Inspection on 06/04/06 for Chiltern Court Care Home

This inspection was carried out on 6th April 2006.

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 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 Joan Browne Unannounced Inspection 6th April 2006 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 DS0000062822.V287871.R01.S.doc Version 5.1 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. DS0000062822.V287871.R01.S.doc Version 5.1 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 Ashbourne (Eton) Limited Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places DS0000062822.V287871.R01.S.doc Version 5.1 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. 8th November 2005 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 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 bedrooms and four double bedrooms have en suite facilities. The home has a pleasant garden to the front of the property, which is well maintained. The current scale of charges at the time of writing this report ranged from £472.15- £715.00 weekly. DS0000062822.V287871.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 6 and 13 April 2006. The lead inspector was Ms Joan Browne who was accompanied by Mrs G Wooldridge (Inspector). Care records and documentation were examined and staff’s practice was observed. Residents, staff and relatives visiting the home at the time of the inspection were spoken to. A tour of the building was carried out. A pre-inspection questionnaire and comment cards were forwarded to the home in advance of the inspection. At the time of writing this report the Commission was in receipt of comment cards from nine residents and one health care professional. Six residents were concerned that the home was not providing suitable activities to meet their needs. Two residents felt that the home was sometimes providing suitable activities to meet their needs and one resident felt that the activities provided were satisfactory. One relative raised concern over the length of time residents were left alone in the sitting room unsupervised. Overall residents felt that staff respected their privacy and dignity and the provision of care was good. Relatives spoken to on the day of the inspection felt that overall the provision of care was good. The area manager was given feedback on the out-come of the inspection. What the service does well: Residents’ attire was clean and colour co-ordinated. A variety of drinks were at hand for residents. The staff managed the inspection process in a professional manner. Staff were friendly polite and respectful. Interaction between residents and staff was good. Those residents able to express an opinion were complimentary of staff members. The home has developed good relationships with a range of health care professionals who support the home. Visiting to the home is flexible. Information about the service is available to prospective residents in the home’s Statement of Purpose and Service User’s Guide. A copy of the home’s most recent inspection report was displayed in the foyer area of the home on the day of the inspection. DS0000062822.V287871.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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. DS0000062822.V287871.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection DS0000062822.V287871.R01.S.doc Version 5.1 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 the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. All residents admitted to the home undertake a needs assessment. However, it was not always evident that a supported plan was in place for all identified needs and could affect how residents’ needs were being met. EVIDENCE: All residents admitted to the home have to undertake a needs assessment. The assessment plans for four residents were examined. The information recorded in some plans depended very much on the author. Some plans examined contained detailed information others did not. Each resident had a moving and handling and Braden sore risk assessment in place. It was noted that one particular resident was assessed as needing a nutritional care plan. However, there was not one in place. It is required that each assessed need is supported by a care plan. DS0000062822.V287871.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Arrangements are in place to ensure that residents’ health and personal care needs were being met. However, care plans need to be fully developed and be working documents supporting all identified needs. Staff’s poor recording practice in the administration of medication has the potential to put residents’ health at risk. EVIDENCE: Four care plans were examined. Plans reflected residents’ identified needs, food preference; times of rising and retiring, personal care needs, interests, preferred term of address, religion and sexuality. Some shortfalls in meeting residents’ identified needs were noted. For example, it was noted that a particular resident had a history of depression. There was no plan in place to support the identified need. In one particular resident’s care plan it was noted that the individual’s preference was to have daily showers. However, staff were unable to fulfil this need because the home does not have a shower unit. Information recorded in the individual’s care plan highlighted that a compromise had