CARE HOMES FOR OLDER PEOPLE
Chiltern Court Care Home Wendover Road Aylesbury Buckinghamshire HP22 6BD Lead Inspector
Chris Sidwell Unannounced Inspection 22nd June 2007 09:30 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.V339222.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.V339222.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 chiltern.court@ashbourne.co.uk 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.V339222.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. 16th January 2007 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 lift to the first floor and a stair lift to a mezzanine area. Forty-three bedrooms are single and five are double. Twenty-four single bedrooms and four double bedrooms have en suite facilities, although these are not in all cases adapted to meet the needs of disabled people. The home has a pleasant garden, which is well maintained. The current scale of charges at the time of writing this report ranged from £481.60- £725.00 weekly. This excludes any payment made by the Health Service in respect of nursing care, which is retained by the home. Additional costs include chiropody, newspapers, transport and personal items. Information about the home can be obtained by visiting or contacting the home. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was conducted over the course of three days and included a one day unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was 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. Eight residents and family members returned the questionnaires. Residents and families were also spoken to on the day of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary 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. What the service does well:
The care needs of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. The manager visits them at home and residents have the opportunity to stay for a trial period. The assessment process takes account of residents’ cultural and religious needs. Most residents have contracts, which explain the terms and conditions of the agreement and reflect their individual funding arrangements. Notice is given of any fee increases. Residents’ cultural and religious needs are identified with them before they move to the home. Residents’ personal, healthcare and medication needs are met. The staff are courteous to residents and their families. Personal care is given in residents’ rooms. The care plans are comprehensive and residents’ healthcare needs are monitored carefully. There is evidence in the files to show that residents have access to local healthcare professionals including the general practitioner. The medication needs of residents are managed well. One resident commented that the staff are ‘very caring and kind’. The standard of food is good and meets the nutritional needs of residents. One resident said ‘the food is good and there is plenty of it’. Menus to meet residents’ religious or cultural needs could be provided, if necessary. Residents’ rooms are homely and they are encouraged to bring their own furniture and mementos with them when they move to the home. Residents’ families and friends are welcomed to the home at any time. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 6 Staff training is good and the recruitment procedures are thorough ensuring that residents are protected form unsuitable people. There is now a full management team in place in the home and relatives and residents spoke highly of the manager. What has improved since the last inspection? What they could do better:
The bathing facilities are inadequate to meet the needs of residents. There are insufficient adapted baths or showers to meet the needs of people with disabilities and most of the ensuite bathrooms cannot be accessed by the
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 7 resident who lives in that room as they have not been adapted to meet their needs. This must be addressed as a matter of urgency. Professional advice should be taken as to the adaptations needed to ensure that the bathing facilities meet the needs of people with disabilities. Hoist slings must not be shared as they represent a risk to residents of acquired infection. The home should use the Department of Health’s guide ‘Essential Steps’ to assess their current infection control management to ensure that residents are protected from the risk of acquired infection. Further information is available on www.dh.gov.uk. The manager should ensure that the home is proactive in contacting care managers when residents reviews are due. The manager should ensure that the home has appropriate pressure relieving chair cushions, as well as pressure relieving mattresses, to ensure that residents with pressure damage can spend some time out of bed if they wish. It is recommended that the manager contact the local National Health Service ‘end of life’ care programme coordinator to ensure that their care of dying people is up to the latest standards. Further information is available on www.endoflifecare.nhs.uk. The activities coordinator should have training in therapeutic activities for the elderly and those with cognitive decline. Staff should be supported to improve their English language skills to improve their ability to communicate with residents. The organisation should enhance the quality assurance programme by undertaking regular resident and family surveys, publishing the results and making these available for prospective residents, their families and other stakeholders. 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.V339222.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.V339222.