Inspection on 17/08/05 for Chiltern Court Care Home

This inspection was carried out on 17th August 2005.

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 16/01/07

Chiltern Court Care Home 06/04/06

Chiltern Court Care Home 08/11/05

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 Joan Browne Announced 17th and 18th of August 2005 9:30am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Chiltern Court Nursing Home Address Wendover Road, Aylesbury, Buckinghamshire, HP22 6BD Telephone number Fax number Email 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 Ashbourne (Eton) Ltd Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Chiltern Court Care Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 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 variey of shopping outlets. Public transport is not easily accessible. The home is a large detached property consisting of a Victorian house with an extension to the rear, which consists of two floors. There is a passenger and stair lift providing access to the first floor. Forty-three bedrooms are single and five are double. Twenty-four single bedroms and four double bedrooms have en suite facilities. The home has a pleasant garden to the front of the property, which is well maintained. Chiltern Court Care Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection that took place on the 17th and 18th August 2005. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector). The inspection consisted of examining a number of records including assessments, care plans, and medication administration record (MAR) sheets. A tour of the building was undertaken and lunchtime was observed on the two units. Several residents and relatives were spoken to. Residents and relatives completed comment cards. Overall residents were satisfied with the care that they were receiving and felt safe living in the home. Relatives were also satisfied with the provision of care however, some concerns were raised about the food menu, staffing levels and some staff not being able to communicate effectively with residents. On the whole their comments were favourable and they felt that the head of care had been responsive to concerns raised and was trying to put ‘things right.’ All the requirements from the previous inspection were discussed. The timescales for those requirements not met have been extended. It is important that the proprietor and manager take these new timescales seriously as these will be followed through at a further visit. Further failure to comply with Regulations may result in the Commission consulting its legal department, with a view to considering enforcement action. What the service does well: What has improved since the last inspection? The home has appointed a general manager, a dynamic care manager and housekeeper manager, a maintenance person and an assistant chef. Areas of the environment have improved, with redecoration, pictures and the purchase Chiltern Court Care Home Version 1.10 Page 6 of furniture for lounges adding to the ambience. Care plans have improved. Quality audits have been introduced. Residents are being weighed monthly. The culture in the home has improved. Nutritional standards have improved. Hygiene and cleaning standards in the home have improved. There has been more training and ongoing support from health professionals. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chiltern Court Care Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chiltern Court Care Home Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 The home’s Statement of Purpose and Service User’s Guide provide sufficient information for prospective residents to be clear about the services the home provides to meet their needs. The home has an effective assessment procedure to ensure that prospective residents’ needs are identified. EVIDENCE: The organisation has produced a Statement of Purpose and Service User’s Guide. The contents in the documents reflect the standard and have been agreed by the Provider Relationship Manager for the Commission. Two assessments of needs were studied and contained detailed information. Some needs identified were reflected in the individuals’ care plans. For example, it was noted in one particular resident’s care plan that staff had described repeated phone calls to ensure an assessment for a wheelchair was followed through. The wheelchair had arrived and this was recorded. It was noted that nutritional and Braden assessments were in place. Chiltern Court Care Home Version 1.10 Page 9 The home has acquired a number of aids and adaptations such as pressure relieving mattresses and cushions from the Primary Care Trust. Staff and senior managers described a significant amount of training relating to the care documentation that had taken place, which it is hoped will further facilitate meeting residents’ needs. Senior managers described continuing support from other health professionals to meet residents’ identified needs. The Commission received positive feedback from a health care professional who has been supporting the home. Chiltern Court Care Home Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Overall there has been an improvement in care plans however, not all care plans examined contained all of the necessary information to enable staff to meet residents’ care needs. Care plans examined indicated that residents’ health care needs were being met adequately. However, protocols relating to diabetes could be strengthened to include monthly blood pressure checks. There are still inconsistencies in the medication administration identified in the body of the report, which have the potential to place residents at risk. EVIDENCE: There has been a considerable improvement in the care plans since the last inspection. This process has been influenced and developed by the care manager’s ideas and practice. Five care plans were examined and information recorded was detailed and incorporated staff’s good practice. For example, the following was noted in a particular resident’s care plan: ‘Ensure call bell is within reach.’ ‘Encourage pointing and gestures as recommended by the speech therapist.’ Chiltern Court Care Home Version 1.10 Page 11 Residents’ comments were included in plans examined, which indicated their involvement in the processing of the care plan. Residents’ likes and dislikes were recorded. The following was noted: ‘Likes English food’. Life stories were completed for individuals. In a particular resident’s care plan relating to catheter care a clear process was noted for staff to follow. However, it was noted in the daily evaluation sheet for a particular resident that the individual’s appetite was poor. An entry was noted in the daily log that the individual had refused lunch and had only drunk a glass of orange juice. There was no written action recorded of staff’s duty of care to indicate that alternative food supplement had been offered. A care plan had not been developed with an action plan outlining how the individual’s poor appetite should be managed. It was noted that some residents were being nursed in bed. Care plans had not been developed to reflect this. For example, there was no written record how often individuals should be checked and what daily activities were in place to stimulate these residents. It is acknowledged that fluid and turning sheets were in place. It was noted that entries recorded in some care plans were scribbled out. Staff are reminded that if errors are made a line should be drawn through the entry and the entry should be re-written. Some care plans were not signed and dated by the authors. The care plan for a resident with the condition of diabetes was examined. A clear protocol was in place to assist staff to care for the resident. It is recommended that care plans relating to diabetes should include that individuals should have their blood pressure taken every month and records maintained as a good practice. It was noted that nutritional risk assessments were in place and residents’ weights were being monitored monthly. Clear protocols were in place for residents on peg feeds. All residents are registered with a general practitioner who visits the home weekly and when required. Chiropody, dental and optician treatment is available to residents and specialist treatment is accessible via the general practitioner. The home had participated in a special project to promote residents’ health and welfare. Positive comments were received from a health care professional who felt “the staff team seem to take nutrition seriously.” Chiltern Court Care Home Version 1.10 Page 12 The medication administration record sheets (MARS) on both floors were examined. Gaps were noted on some sheets. The blister packs were checked and it was noted that on some occasions the medication was administered but not signed for. On other occasions staff failed to use the codes recorded on MARS to denote the reason why medication was not administered. Scribbled over entries were noted. Handwritten entries recorded on MARS were not checked by two staff members and signed and dated. It was noted that when antibiotic treatment was completed trained nurses were not always signing and dating entries. There was an entry recorded in the Controlled Drugs register for MST 10mg for a particular resident. A staff member’s signature member’s was not recorded. There was a discrepancy noted in the controlled drug register for Temazepam medication. Tablets were returned to the pharmacy however, the number of tablets returned was not recorded and there was no entry of the return date, staff members’ signatures were missing. The manager must investigate this anomaly and forward a report of the findings to the Commission within two weeks of receiving this report. Poor administration and recording practices were noted. Medication was administered to residents at the dining table and placed on the tablemats. It was noted that a particular staff member was recording the first letter of their initial and not the full initial. However, it was noted that staff were ensuring that individual’s pulse rates were recorded on MARS when administering Digoxin medication. Protocols were not in place for the administration of Warfarin and Fosamax medication. It is recommended that protocols be developed. PRN management plan for analgesics should also be developed. It is acknowledged that MAR sheets are being monitored however, there was no action plan in place. The manager must ensure that staff’s competencies in medication administration are regularly assessed. The manager must ensure that staff administer medication in accordance with the Nursing and Midwifery Council Medication