been made and the resident agreed to have a bath three times a week. It is recommended DS0000062822.V287871.R01.S.doc Version 5.1 Page 10 that the provider should consider having a shower facility installed so that residents can have the choice of having a bath or shower. There was evidence that care plans were reviewed monthly. Signatures of residents or their representatives were noted on some care plans to confirm their involvement. Scribbled over entries were noted in some care plans. This is not a good practice and should cease. It was noted that staff members were not always adhering to residents’ moving and handling risk assessments. For example, it was noted that one staff member was moving a particular resident with the use of the stand-aid hoist. However, the information recorded in this particular resident’s moving and handling assessment clearly identified that two staff members should assist with moving and handling. It is required that all staff must refer to individuals’ moving and handling risk assessment when assisting with moving and handling. Any changes must be reflected in the assessment plan. Improvement is needed to ensure that care plans inter-relate with the daily log and staff report on residents’ mood and their involvement in any social activity. Those residents whose care was tracked confirmed that their health care needs were being adequately met. Key workers spoken to were able to demonstrate how they were supporting residents with their personal and oral care. It was noted that for those residents who were being nursed in bed a detailed care plan of how personal care was being provided was not always in place. There was evidence in residents’ care records that other health care professionals such as the tissue viability nurse, the dietician, physiotherapist and occupational therapist were involved in their care and supporting the staff team to meet their identified needs. Turning charts and fluid balance charts for residents being nursed in bed were in place. However, not all charts were fully completed. It was evident that residents’ weights were being monitored and recorded monthly. However, there was no specific action plan in place for those residents who were experiencing weight lost. It was noted that specific care plans were in place for those residents with peg feed tubes and they were reviewed monthly. It is recommended that for those residents with a history of epilepsy and on medication to control the illness should have protocols developed as a good practice. The medication administration record (MAR) sheets were examined. Several gaps were noted. The blister packs were checked and it was evident that the medication was administered. Scribbled over entries were noted on MAR sheets. As a good practice when an entry is recorded by error the staff member should record a footnote on the sheet. For example, entered in error. Handwritten entries recorded on the MAR sheets did not always have two staff members’ signatures. It was noted that a record was being maintained for the administration of Epilum medication, which is given for epilepsy. However, the record was not DS0000062822.V287871.R01.S.doc Version 5.1 Page 11 adequately maintained. For example, the tablets were checked and the amount of medication that was administered did not balance with the remaining tablets in the packet. The manager must investigate this anomaly and forward a report of the findings to the Commission within two weeks of receiving this report. There was a specimen signature list for those staff who administer medication in place. There was also a photograph for each resident in the MAR folder. There was no written evidence that MAR sheets were being monitored. A requirement is being made in this report that all staff must administer medication in accordance with the nursing and midwifery council (NMC) guidelines. Regular monitoring of MAR sheets must be carried out. It is acknowledged that the area manager has identified that errors recorded on the MAR sheets had been made by agency and bank nurses. However, failure to comply with this requirement for a second time may lead to the Commission considering enforcement action. It was noted that one particular resident was self-administering vitamin tablets. The tablets were observed on the bedside table and it was not apparent that a lockable storage cupboard was provided to store the tablets. There was a risk assessment in place. However, the risk assessment was last reviewed in July 2005 and did not outline who would take responsibility for any mishaps. This was brought to the area manager’s attention to be addressed. Staff were observed providing personal care to residents sensitively and respecting their privacy and dignity. Interaction between staff and residents was good. The majority of residents spoken to said that ‘staff were kind and respected their privacy’. One particular resident mentioned that sometimes ‘staff can be a bit rough.’ Some residents mentioned that sometimes they find it difficult to communicate with some staff. The chiropodist was observed providing treatment to several residents in the main lounge, which made it look like residents’ privacy was not respected. This practice should cease. Any treatment given to residents should be carried out in the privacy of their bedrooms. Residents’ preferred term of address was recorded in care plans examined. The hairdresser was present at the time of the visit. Residents looked good and were enjoying having their hair attended to. Residents’ attire was clean and colour co-ordinated with attention to detail. Several visitors spoken to during the inspection were complimentary about the provision of care and felt that staff treated residents with respect. DS0000062822.V287871.R01.S.doc Version 5.1 Page 12 DS0000062822.V287871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service and takes into account the views and experiences of people using the service. There are no structured arrangements in place to ensure that residents’ social and recreational needs are being met. Lunchtime needs to be better managed to ensure that the lunchtime activity is enjoyable and relaxing for residents. EVIDENCE: The home does not have a structured activity programme in place. The activity organiser’s position has been vacant for sometime. It is acknowledged that the area manager has tried to recruit to the vacant position. It was disappointing to note that an out of date copy of an activity programme dated 2 February 2006 was displayed in a particular resident’s bedroom wall. This may have caused some confusion to the resident. Residents were observed unsupervised sitting in a circle in the lounge looking blankly. A relative commented that ‘sometimes residents are left too long alone in the sitting room without being able to access help’. Some staff spoken to did not see part of their role as being involved in facilitating activities for residents. It was noted that the majority of those residents who completed comment cards felt that the home was not providing suitable activities to meet their needs. One resident spoken to was disappointed that he was not able to have a bet on the Grand National. He also DS0000062822.V287871.R01.S.doc Version 5.1 Page 14 said that he missed not being able to follow the Oxford boat race on television. It was evident that these cultural activities were not picked up by staff and recorded in the care plan to be actioned. It is acknowledged that a few days before the inspection the home had organised an outside entertainer to entertain residents. Those residents spoken to commented that they had enjoyed the entertainment. Daily newspapers and magazines were ordered for those residents who wished to have one. It was noted that a volunteer visits the home once a week to facilitate bingo with those residents who wish to participate. It was disappointing to note that care staff do not provide any support and assist the volunteer with this activity. Arrangements must be made for staff to be involved in assisting with this activity to support residents. The home has no restrictions on visiting and friends and relatives are able to visit at any time. Visitors spoken to on the day of the inspection said that staff made them feel welcome. A visitor with a PAT dog visits residents regularly. A weekly Church of England service is held in the home. Residents have access to an advocate who visits the home. However, this service was about to be stopped due to cuts in local funding. One relative spoken to said that the service was invaluable and was disappointed to note that it was not going to be readily available in the future. It was noted that two residents were handling their own financial affairs. Relatives were supporting the other residents with their finances. It was evident that residents are made aware of their entitlement to bring personal possessions, which is agreed before admission. Some residents’ bedrooms were personalised with their own furniture such as, armchairs. One visitor spoken to commented that her relative had never owned a telephone. However, the home’s staff were very supportive when this particular resident requested to have their own personal telephone. Residents spoken to said that the food was satisfactory. One particular resident commented that he was offered ‘more than he could possibly eat’. Three meals are offered daily in addition to snacks and hot and cold drinks. The serving of lunch on both floors was observed. It was evident that mealtimes needed to be better managed to ensure that more time was spent with those residents who require assistance with feeding and prompting. On the first floor it was noted that medication was administered at the same time residents were eating lunch, which was distractive to some residents. Lunch appeared to be better managed on the ground floor. The radio was on with background music, which was age appropriate. Residents looked relaxed with lots of smiles. It was noted that the home was providing care to one non-indigenous resident. Information on the individual’s cultural and dietary preference was not detailed DS0000062822.V287871.R01.S.doc Version 5.1 Page 15 in the care plan. This was brought to the area manager’s attention to be addressed. DS0000062822.V287871.