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): 2, 3 and 6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The care needs, including religious and cultural needs, of potential residents are identified with them, prior to their move to the home, to ensure that they can be met. A programme is in place to ensure that all residents have contracts which explain the terms and conditions of the agreement with the home and reflect their individual funding arrangements. EVIDENCE: The files of four residents were examined. All had evidence that the manager or senior nurse had visited them prior to their move to the home and their needs had been assessed. The residents spoken to said that they had received enough information about the home before they moved and had had the opportunity to visit or stay for a short period prior to moving. One family member said that friends or their doctor had recommended the home. One family member was spoken to on the day of the unannounced visit and she said that she was happy with the information that they had been given and said that the staff had worked hard to make her relative’s move as easy and Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 10 comfortable as possible. There were copies, in the files seen, of care manager’s assessments. The documentation used to guide the assessment of potential residents who are self funding is comprehensive. There is reference to potential residents’ religious and cultural needs. Evidence was seen in the resident’ files that they have contracts. The contract documentation reflects the terms and conditions of the organisation’s agreement with the resident and the nature of the funding arrangements. The pre inspection documentation showed that 41 of the 51 residents who are supported by a council or health trust have a copy of the agreement specifying the arrangements made. The manager said that she was in the process of ensuring that all residents had a copy of this agreement. There was evidence in the files that residents had been given notice of fee increases. The home does not offer intermediate care. Chiltern Court Care Home DS0000062822.V339222.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents’ personal, healthcare and medication needs are met and in a manner which protects their autonomy and dignity. EVIDENCE: The care of four residents was followed through. There has been a marked improvement in the care plans since the last inspection. Their files contained comprehensive care plans and the staff spoken to were knowledgeable about their care. The care plans had been reviewed regularly and updated when appropriate. Both qualified nurses and care staff make entries to the care plan. The residents who returned the questionnaires and those spoken to on the day of the unannounced visit said that they were involved in planning their care and most said that staff were responsive to their wishes. The preinspection documentation provided by the home showed that of the twenty five of the thirty-three people who have been resident for more than twelve months had had a review of their care plan by their care manager within the last twelve months. Whilst this is the responsibility of the appropriate social services departments, the home should be proactive in requesting these on behalf of residents.
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 12 The risk of residents acquiring pressure damage due to immobility is assessed and the appropriate equipment is made available. The home’s monthly audit showed that four residents had pressure damage. The care of two was looked at in detail. Both had appropriate assessments, nutritional support and appropriate pressure relieving mattresses. There is a need to ensure that the home also has appropriate pressure relieving chair cushions to ensure that residents with pressure damage can spend some time out of bed if they wish. The tissue viability nurse from the local Primary Care Trust (PCT) had given advice on the best treatment options for one. Nutritional risk assessments had been undertaken for all residents. The staff and chef were aware of residents’ dietary needs and could provide special diets when necessary. Residents are weighed regularly and action is taken to provide additional nutritional support where necessary. Continence assessments are undertaken and appropriate aids are provided by the PCT. There are medication policies in place. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records were accurately completed. Controlled drugs were stored satisfactorily and all entries to the controlled register were signed. A contract is held for the safe disposal of unused medication. The registered nurse spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. The staff were observed to be treating the residents with respect and their dignity was protected. All care is given in residents’ rooms. The staff were observed to be helping those who could not eat discretely and no one was observed to be left unattended at meal times, if they could not manage to eat their meal independently. The staffing levels have been increased since the last inspection and the staff spoken to said that they felt that although they were still busy the increase had given them more time to care for residents and to help them at mealtimes. There is a qualified nurse on duty at all times and the home can care for people at the end of their life. There were a number of thank you letters from relatives who were appreciative of the care that had been given to their family member at the end of their life. It is recommended that the home contact the local National Health Service ‘end of life’ care programme coordinator to ensure that their care is up to the latest standards. Further information is available on www.endoflifecare.nhs.uk. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Progress has been made to implement a stimulating activities programme to bring interest and diversion for residents. Their individual hobbies are supported where possible. The food is of a good standard meeting residents’ nutritional needs although there is room for improvement in the way in which residents are helped to make their choices known. EVIDENCE: The home has appointed an activities coordinator since the last inspection and a range of daily and special activities are arranged. One lady said that she liked gardening and she had access to a potting shed in the garden and had planted hanging baskets for the front entrance. The activities coordinator is able to take residents out to the local garden centre, which is within walking distance. One resident was enjoying a trip on the day of the unannounced inspection. A strawberry tea has recently been arranged and one family member wrote in a thank you letter ‘Mum was the most chatty we have heard her for weeks’. The activities’ coordinator was enthusiastic and wished to learn more about therapeutic activity for the elderly or those with dementia. It is recommended that she be given the opportunity to attend training in this area. A number of respondents to the questionnaires said that they or their