Guidelines. Nurses should be reminded of their accountability. Some female residents were observed wearing socks and pop socks which could have been their choice. This should be clearly documented in their care plans. Overall residents’ attire was appropriate for the weather. Jewellery and clean fingernails were noted. It was noted that some residents who were being nursed in bed had been given drinks, which were placed out of their reach. Chiltern Court Care Home Version 1.10 Page 13 Some unacceptable care practices were noted. Residents were sat in wheelchairs for the entire day. This may have been residents’ choice. If this was the case it should be recorded in individual’s care plans. There was no evidence that a toilet regime was in place for those residents who were suffering with incontinence. Staff were not observed offering to take residents to the toilet before or after meals. It was perceived that because residents were wearing pads it was not necessary to offer them the toilet. It was noted that one resident had been offered a bath in the afternoon. The staff member assisting the resident with the bath chose to dress the resident in her nightdress. This was about 3 0’ clock in the afternoon. The resident was visited by her daughter and a friend. They had planned to take the resident outside to enjoy the sunshine but were unable to do so because she was inappropriately dressed. The manager is required to address these unacceptable care practices. There was no facility available for residents to make and receive telephone calls in private. The manager is required to provide a telephone facility accessible on both floors for residents to receive and make phone calls in private. Chiltern Court Care Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, & 15 The home’s activity programme needs to be more vigorous to ensure that residents’ social and recreational interest and needs are catered for. Visitors are welcome to visit at any time this ensures that residents maintain contact with their families and friends. The home advertises the services of an advocate this would ensure that residents are supported to exercise choice and control over their lives. The lunchtime meal was managed well on one unit. Further assessment and review of food menus would ensure that all residents receive a wholesome appealing balanced diet in pleasing surroundings. EVIDENCE: Staff were not observed spending one to one time with residents. Relatives commented that there were a lack of activities and entertainment. However, the home now employs a part-time activity organiser. On the second day of the inspection residents were observed participating in a sing a long that was facilitated by the activity organiser who involved her family to participate in the activity as well. Residents enjoyed the singing and those who wished to, sang their favourite songs. Chiltern Court Care Home Version 1.10 Page 15 The activity organiser confirmed that she intends to develop the activity programme further. She recently attending a training programme and had obtained some ideas to assist her with the development. Some relatives spoken to during the inspection commented that since the appointment of the new care manager they have been made aware and consulted about their relatives’ care. Some relatives felt that the care varied depending on which staff were on duty. Overall relatives felt that the home had progressed since the new organisation had taken over the home but there was still ‘a long way to go’. The home encourages residents and their relatives to take up the services of an advocate if they wished to. Information regarding the advocacy service was displayed on the notice board. The lunchtime meal was observed on both floors. Lunch served was roast chicken with gravy, roast or creamed potatoes and vegetables. Dessert was bread and butter pudding with custard. Lunch was tasty and portions were adequate. On the ground floor the serving of lunch was well managed. All staff were involved in this activity including the trained nurse. Staff offered those residents who needed assistance with feeding in a discreet and sensitive manager. Independent eating was encouraged. On the first floor there were eight service users who needed assistance with feeding. The serving of lunch appeared chaotic. Staff did not appear sensitive to residents’ needs and some remained standing when assisting residents with feeding. Poor hygiene practice was noted. Staff were observed touching the food and scraping food in the bin in between meals and not washing their hands. One resident had her meal liquefied. Staff presented it in an unappealing and unattractive manner. Medication was served at the same time residents were eating their meals, which was distractive to some residents. Some staff were finding it difficult to communicate with residents. It was noted that one resident had refused breakfast and had also refused to eat lunch. A glass of milk was offered. There was no care plan in place relating to the individual’s poor appetite. Relatives commented that since the new catering company had taken over ‘the food did not appear to be very well balanced or thought out, too much repetition.’ It was noted that choices on the tea menu on Sundays consisted of sausage rolls, cocktail sausages and potato salad. This was discussed with the chef who agreed to review the menu. The manager and chef stated that the food menu was discussed with the dietician who felt that the food was nutritionally well balanced. Chiltern Court Care Home Version 1.10 Page 16 On both units the dining areas had been re-decorated and new dining room chairs had been purchased. The tables were covered with tablecloths and the appropriate crockery, cutlery and condiments were available. Flowers were displayed on the tables. The manager is required to assess the dependency levels of the residents and deploy appropriate numbers of staff at mealtimes. Timescale set at the previous inspection 31.01.05 not met. The manager and proprietor must write to the Commission explaining the delay in meeting this requirement detailing how this requirement will be met within two weeks of receiving this report. Chiltern Court Care Home Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Two-way communication with residents and relatives should ensure that complaints are appropriately actioned which should ensure that residents and relatives’ views are listened and responded to. Staff appear aware of how abuse may manifest itself and are supported by the organisation’s policies and procedures. These measures should ensure that residents are protected from abuse. EVIDENCE: The Commission for Social Care Inspection area office had been copied into a complaint that was forwarded to the home. This complaint remains outstanding. The manager and area manager have been advised to resolve the complaint with the complainant. Relatives spoken to confirm that concerns raised regarding care practices have been responded to favourably by the care manager. The manager is required to ensure that the complaints folder is developed further and a record is kept of all concerns raised with clear action of outcomes. Appropriate reporting strategies are in place to address adult protection issues. Topics such as adult protection and abuse awareness need to be discussed regularly in staff meetings, along with ongoing training in adult protection and the home’s inter agency adult protection and whistle blowing policy. This should ensure residents’ safety. Chiltern Court Care Home Version 1.10 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 , 24 & 26 Issues relating to the environment, which have been highlighted in this report, need attention to ensure that residents’ health and welfare is not compromised. Pedal bins are needed in areas of the building to help prevent the spread of cross infection that could potentially put residents health at risk. EVIDENCE: The home is a large Victorian property with an extension. It is set in pleasant gardens and is situated on the rural outskirts of Wendover next to a large garden centre and opposite a public house. Residents have access to the grounds and garden, which are well maintained. It is acknowledged that the new organisation has replaced floor coverings, furniture and furnishings in communal areas and some bedrooms. However, during a tour of the building a number of shortfalls were identified these include the following: Chiltern Court Care Home Version 1.10 Page 19 • • • • • • • • • • • • • • • • • Bedrooms 21A and 21B chest of drawers need replacing. Overhead light to be provided Bedrooms 17A and 17B chipped paintwork needs touching up. Toilet holder in en suite needs replacing Bedroom 18 en suite light bulb needs replacing Staff toilet on the ground floor needs decorating. Chipped tiles needs replacing Bedroom 15 curtains need re-hanging Bedroom 41 holes in en suite walls need filling in and repainting Bedrooms 43A and 43B to be fitted with ceiling screens Bedrooms 42A and 42B to be fitted with ceiling screens Bathroom on the 1st floor- Ivy growing in needs cutting back Bedroom 29 chest of drawers need replacing Bedroom 24 bath panel in en suite to be made secure Pipes in linen cupboard to be boxed in Bedroom 5 curtain needs re-hanging Bedroom 4 cracked tiles near wash hand basin to be replaced Bedroom 1 bedside table to be replaced. Clutter in bedroom 27 to be risk assessed and kept under review Sluice rooms to be fitted with extractor fans. The proprietor and manager are required to forward to the Commission a plan of how these shortfalls will be addressed within six weeks of receipt of this report. A rolling programme of repairs and refurbishment should be incorporated into the budgets. The home has limited storage areas. Some bathrooms appeared cluttered as they were being used to store equipment. It is recommended that the manager review this practice. Some bedrooms were personalised with residents’ furniture, pictures and mementoes, which reflected their individual characters. On the day of the inspection the home was clean and tidy and free from offensive odours. It is acknowledged that the home employs a dedicated housekeeper who ensures that hygiene and cleanliness in the home is maintained to a high standard. It was noted that general waste bins in some areas of the building needed to be replaced with foot pedal bins to prevent the spread of cross infection. Chiltern Court Care Home Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staffing levels and staff deployment appear inadequate, this has the potential to indicate that not all residents’ needs are met. Some recruitment files lacked evidence that the