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home keeps a record of all complaints. However, investigation of complaints can sometimes be delayed and could lead to residents and relatives loosing confidence in the home’s complaints procedure. Staff appear aware of how abuse may manifest itself and are supported by the organization’s policies and procedures. These measures should ensure that residents are protected from abuse. EVIDENCE: The home has a complaints procedure in place. A record is kept of all complaints made. The Commission was in receipt of two written complaints one of which was anonymous. They were forwarded to the home to be investigated. At the time of writing this report there has been no outcome into the investigation of these complaints. The home has an abuse and whistle blowing policy in place. Staff spoken to appeared aware of how abuse can manifest itself. They were confident that senior managers would deal with any allegation or suspicion of abuse appropriately. Staff confirmed that they had undertaken training in abuse awareness. However, to date staff have not been able to access outside training in relation to the updated Buckinghamshire inter-agency adult protection policy. DS0000062822.V287871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Ongoing maintenance work to improve the appearance of the premises needs to take place. This would create a comfortable and safe environment for residents living there. 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. Work is planned to re-pave the drive and to review the ramp at the front of the building by fitting a handrail to support those residents who are wheelchair users to be more independent. During a tour of the building a number of maintenance issues were identified as needing attention. These include the following: • • Tap in bedroom 36 was leaking and needed repairing Chipped paint work on walls in bedroom 7, 10, 25 & 36 need repainting DS0000062822.V287871.R01.S.doc Version 5.1 Page 18 • • • • • Staff toilets on the ground and first floor need redecorating Work surfaces and kitchen cupboards in the kitchenettes need replacing Bed frames and commodes were dusty and required cleaning Ceiling lights in some areas of the building contained dead insects and required cleaning Some mis-shaped pillows and worn sheets needed to be replaced Dead flowers were observed in some bedrooms. Nursing and domestic staff should ensure that flowers are checked daily and removed when necessary. The area manager confirmed that money has been allocated to carry out planned maintenance work. On the day of the inspection the home was clean and tidy and free from offensive odours in the communal areas. However, a stale odour was noted in the sluice rooms on both floors. It is being made a requirement that extractor fans and deodorisers are fitted in sluice rooms to eliminate any stale odour. DS0000062822.V287871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Night staffing levels and staff deployment appear inadequate, this has the potential to indicate that not all residents’ needs are being met. Some recruitment files lacked evidence that the necessary checks relating to references had been undertaken. Thus having the potential to put residents at risk. EVIDENCE: At the time of the inspection the home was providing care to one resident with high needs, forty-five with medium needs and one with low needs. There was no evidence available to substantiate that the ratio of care staff to residents had been determined according to the assessed needs of residents, and a system for calculating staff numbers had been fully developed. The rota was examined and there were eight care staff and two registered nurses on duty throughout the day. The night rota indicated that there were two trained nurses on duty and four carers. A trained nurse and one carer cover the ground floor and three cares and a trained nurse cover the first floor. This poses a safety risk and indicates that at times care provided to residents on the ground floor could be compromised if one carer is expected to move and handle residents. Residents spoken to on the ground floor said that at nighttime they have to wait for a long time to be made comfortable and settled for bed. The home has failed to comply with the night staffing numbers agreed with the Commission at the last unannounced inspection in November 2005. DS0000062822.V287871.R01.S.doc Version 5.1 Page 20 A requirement was made that the staffing level on the ground floor must be increased to two carers. This was brought to the area manager’s attention. She explained that a carer on the first floor is expected to assist on the ground floor. From discussion with residents it was evident that this arrangement was not always put in place. A further requirement is being made that two cares along with the trained nurse must be allocated on the ground floor at nights The proprietor and area manager are advised that failure to comply with this requirement may result with the Commission contacting its legal department, with a view to considering enforcement action. It is acknowledged that the home is now providing domestic cover in the home seven days a week. Arrangements were being made to employ more domestic staff. Information submitted on the pre-inspection questionnaire indicated that 50 of the home’s care staff have achieved a National Vocational Qualification (NVQ) at level 2 in direct care. Staff records relating to the four most recent employees were examined. Each staff member had a POVA first and a Criminal Record Bureau clearance check in place. There was also Accession state worker registration certificates in place for those staff members who required them. Statements of