whilst most staff had the training under the umbrella title resident welfare it had not been updated on an annual basis. The operations manager, home manager and training manager agreed additional programmes to ensure that all staff had had this training. The operations manager agreed that sufficient staff would be available to release staff for this training. Chiltern Court Care Home DS0000062822.V322773.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, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents rooms are homely although the home as a whole would benefit from a systematic approach to upgrading the facilities if they are to be brought to the standard of the Southern Cross Healthcare Group as a whole. Control of infection practices must be improved to protect residents from the risk of acquired infection. EVIDENCE: The building is elegant Edwardian building which has not in the past benefited from a regular programme of repairs and maintenance. This is now being addressed and some repairs have been started. Two bathrooms on the top floor are to be refurbished, as are the kitchenettes in the lounges. Leaking gutters have been replaced. The stair lift between the top floor and the annex remains unreliable. Carpets have been washed and some carpets have been replaced. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 19 The corridors do not have handrails and the refurbishment of the bathrooms has not had the benefit of occupational therapy advice to ensure that the refurbished rooms meet the needs of the elderly or those with disabilities. Not all toilets had raised seats or handrails to assist residents. The décor is shabby in parts. There is a need to agree an overall development plan for the home, which describes how the deficiencies in the environment will be addressed over a period of time. There is also a need to ensure that any refurbishment is undertaken with the advice of specialists in the provision of facilities for those with disabilities. Residents are encouraged to bring in their own furniture and ornaments and resident’s rooms were by and large homely. One resident said that she had been able to create her own little world in her room and had everything she needed around her. There are control of infection policies and procedures in place although the staff had not had training in infection control. This was to be arranged shortly. One carer was observed carrying sheets along the corridor to the sluice areas without an apron and not carrying them in a laundry bag as is recommended. Hoist slings are shared between residents. This is contrary to the guidance given by the Department of Health in its guidance published in June 2006. A copy of the guidance was left in the home. Chiltern Court Care Home DS0000062822.V322773.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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing levels are poor and staff have had insufficient training to ensure that they have the knowledge and skills necessary to meet the needs of residents. Recruitment procedures are thorough ensuring that residents are protected from unsuitable staff. EVIDENCE: A staff rota is maintained. The staff list showed that there are eleven qualified nurses permanently employed and one qualified nurse employed on a bank contract. There were fifteen care assistants. Families have raised concerns at relatives meetings about the shortage of care staff and there was evidence to show that care staff is working additional shifts to cover the rota. At the last inspection a requirement was made that the home operate within the staffing notice agreed with nursing homes on registration. Southern Crosss own documentation shows that the staffing notice required four carers on the ground floor during the day and two at night. Four carers were required on the first floor rising to 5 carers when occupancy was 27 and 28 residents with two at night. An action plan with a letter from the Operations Director was received on the 30th October 2006 stating that the home operates within the staffing notice. Evidence from the rotas and on the day of the inspection show that this is not the case. There are only three carers on each floor during the day and only one on the ground floor at night. There is evidence described in Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 21 the health and personal care section of this report, which shows that residents were not always supervised. There are 13 carers at present two of whom hold the National Vocational Qualification in Care at Level 2 vocational Qualification in Care. There are also a number of overseas staff who hold qualifications in their own country. Southern cross Healthcare are at present verifying whether these qualifications can be seen as equivalent. The home does not at present meet the standard that 50 of staff hold this qualification. The recruitment files of six members of staff were checked. All had the required documentation to show that the staff members identity had been checked and that references and Criminal Records Bureau disclosures had been undertaken before the staff member commenced work. Staff have contracts of employment, job descriptions and a staff handbook. Interview records are kept. The staff training records had not been kept up to date and the manager was in the process of seeking information from staff as to their level of training and updating existing records to ensure that all staff have the basic mandatory training, with annual updates when necessary. There was evidence that some specialist training had been undertaken although details as to who had attended had not been yet been recorded. Two of the staff records seen had records to confirm that the staff member had had completed an induction programme. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 22 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, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements have improved with the appointment of a permanent manager in October 2006, which residents and their families appreciate. However it is not clear whether Southern Cross Healthcare have an overall development plan for the home which identifies clear targets for improvement of both the environment, staffing levels and training and the service offered to residents. Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 23 EVIDENCE: The manager was appointed to the home in October 2006 following a period without or with an interim manager. The staff spoken to said that they had confidence in the manager and were pleased to have a permanent manager. She is in the process of registering with the Commission for Social Care Inspection. There is no written development plan for the home although a number of baseline audits have been undertaken. Southern Cross Healthcare have a quality assurance programme, which is being introduced to the home. The programme includes regular audit of care plans, medication and care standards. Quarterly meetings are held with relatives, the last one being held on the 11th December 2006. Residents raised a number of concerns, which were answered in part, although not all their concerns were addressed. Relatives raised a number of concerns, which were also found to be of concern at this inspection. Records were available in the home to show that the operations manager, in line with Regulation 26 of the Care Homes Regulations 2001, undertakes quality assurance visits. Southern Cross Healthcare hold personal allowance for 28 of the 45 residents. This is banked in a separate no interest account. Some cash may be held in the home on behalf of residents. The accounts for three residents selected at random were checked and found to be correct. There are safes on each floor for staff to deposit money or valuables, which are given out of hours. Receipts are given. There are plans to introduce regular staff supervision and appraisal in the home although these have not yet been implemented. The pre inspection questionnaire showed that regular maintenance of equipment is undertaken and records to verify this were seen in the home. Not all staff have had the basic mandatory health and safety training with annual updates and this is being arranged at present. Care staff have not had infection control training. Staff do not have first aid training. The lack of staff training on basic health and safety topics must be addressed. There are generic risk assessments in place although these have not been updated since 2004. They are also stored in the managers office and may not therefore be available to all staff. A fire risk assessment was undertaken in November 2006. Fire drills are held regularly and there was evidence to show that fire alarm checks are undertaken regularly. The last fire drill was held on 5/01/07. Chiltern Court Care Home DS0000062822.V322773.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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X 2 X 1 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 2 Chiltern Court Care Home DS0000062822.V322773.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 14 (2) Requirement The registered person must ensure that the changed needs of residents are reflected in the care plan, with up-to-date assessments undertaken to support staff to meet the needs of the individual. This is an unmet requirement of previous inspection report and a new timescale has been set. The registered person must ensure that sufficient staff are available to assist residents with their meals. The registered person must ensure that residents with swallowing difficulties are supervised when eating and drinking. The registered person must ensure that bathing facilities are available to residents and if they require upgrading that this is done in a timely way and alternative facilities are made available to residents. The registered person should ensure that it is possible to meet DS0000062822.V322773.R01.S.doc Timescale for action 31/03/07 2 OP8 12(1) and 18(1) 13(4)c 14/02/07 3 OP8 14/02/07 4 OP22 23(2)j 14/02/07 5 OP15 12(2) 28/02/07 Chiltern Court Care Home Version 5.2 Page 26 6 OP16 22(4) 7 OP18 13(6) 8 9 OP26 OP26 16(2)j 16(2)j 10 OP27 18 (1) a 11 OP30 18(1)c 12 OP36 18(2) 13 OP38 13(4) residents choices as to when they get up and go to bed. The registered person should ensure that complaints are responded to promptly and the issues raised are dealt with reliably. The registered person must ensure that staff have training in safeguarding vulnerable people with annual updates as necessary The registered person should ensure that staff have infection control training. The registered person should ensure that residents to not share hoist slings to protect them from the risk of cross infection. The registered person should ensure that the homes staffing levels do not fall below those stipulated in the staffing notice and are sufficient to meet the assessed needs of residents and to supervise them to ensure that they do not come to harm. This is an unmet requirement of previous inspection report and a new timescale has been set. The registered person must ensure that all staff have an induction programme and basic mandatory training with annual updates where necessary. Records must be kept to verify this. The registered person should ensure that a system of staff supervision and appraisal is implemented and rolled out to all staff. The registered person should ensure that there is a qualified first aider on each shift. DS0000062822.V322773.R01.S.doc 28/02/07 30/06/07 30/06/07 31/03/07 28/02/07 30/06/07 30/06/07 30/06/07 Chiltern Court Care Home 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 OP1 Good Practice Recommendations The registered person should ensure that all residents and their family or representative have an up to date copy of the homes statement of purpose and the service users guide. The registered person should ensure that the home confirms in writing to residents that they can meet their assessed needs. The registered person should ensure that the home is proactive in contacting care managers when residents reviews are due. Southern Cross Healthcare should review the use of the pressure damage risk assessment tools and the dependency assessment tool to ensure that they work together and that staff have a full understanding of both. Service users leisure activities should be recorded and that a programme of group and one to one activities be implemented. It is recommended that a programme to enable staff to obtain the National Vocational Qualifications in Care be established. It is recommended that a development plan be developed with clear targets for the improvement of the staffing levels and training, environment and service offered to residents. It is recommended that the registered person review the health and safety systems in the home to ensure that they are fully implemented and up to date. 2 3 4 OP3 OP3 OP8 5 6 7 OP12 OP28 OP33 8 OP38 Chiltern Court Care Home DS0000062822.V322773.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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. Extracts may not be used or reproduced without the express permission of CSCI Chiltern Court Care Home DS0000062822.V322773.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!