necessary checks had been undertaken before commencing employment, having the potential to put residents at risk. It is acknowledged that a considerable amount of training has taken place. However, some further training is required to ensure full competence amongst the staff team. EVIDENCE: A care manager, nurses and care staff along with the administrator and a number of ancillary staff supports the manager. The home’s staffing rota was made available during the inspection. However, information recorded was difficult to follow and it did not outline clearly how many staff were on duty on each shift. The staffing agreement that was agreed with the Commission was that there should be two trained nurses and eight carers covering the day shift. The night shift should be covered with two trained nurses and four carers. However on the day of the inspection staffing numbers were reduced and the Commission had not been made aware of the reduction of staffing numbers. Chiltern Court Care Home Version 1.10 Page 21 The manager explained that the reason for the reduction was that the home was not fully occupied. There appeared to be staff shortages because the home was using agency staff. Relatives stated that there are times when ‘staff are rushed off their feet particularly at weekends and staff do not have the time to sit and interact with residents. The use of agency staff means unfamiliar faces for residents.’ It was noted that a large number of residents were very needy and frail. The home had assessed the dependency levels of residents using the RNCC assessment tool, which is based on residents’ nursing needs and does not look at other needs such as personal care needs and mobility. The manager is required to keep the dependency level of residents under review using a more appropriate tool to ensure that the appropriate levels of staffing is being provided. The reduction of staffing numbers in the afternoon must cease. It is strongly recommended that senior managers should discuss the staffing situation in the home with the Commission as a matter of urgency. Staff recruitment files were examined. It is acknowledged that the manager and the new organisation had worked hard to ensure that all staff records conformed to Regulation 19 and Schedule 2 of the Care Homes Regulations. However, it was noted that some staff members were not in receipt of Criminal Record Bureau (CRB) clearances and a member of staff had commenced work without having a ‘POVA first’ check and a CRB clearance. The manager was requested to put a risk assessment in place to protect residents’ safety. A copy of the assessment has been forwarded to the Commission. The information sent to the Commission before the inspection detailed that not all staff had completed the following mandatory training: Moving and handling, fire awareness, health and safety, basic food hygiene and resident welfare. However, staff had recently undergone training in continence and COSHH products. Some trained nurses had undergone medication, care plan and supervision training. It is required that the manager forward to the Commission an up to date staff training matrix listing staff names and outlining training under taken and when training is planned. Chiltern Court Care Home Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 & 38 The home’s approach to quality assurance needs to be developed further to ensure that the home is run in the best interest of residents. Residents’ financial interests are generally safeguarded by good record keeping. A structured supervision framework needs to be developed to ensure that residents benefit from a staff team who are appropriately supervised. The home’s health and safety procedures relating to water temperatures need to be strengthened to ensure that residents well-being and safety is not compromised. EVIDENCE: The organisation has a quality assurance system in place to ensure that the views of service users are obtained. However, the system had not yet been measured in the home. Chiltern Court Care Home Version 1.10 Page 23 It was noted that the manager had started to carry out his own internal selfauditing in some areas. A recent audit of the medication administration record sheets (MARS) had taken place. However, areas identified, as needing attention will need to be followed through. Residents and relatives were made aware of the inspection and they completed comment cards. Two residents’ personal allowance sheets were checked. Balances on sheets tallied with money in safe. It was noted that Residents’ personal allowance is not kept in an account that gains interest. This system should be reviewed to ensure that residents receive interest on their money. It was noted that two residents were managing their own finances. To date a structured supervision framework was not in place. The manager must ensure that all staff are in receipt of one to one supervision on a regular basis. Timescale set at the previous inspection 28.02.05 not met. The manager and proprietor must write to the Commission explaining the delay in meeting this requirement detailing how this requirement will be met. Not all staff had undertaken training in moving and handling, fire awareness, health and safety and basic food hygiene. However, arrangements were being made for staff to complete training. Daily records of food and