terms and conditions of employment and declaration statements of health fitness were in place and two references were in place. However, not all references were from the most recent employer. It was noted that references were not always obtained from the name of the referees recorded on the application forms. It was not always evident that the person writing the reference was a line manager or colleague and that gaps in employment records were fully explored at the interview. It is required that the authenticity of all references must be checked. References should have an official stamp or complimentary slip and if possible followed up by a phone call. Where possible a recent photograph of staff members should be on file. Information obtained on the pre-inspection questionnaire in relation to staff training indicated the following: - 98 of staff had undertaken moving and handling training, 86 had undertaken health and safety training, 94 food handling and hygiene, 96 resident welfare and 76 fire awareness training. The majority of staff spoken to on the day of the inspection confirmed that they had undertaken mandatory training. A heath care professional confirmed that staff have attended all training offered by the primary care trust. However, trained staff still appear to need a lot of reassurance and advice to support their basic nursing care. DS0000062822.V287871.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home does not have a registered manager or deputy manager. There are no systems in place to ensure that the home is run in the best interests of residents. Health and safety at the home need to be conscientiously managed to ensure that residents and staff safety and welfare are not compromised. EVIDENCE: The home does not have a registered manager or deputy manager in post. The regional manager informed the Commission in writing that the area manager would be available in the home three days a week and a senior home’s manager two days a week to support staff. However, this arrangement is not always in place. The lack of senior management cover in the home appears to have an impact on the trained nurses’ confidence. They feel unsupported and appear hesitant to make any decisions for fear that it might DS0000062822.V287871.R01.S.doc Version 5.1 Page 22 be challenged. Communication in the home is also affected. For example, on the day of the inspection there was a request from the hospital for a resident to be re-assessed because the individual was ready to be discharged home. No confirmed date of when the assessment would be undertaken could be given to the hospital. The hospice nurse was contacted to administer a subcutaneous injection to a resident. A trained nurse could have undertaken this procedure. There was no evidence that care plans and medication administration record sheets were being monitored on a regular basis. There was no evidence available that residents and relatives’ views are sought regarding the service delivery. The home does not have a structured supervision framework in place. The home’s administrator is not an appointee for residents’ personal allowance. However, those residents who are funded by social services receive personal allowance every four weeks. This money is kept in a non-interest bank account that is pooled. Some residents’ relatives who are not able to visit regularly deposit a small amount of money, which is managed by the home’s administrator to purchase toiletries and to cover fees such as the hairdresser and chiropody. From discussion with the administrator it became apparent that residents do not have access to their personal allowance when she is not on duty. There is a transaction sheet in place for each resident that gives a breakdown of all money that is deposited or withdrawn. Two residents’ personal allowances were checked and cash in safe corresponded with balance on sheets. However, it was noted that on some sheets two signatures were not always evident. It is required that two staff signatures must be recorded on transaction sheets when money is deposited or taken out of residents’ accounts. Staff training records highlighted that 98 of the staff had undertaken training in moving and handling and 76 in fire awareness. It was noted that the last fire drill had taken place in August 2005. A minimum of two fire drills should be undertaken yearly and it was evident that a fire drill was overdue. It is required that a fire drill must be undertaken with all staff, which must include the night staff. There was evidence that the home’s fire record was being maintained and the fire panel was being checked weekly. However, it was noted that outstanding maintenance work on fire doors had not been addressed. Staff spoken to during the inspection demonstrated a good understanding on the home’s infection control and health and safety procedures. DS0000062822.V287871.R01.S.doc Version 5.1 Page 23 Chemical substances harmful to health (COSHH) sheets were in place for solutions and substances used in the home. Domestic staff confirmed that they had undertaken the appropriate COSHH training. Food stored in the refrigerator in the general kitchen was appropriately labelled and dated. The food storage area was clean and tidy. It was evident that a cleaning schedule was in place and it was being adhered to. Hot water temperature records