Inspection on 08/11/05 for Chiltern Court Care Home

This inspection was carried out on 8th November 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 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 8th November 2005 20:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 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.V263491.R01.S.doc Version 5.0 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 Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 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. 17th August 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. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced night inspection that took place on the 8th November 2005 from 20.00 pm to 23.15 pm. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge (Inspector). The inspection consisted of observing staff’s practice, examining a number of records including assessments, care plans, and medication administration record (MAR) sheets. A tour of the building was undertaken and some residents and staff were spoken to. The requirements from the previous inspection were discussed. The acting manager stated that some requirements had been actioned and work was in progress on others. It is imperative that the proprietor and acting manager ensure that full compliance is achieved. A further visit will be carried out to ensure that full compliance has been met. Non-compliance of 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? What they could do better: Medication administration and recording must be improved. Staff’s competencies in the administration and recording of medication must be regularly assessed. Swing top bins must be replaced with foot pedal bins to prevent the spread of cross infection. The agreed staffing levels in the home must be maintained. Bedroom doors must not be kept open with door wedges or other obstacles. A hazardous warning sign must be placed over the hot Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 6 water tap on the first floor staff toilet to prevent scalding. All staff must be familiar with the home’s health and safety and emergency procedures. 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. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 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 Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 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 The home has an effective assessment procedure to ensure that prospective residents’ needs are identified. EVIDENCE: The assessment document for the most recent admission to the home was examined. It was evident that the resident’s needs were assessed prior to admission. Needs identified were reflected in the individual’s care plan. Nutritional and Braden assessments were in place. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 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 There has been an improvement in care plans however, not all care plans examined indicated that residents’ health care needs were being met adequately. There are still inconsistencies in the recording and administration of medication, which have the potential to put residents at risk. EVIDENCE: Overall there has been an improvement in the recording of care plans. Residents’ likes and dislikes were being recorded and detailed action plans were in place. For example, it was noted that a particular resident was depressed. The action plan stated that staff should talk to the individual and offer lots of support. However, not all staff were being consistent and recording their good practice in the daily report writing. For example, it was noted that a particular resident’s dressing had been changed, but this information was not recorded in the daily log. Nutritional risk assessments were in place and weights were being monitored monthly. Protocols were in place for residents on peg feeds. Trained nurses spoken to were knowledgeable and appeared competent about the procedure. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 10 However, their competencies were not regularly assessed. It is recommended that staff’s competencies should be assessed on a regular basis. It was noted that the dressings on a particular resident’s legs were saturated. She had both feet wrapped in incontinent pads to try and soak up the fluid. This practice was unacceptable. Staff should provide appropriate supervision and change dressings when necessary. 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 MAR sheets to denote the reason why medication was not administered. The manager must ensure that staff’s competencies in medication administration are regularly assessed. The manager must also ensure that staff administer medication in accordance with the Nursing and Midwifery Council Medication Guidelines. Nurses should be reminded of their accountability. Regular monitoring of MAR sheets must be carried out. It was noted that nearly all the residents on both floors were in bed. However, some were not asleep and were happy to share their experiences and discuss the night routine. Some residents stated that ‘staff were kind and they felt that they were well cared for.’ However, from discussions with various residents it was evident that the care provided at night was not always of the same standard. Residents commented that at times only one member of staff would assist them with moving and handling, turning and change of pad. This posed a safety risk and has the potential to compromise the care. One particular resident stated that ‘staff tell her not to ring the bell at night.’ Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 11 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): 15 Arrangements were in place to ensure that residents receive wholesome and appealing food. EVIDENCE: Those residents who were awake were offered milky drinks and sandwiches by the night staff. Staff confirmed that this was normal practice. However, some residents spoken to said that hot drinks were not always offered. One particular resident was complimentary about the chef and stated that she provides her with a supply of brown bread daily, which she keeps in her refrigerator and eats as and when she wishes to. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 12 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 The home has developed a complaints folder to ensure that complaints are appropriately actioned. Policies and procedures are in place to ensure that residents are protected from abuse. EVIDENCE: The home has now developed a complaints folder and all staff have been made aware that any concerns raised by residents and relatives must be recorded. The Commission for Social Care Inspection had received an anonymous complaint regarding insufficient numbers of staff on duty during the night. As a result staff were expected to assist residents single-handed. Some night staff were on sick leave and morale amongst the night team was low. The night rotas were examined and it was noted that on the first floor one trained nurse and two care assistants were allocated. However, on the ground floor there was one trained nurse and one care assistant. The arrangement in place was far from ideal and had the potential to put residents and staff at risk. An immediate requirement was made for an additional carer to be allocated on the ground floor. The timescale given was twenty-eight days. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 13 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, 21 & 26 Overall the home was being maintained to a satisfactory standard. However, issues highlighted in the previous report relating to the environment need attention to ensure that residents’ health and welfare are not compromised. 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. Floor coverings, furniture and furnishings in communal areas and some bedrooms have been replaced recently, which has enhanced the environment. The manager stated that work was in progress to address the maintenance issues identified as need attention at the announced inspection in August 2005. A check to ensure that all work has been completed will be carried out at a later date. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 14 Some bathrooms appeared cluttered as they were being used to store commodes and other equipment. It is recommended that the manager review this practice as it poses a safety risk. The communal areas in the home were clean and tidy and free from offensive odours. A resident spoken to, was complimentary about the cleaner whom she said works hard to maintain cleanliness in the home. She went on further to comment that the home needed to employ more housekeeping staff as there were times, especially at week ends when there is no domestic cover. To date swing top bins had not been replaced with foot pedal bins to prevent the spread of cross infection. The manager stated that the home had not been able to obtain the bins. A further timescale has been set to obtain the bins Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 15 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 Staffing levels and staff deployment appear inadequate, which has the potential to put residents at risk. EVIDENCE: The staffing arrangement that was agreed with the Commission sometime ago was not in place. This was disappointing to note because, at the announced inspection in August a requirement was set that there should be two trained nurses and eight carers covering the day shift, and two trained nurses and four carers on the night shift. The requirement made was not complied with, also the home failed to inform the Commission that there was a reduction in the agreed staffing levels. An immediate requirement was made requiring that the level of staffing at nights on the ground floor must be increased to two carers. A further immediate requirement was made, which stated that the staffing levels on the afternoon shift must be increased to meet residents’ needs and that the home must make arrangements to ensure that there is domestic cover in place at the week-ends. The timescale set to comply with the requirements was twenty-eight days. The proprietor and manager are strongly advised that failure to comply with this requirement may result with the Commission contacting its legal department, with a view to considering enforcement action. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 16 A list of the roles and responsibilities displayed in the office indicated that staff’s roles had a focus on domestic chores. For example, staff are expected to empty rubbish bins, clean and tidy the kitchenettes. Staff indicated that residents were in bed for their convenience. A bank member of staff was spoken to and she described an appropriate recruitment process. However, the induction programme was not so good. The staff rota was examined and it was noted that staff were working an excessive amount of long days. Some staff said that it was their choice. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 17 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, 37& 38 Arrangements are in place to ensure that residents live in a home, which is well managed. The home’s record keeping needs to be strengthened to safeguard residents’ interests. Staff’s knowledge on the home’s health and safety and emergency procedures need to be strengthened to ensure that residents’ well-being and safety is not compromised. EVIDENCE: Since the last inspection the manager had resigned. However, the deputy manager is acting up as manager and arrangements were put in place to ensure that she was well supported by senior managers. She explained that Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 18 her first week in post had been challenging. Lines of accountability were clear within the home and with external management. Some bedroom doors were observed wedged open with doorstoppers and obstacles such as dustbins and footstools. Vinyl gloves were not stored discreetly. Toiletries belonging to residents were observed in the first floor bathroom, which made it look like they were being shared; they also posed a safety risk. Staff are reminded of their duty to return residents’ toiletries to their bedrooms after use. The hot water temperature in the staff toilet on the first floor exceeded 43 degrees Celsius. It is required that a hazardous warning sign is placed over the tap to prevent scalding. Handover sheets relating to doctor’s visits were in place. However, the information relating to individuals was not recorded on separate sheets and therefore was in breach of the Data Protection Act 1998. It is recommended that information be recorded on separate sheets to comply with legislation. Staff’s knowledge on health and safety and the home’s emergency procedures were tested. Not all staff were familiar and confident with the procedures in place. It is required that staff are made aware of the home’s health and safety and emergency procedures. All trained nurses must be made aware of the action, which should be taken if a resident’s condition deteriorates suddenly, or sustains a fall causing bony injury. The emergency service must be contacted and not the out of hours emergency doctor. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X X X X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X 2 2 Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement The manager must ensure that nurses administer and record medication in accordance with the Nursing and Midwifery Council (NMC) guidelines. (Previous timescale of 28/02/05 not met) The manager must ensure that staff’s competencies in the administration and recording of medication are assessed regularly. (Previous timescale of 28/02/05 not met) The manager must replace swing top bins in areas of the building to prevent the spread of cross infection. (Previous timescale of 18/10/05 not met). The manager and the proprietor must maintain the agreed staffing levels and inform the Commission of any shortfalls. (Previous timescale of the 30/10/05 not met.) The manager must ensure that night staffing levels are increased on the ground floor to ensure that residents’ needs are met. The staffing levels in the DS0000062822.V263491.R01.S.doc Timescale for action 08/11/05 2. OP9 13(2) 08/11/05 3 OP26 13(3) 31/12/05 4 OP27 18(1)(a) 08/11/05 5 OP27 18(1)(a) 07/12/05 Chiltern Court Care Home Version 5.0 Page 21 6 OP38 13(4)(a) 7 OP38 13(4)(a) 8 OP38 10(1) afternoon on the ground floor must be increased to meet residents’ needs. Arrangements must be put in place to ensure that there is domestic cover at the weekends. The manager and the proprietor must ensure that bedroom doors are not wedged 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. (Previous timescale of the 18/08/05 not met) The manager must ensure that a hazardous warning sign label is placed over the hot water tap on the first floor staff toilet to prevent scalding. The manager must ensure that all staff are familiar with the home’s health and safety and emergency procedures. Trained nurses must contact the emergency service in the event of a resident’s condition deteriorate, or they sustain a fall causing bone injury. 18/08/05 15/12/05 30/12/05 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 Refer to Standard 8 8 Good Practice Recommendations It is recommended that the manager should ensure that staff’s competencies in peg feeds are assessed on a regular basis. It is recommended that the manager should ensure that DS0000062822.V263491.R01.S.doc Version 5.0 Page 22 Chiltern Court Care Home 3 4 21 37 arrangements are put in place to change residents’ dressings when needed. It is recommended that the manager should review the unacceptable practice of storing commodes and equipment in bathrooms. It is recommended that the manager should ensure that information relating to individuals is recorded on individual sheets to comply with the data protection act 1998. Chiltern Court Care Home DS0000062822.V263491.R01.S.doc Version 5.0 Page 23 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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