refrigeration temperatures were in order. Food in the refrigerators were labelled, appropriately. A cleaning schedule was in place and was areas in the kitchen were clean and free from dust and cupboard was tidy and well maintained. examined and were dated and stored being followed. All grease. The stock Records relating to the fire panel, central heating, gas equipment, nurse call bells and hoists were examined and up to date. However, it was noted that water temperatures recorded did not conform to health and safety regulations. Some temperature readings exceeded 43 degrees Celsius. The manager is required to ensure that restrictor valves fitted on hot water taps are checked and adjusted. It was noted that a bedroom door on the first floor was kept open with a door wedge. The manager must ensure that those residents who wish to keep their bedroom doors open have the appropriate door holding devices or dor-gards fitted to doors. Risk assessment on vinyl gloves, plastic aprons steradent tablets should be kept under review. Chiltern Court Care Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 x x x x 3 x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 3 1 x 2 Chiltern Court Care Home Version 1.10 Page 25 YES Are there any outstanding requirements from the last inspection? 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 9 Regulation 13(2) Requirement The manager must ensure that nurses administer and record medication in accordance with the Nursig and Midwifery Council (NMC) guidelines. (Previous timescale of 28.02.05 not met) The manager must investiate the anomaly relating to the number of Temazepam tablets returned to the pharmacy and forward a report of the findngs to the Commission for Social Care Inspection Aylesbury office within two weeks of receiving this report. The manager must ensure that staff competencies in the administration and recording of medication are assessed regularly. (Previous timescale of 28.02.05 not met) The manager must must explore a solution to the unacceptable practice of residents sitting in wheelchairs for the entire day and not being toileted. The manager must observe the serving of meals at lunchtime on both units with a view of improving how lunchtime could be more enjoyable and relaxing. Version 1.10 Timescale for action 30.10.05 and ongoing 2. 9 13(2) 14.10.05 3. 9 13(2) 30.10.05 4. 10 10(1) 18.08.05 and ongoing 30.10.05 and ongoing 5. 15 10(1) Chiltern Court Care Home Page 26 6. 16 22(1) 7. 8. 19 26 23(1)(a) (2)(d) 13(3) 9. 27 18(1)(a) 10. 27 18(1)(a) 11. 29 19(1)(a) 12. 30 18(1)(a) 13. 36 18(2) 14. 15. 38 38 13(4)(a) 13(4)(a) (Previous time scale of 31.01.05 not met) The manager must develop the complaints folder further and keep a record of all concerns raised with clear action of outcomes Maintenance issues identified in this report must be addressed. The manager must replace swing top bins in areas of the building to prevent the spread of cross infection. The manager must keep the dependency levels of residents under review using an appropriate tool to meet residents needs. The manager and the proprietor must maintain the agreed staffing levels and inform the Commission of any shortfalls. The manager and proprietor must ensure that staff do not commence employment without a POVA first check and and a CRB clearance is obtained. The manager and the proprietor must ensure that all staff undergo manadatory training. An up to date training matrix must be forwarded to the Commission listing staff names and outlining training undertaken and when training is planned. The manager must develop a structured supervision framework to ensure that all staff receive supervision at least six times yearly. (Previous timescale of 28.02.05 not met) The manager must ensure that hot water temperatures conform to health and safety regulations The manager must ensure that risk assessments on vinyl gloves, plastic aprons steradent tablets Version 1.10 31.10.05 31.12.05 18.10.05 and ongoing 30.10.05 30.10.05 18.08.05 and ongoing 30.10.05 18.08.05 and ongoing 18.08.05 and ongoing 31.10.05 and ongoing Page 27 Chiltern Court Care Home are kept under review. 16. 38 13(4)(a) The manager and the proprietor must ensure that bedroom doors must not be kept open with door wedges or other obstacles. Those residents who wish to keep their bedrooms door open must have the appropriate door holding devices or dor-gards fitted after consultation with the fire officer. 18.08.05 and ongoing 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 7 7 7 Good Practice Recommendations It is recommended that the manager should ensure that care plans are developed for residents who are being nursed in bed. It is recommended that the manager should ensure that that entries recorded in care plans are not scribbled over. It is recommended that the manager should ensure that protocols relating to diabetes should include that individuals should have their blood pressure measured monthly. It is recommended that the manager should explore options which give residents interest on their money held in bank accounts. 4. 35 Chiltern Court Care Home Version 1.10 Page 28 Commission for Social Care Inspection Cambridge House, Smeaton Close 8 Bell Business Park, Aylesbury Buckinghamshire HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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