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 14 family member would like more ‘one to one’ activity and ‘less reliance on the television’. The family members who returned the questionnaires and those spoken to on the day said that they were made welcome in the home. One resident said that his wife visited him several times a day and was sometimes able to bring his dog, which he enjoyed. There are no restrictions on visiting and the home’s commitment to assisting residents to maintain contact with family and friends is described in the Residents’ guide and promotional literature. The home does not manage residents’ personal finances, which are managed by themselves or by family members on their behalf. There is a rotating menu and residents are offered a choice of main meal. Southern Cross Healthcare is implementing a new menu system, which the chef is considering. The residents spoken to said that they enjoyed the meals and most of those who returned the questionnaires agreed. One resident said that the ‘food is very good and plenty of it’. One family member however suggested that as ‘food is the highlight of the day for many residents, more space should be provided in the dining room, a proper menu shown each morning, not the night before, and a restaurant style experience should be aimed for’. The manager stated that this is being discussed at the relatives meetings. There is a need to review how residents make their choices known, as many will not be able to remember what they ordered the day before. The staff spoken to said that they asked residents what they would like the day before if they felt that they could understand, if not they made the choice on the resident’s behalf. Whilst the food is of a high standard there is a need to review how it is presented and the way in which residents are supported to make their own choices. The chef said that special diets could be provided and meals to meet residents’ health, cultural or religious needs if necessary. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 15 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 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The complaints and protection policies and procedures in the home have improved considerably since the last inspection. There is a need to ensure that any response is made within the timescale stated in the homes policy and that any response by relatives is followed up if residents and their families are to have confidence that their concerns will be addressed. EVIDENCE: There are complaints policies and procedures in place. A complaints log is now kept and action was seen to be taken in response to concerns and complaints. There was one written complaint in the file, which had been replied to. The response was defensive and the family member had replied to the response. This was not followed up. The pre-inspection documentation shows that five complaints had been received in the last year of which eighty per cent had been responded to within the timescales specified. The manager now has a system in place to ensure that if the response is required from another manager in the organisation she follows up the complaint to ensure that the timescales are met. All the family members who returned the questionnaires said that they knew how to make a complaint. One resident said that she was had not been told how to make a complaint although another said that they had never had to make a formal complaint and that if she were unhappy with any aspect of the service it would usually be dealt with immediately. The home is aware of the local multi-agency strategy for the protection of vulnerable adults. Staff have had safeguarding training since the last inspection and those spoken to said that they would have no hesitation in
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 16 reporting any concerns about residents’ welfare. The Commission for Social Care Inspection has not received any concerns or complaints about the home and has not been notified of any allegations made to the local authority, since the last inspection. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 17 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Residents’ individual rooms are homely and they are encouraged to personalise them with their own furniture and mementos. There is programme of redecoration, which is gradually improving the environment for residents. However the bathing facilities remain inadequate to meet the needs of people with complex disabilities. EVIDENCE: There is a programme of maintenance and redecoration in place. A number of residents’ rooms had been redecorated since the last inspection and there were plans for redecoration of the corridors and communal area to start the following week. The manager stated in the pre-inspection documentation that a bid has been made to refurbish other areas of the home, although the outcome was not yet known. The residents spoken to were pleased that they had a choice as to colour of their rooms. Residents are encouraged to personalise their rooms with items of their own furniture and pictures and ornaments and many had chosen to do so.