indicated that water temperatures are recorded monthly and were within the appropriate range. Maintenance records indicated that the gas boiler and central heating system were serviced on 10 March 2006 and was satisfactory. The passenger lift was serviced on 29 March 2006. The bath and mobile hoists were serviced on 27 January 2006. During a tour of the premises one bedroom door was wedged open with a bedside table and the office door on the ground floor was wedged open with a stool. Staff are reminded that doors must not be kept open with obstacles other than the appropriate door holding devices. It was noted that in bedroom 32 a four -way plug adaptor was in place. A risk assessment was not in place. The area manager must ensure that a risk assessment is put in place. DS0000062822.V287871.R01.S.doc Version 5.1 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X 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 X X X X 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 2 X 2 DS0000062822.V287871.R01.S.doc Version 5.1 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 15(1) Requirement The proprietor in the absence of a registered manager must ensure that needs identified at assessment are supported by a detailed care plan. The proprietor in the absence of a registered manager must ensure that staff refer to residents’ moving and handling risk assessments when moving and handling residents. Individual’s assessment must be kept updated. The proprietor in the absence of a registered manager must investigate the anomaly relating to the number of Epilum tablets and forward a report of the findings to the Commission for Social Care Inspection Aylesbury office within two weeks of receiving this report. The proprietor in the absence of a registered manager must ensure that nurses administer and record medication in accordance with the Nursing and Midwifery Council (NMC) guidelines. Previous timescale DS0000062822.V287871.R01.S.doc Timescale for action 30/06/06 2 OP7 15(2)(b) 30/06/06 3 OP9 13(2) 16/05/06 4 OP9 13(2) 30/05/06 Version 5.1 Page 26 5 OP15 6 OP19 7 OP26 8 OP27 9 OP29 10 OP31 11 OP35 12 OP38 of 08/11/05 not met. The proprietor in the absence of a registered manager must ensure that lunchtime is better managed and it is enjoyable and relaxing. 23(2)(b) The proprietor in the absence of a registered manager must ensure that maintenance issues identified in standard 19 in this report are attended to. 16(2)(j)(l) The proprietor in the absence of a manager must ensure that extractor fans and deodorisers are fitted in the sluice room on the ground and first floor to eliminate any stale odour. 18(1)(a) The proprietor in the absence of a registered manager must ensure that two carers are allocated on the ground floor at nights to meet residents’ needs. The Commission must be informed of any shortfalls in staffing numbers. Previous timescale of the 07/12/05 not met 19(1) The proprietor in the absence of Schedule a registered manager must 2 ensure that weaknesses identified in the home’s recruitment procedure are addressed. 8(1) The responsible individual must provide a written action plan to the Commission to identify the steps taken to recruit a registered manager. 10(1) The proprietor in the absence of a registered manager must ensure that two staff signatures are recorded in individuals’ transaction sheets when money is deposited or withdrawn. 23(4)(e) The proprietor in the absence of the manager must ensure that a minimum of two fire drills are conducted in the home 10(1) DS0000062822.V287871.R01.S.doc 30/06/06 30/08/06 30/09/06 30/05/06 30/05/06 16/05/06 30/05/06 30/05/06 Version 5.1 Page 27 13 OP38 13(4)(a) 14 OP38 13(4) The proprietor in the absence of a registered manager must ensure that doors are not kept open with door wedges or other obstacles. Those residents who wish to keep their bedroom doors open must have the appropriate door holding devices or dor-gards fitted after consultation with the fire officer. Previous timescale of 18/08/05 not met. The proprietor in the absence of a registered manager must ensure that a risk assessment in put in place for the 4-way plug adaptor in bedroom 32. 30/05/06 30/05/06 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 OP7 Good Practice Recommendations It is recommended that the proprietor should ensure that care plans inter-relate with the daily log and staff report on residents’ moods and their involvement in any social activity. It is recommended that the proprietor should ensure that turning charts and fluid balance charts are fully completed. It is recommended that the proprietor should ensure that protocols be developed for those residents with a history of epilepsy who are on medication. It is recommended that the proprietor should ensure that the practice of residents having chiropody treatment in the lounge ceases. It is recommended that the proprietor should ensure that care staff are deployed to assist the volunteer with facilitating bingo sessions. It is recommended that the proprietor should consider having a shower unit installed so that residents can have a choice of having a shower or bath. 2 3 4 5 6 OP8 OP8 OP10 OP12 OP19 DS0000062822.V287871.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury 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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