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 18 The garden is attractive and there is wheelchair access. One resident has a potting shed plastic greenhouse, although she was disappointed that a glass greenhouse, which was seen as a health and safety issue, had had to be removed. A requirement was made at the last inspection that the bathrooms be upgraded and that the advice of a specialist in the provision of facilities to meet the needs of people with disabilities be taken. This requirement has not been fully complied with. One bathroom has been converted to a wet room and now has a shower. The toilet seat was broken on the day of the inspection although it had been replaced by the time the inspection had been completed. The room does not have the benefit of natural light and smelt very musty and damp when the door was opened. There did not appear to be any other form of ventilation. A second bathroom has a domestic type acrylic bath with holes cut in the bath panel to take the feet of a hoist. Unfortunately the original hoist has been replaced and the new hoist did not fit and did not go low enough for residents to be lowered into the water. The staff also said that residents had to share bath hoist slings, which is contrary to Department of Health guidance on preventing cross infection. This bathroom does not meet the needs of residents, most of whom have complex physical disabilities. The remaining two bathrooms have not been upgraded to meet the needs of residents with disabilities and again hoist slings are shared. Although some rooms have ensuite facilities, most are not accessible to the residents who live in that room, as they are not adapted for use by people with disabilities. The bathing facilities in the home are inadequate to meet the needs of people with disabilities and must be upgraded. Professional advice should be taken to ensure that the upgraded facilities meet the needs of those with complex physical disabilities. With the exception of the shared hoist slings the infection control procedures have improved since the last inspection. The pre-inspection documentation stated that the infection control policies and procedures were updated in June 2006 and staff were observed to washing their hands and were wearing appropriate protective aprons. Alcohol hand rub is available to staff. The training records showed that staff have had infection control training. However hoist slings are still shared in bathing areas and present a risk of acquired infection to residents. The home has not yet used the Department of Health’s guide ‘Essential Steps’ to assess their current infection control management and it is recommended that this be done. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The staffing levels have been increased and staff now have training to help them meet residents’ needs. Recruitment procedures are thorough and protect residents from unsuitable staff. EVIDENCE: The staffing levels have been increased since the last inspection. Evidence to confirm this was seen on the rotas and the budget records. An additional carer is now on duty in the mornings on both floors and at night. The staff spoken to confirmed this and said that they feel that it gave them more time to meet the needs of residents. The residents spoken to said that staff were always available to help them although one said that she sometimes had to wait a while. The pre-inspection questionnaire indicated that there was high turnover of staff during the last year although the staff spoken to said that this had stabilised since the appointment of a permanent manager in October 2006. There were no qualified nurse vacancies. The residents and family members who returned the questionnaires said that the staff were caring and considerate although two felt that they were sometimes short staffed and one said that she felt that communication between residents and staff is ‘restricted because most staff do not have English as their first language’. This should be monitored and the home should assist staff to improve their English if necessary. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 20 Fourteen carers hold nursing or other qualifications obtained their own country which are seen as equivalent to the National Vocation Qualification in Care at Level 2 and a further two are undertaking the qualification at the local college. The training offered to staff has improved considerably since the last inspection. Most staff had completed the mandatory training and a number of staff had undertaken training in pressure damage prevention, care planning, specialised tube feeding and wound healing. There was evidence that staff undertake an induction programme. The recruitment records of four recently recruited staff were examined. All contained the required documents to show that suitable checks had been made prior to the staff member starting work. Application forms had been completed and interview records were kept. Two references and criminal records bureau disclosures were on file. One file did not contain a work permit. The paperwork within the files was loose and untidy and the organisations own documentation checklists had not been maintained. The manager stated that the recruitment files had not been audited in line with Southern Cross quality assurance audit and it is recommended that this be done. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 26, and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence, including a visit to this service. The management of the home has improved significantly since the last inspection and improvements have been made to ensure that the home is a comfortable and safe place for residents to live in. There is a need to develop the quality assurance system further to ensure that high standards are maintained and residents’ views are taken into account. EVIDENCE: The manager was appointed in October 2006 and has previous experience of managing a care home. She is a graduate, registered nurse and is currently undertaking the National Vocational Qualifications in Care and Management at Level 4. She is in the process of applying to register with the Commission for Social Care Inspection. She has worked hard to address the deficiencies found at the last inspection and has raised the overall standard of service and care in the home. The staff spoken to said that they found the manager and deputy
Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 22 approachable. She now holds regular staff, resident and relative meetings to ascertain their view on the running of the home and the care offered. These meetings are documented and copies are available in the main entrance for those who could not attend. Southern Cross Healthcare has a quality assurance programme, which is being implemented in the home. Regular audits of care plans and medication management have been undertaken. Routine monitoring of adverse care outcomes, (e.g. pressure damage, weight loss) is also undertaken. An anonymous survey of residents’, families’ or other stakeholders’ views has not yet been undertaken and the results are not published for the benefit of prospective residents. This would enhance the quality assurance system The Commission for Social Care Inspection requested an improvement plan following the poor outcomes identified for residents at the last inspection. This was provided within the deadlines set. With the exception of the slow progress made to provide bathing facilities which meet the needs of people with disabilities, the improvements required have either been made or substantial progress has been made towards meeting them. There is a need to ensure that these improvements are consolidated and remain in place. The home does not manage any money on behalf of residents. A small amount of personal allowance may be managed by the home to ensure that residents have access to money for every day needs. This banked in a separate no interest account. Individual receipts are given and records are kept. Regular formal supervision of staff has now been commenced and records were seen to confirm this. The staff spoken to said that they found the process helpful. There are plans to implement full appraisal for all staff over the next year. There are health and safety policies and procedures in place. Training records showed that staff had had up to date training in safe working practices, including manual handling, food hygiene and infection control. Infection control policies have been updated since the Department of Health published new guidance in June 2006. The home has not used the Department of Health guide ‘Essential Steps’ to assess their current infection control management and it is recommended that this be done. The pre-inspection documentation showed that regular maintenance of services and equipment is undertaken. The maintenance man undertakes regular checks of equipment including bedrails and wheelchairs. The fire records showed that a fire risk assessment had been undertaken and the fire log was fully completed. The staff spoken to understood the fire evacuation procedures. Water temperatures at water outlets ere tested regularly to ensure that residents are not at risk of scalding. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 23 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 1 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 24 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 OP22 Regulation 23(2)j Requirement The registered person must ensure that bathing facilities meet the needs of people with disabilities. Professional advice must be sought to ensure that the facilities and equipment purchased is suitable. This is an unmet requirement of the previous inspection, which has only been partially complied with. A new timescale has been set. The registered person should ensure that residents to not share hoist slings to protect them from the risk of cross infection. This is an unmet requirement of the previous inspection, which has only been partially complied with. A new timescale has been set. Timescale for action 31/10/07 2 OP26 16(2)j 31/10/07 Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 25 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 OP3 Good Practice Recommendations The registered person should ensure that the home is proactive in contacting care managers when residents reviews are due. The manager should ensure that the home has appropriate pressure relieving chair cushions, as well as pressure relieving mattresses, to ensure that residents with pressure damage can spend some time out of bed if they wish. It is recommended that the manager contact the local National Health Service ‘end of life’ care programme coordinator to ensure that their care is up to the latest standards. Further information is available on www.endoflifecare.nhs.uk. The activities coordinator should have training in therapeutic activities for the elderly and those with cognitive decline. Staff should be supported to improve their English language skills to improve their ability to communicate with residents. Whilst the food is of a high standard there is a need to review how it is presented and the way in which residents are supported to make their own choices. Further advice is available in the Commission for Social Care guidance ‘The Highlight of the day’ available on www.csci.org.uk. The organisation should monitor the effectiveness of the complaints procedures, ensure that all residents know how to make a complaint and that any correspondence is responded to, to give people confidence that their concerns will be addressed. The home should use the Department of Health’s guide ‘Essential Steps’ to assess their current infection control management to ensure that residents are protected from the risk of acquired infection. Further information is available on www.dh.gov.uk. The recruitment procedures should be audited to ensure that the required documentation is in place for all staff. Regular residents surveys should be undertaken and the results published and made available for prospective
DS0000062822.V339222.R01.S.doc Version 5.2 Page 26 2 OP8 3 OP11 4 5 6 OP12 OP12 OP15 7 OP16 8 OP26 9 10 OP29 OP33 Chiltern Court Care Home residents and their families and other stakeholders. Chiltern Court Care Home DS0000062822.V339222.R01.S.doc Version 5.2 Page 27 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
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