Inspection on 23/05/06 for Chiltern Retirement Home

This inspection was carried out on 23rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chiltern Retirement Home 01/10/07

Chiltern Retirement Home 27/10/05

Chiltern Retirement Home 14/06/05

Chiltern Retirement Home 25/02/05

Chiltern Retirement Home 09/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Chiltern Retirement Home 23 Kingsfield Oval Basford Stoke-on-trent Staffordshire ST4 6HN Lead Inspector Peter Dawson Key Unannounced Inspection 23 May 2006 09:00 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 Retirement Home DS0000008210.V293342.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. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chiltern Retirement Home Address 23 Kingsfield Oval Basford Stoke-on-trent Staffordshire ST4 6HN 01782 711186 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) Mr D Arnold Mrs Diane Arnold Care Home 14 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (14), of places Physical disability over 65 years of age (4) Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th October 2005 Brief Description of the Service: Chiltern House is situated in a residential area close to Newcastle and is easily accessible by public transport. There are 10 single and 2 shared bedrooms, seven have en-suite facilities. There is an assisted bathroom and separate shower room with walk in shower, both located on the ground floor. There are bedrooms on the ground and first floor, with access to the first floor via the stairs or stair lift. Additional categories of registration are for two people over 65 requiring dementia care and four people over 65 who may have a physical disability. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this unannounced key inspection there were 12 people in residence including one in hospital. The weekly charges for care in this home from April 2006 are £335-£385. This information was given by the Registered Manager in the pre-inspection questionnaire dated 12/05/06. A pre-inspection questionnaire was completed by the Manager and provides a basis for this inspection. All residents were seen and spoken to either together or individually. Six residents returned completed questionnaires to the Commission and six relatives also returned questionnaires. Both residents and relatives were very complimentary and satisfied with the care provided at Chiltern House. Comments included – “It would be hard to find anywhere better” “All care given by Mrs Arnold and her staff is excellent” and “We are more than happy. Mother is looked after so well – we could not ask for more”. The only area where it was suggested improvements could be made were in the provision of suitable activities in the home. Three residents expressed this view in feedback surveys and was re-iterated in discussions with residents. The Manager is aware of this and intends to extend and improve these provisions. Three visiting relatives were seen during the inspection, all spoke very highly of the care and services provided at Chiltern House and the friendly and supportive attitude of staff to their relatives. The relatives of a recently admitted resident were totally satisfied with the choice of home and the efforts made by staff in the settling in period. They confirmed their relative had settled quickly and extremely well and had no concerns about any aspect of care. A resident who is registered partially sighted attends the regular meetings of the Blind Association including social events. She has talking books and newspapers regularly which she uses in a cassette in her bedroom or one in the lounge for that purpose. She has recently had an eye test. The furniture is located in her bedroom as she prefers and not moved without her permission. She has large clock and other items to assist her. The inspector was particularly impressed with the actions taken in relation to a resident with a serious medical condition who deteriorated rapidly and required specialist care which was discussed with resident, relative, GP, District Nurse and hospital. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 6 An excellent plan of care was provided to cover all required contingencies in the palliative care of the resident who was able to remain as she wished at Chiltern House with support from the home and input from a range of health care professionals. This was confirmed in a card sent to staff by relatives following the death of the resident. What the service does well: 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. Chiltern Retirement Home DS0000008210.V293342.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 Chiltern Retirement Home DS0000008210.V293342.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): 1–5 The quality outcome of this standard is good. This judgement was made using available evidence and a visit to the service. Standards relating to Choice of Home were found to be met. EVIDENCE: The statement of purpose and service users guide has been updated in the last year. Copies are readily available for residents and visitors in the reception area of the home. All residents are given a copy also. Pre-admission assessments are completed by the homes staff in all cases prior to admission. Prospective residents are seen in their current environment. In relation to the last 2 admissions which were tracked, the homes assessment and a Care Management Assessment had been obtained prior to admission. Appropriate introductions had been made to the home prior to admission – in one instance there had been previous respite care and the other a visit made by the resident and family prior to admission. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 9 Both residents had received contracts with the home (seen) as self-funding residents. The two residents were spoken to and confirmed that they had settled well, assisted greatly by staff and they had no complaints or concerns about the placement. Relatives of one of those residents also confirmed their total satisfaction with the admission process and commented very positively about he role of staff in welcoming them and their relative into the home. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 11 The quality outcome of this standard is good. This judgement is made using available evidence and a visit to the service. EVIDENCE: Care plans were sampled for 2 residents as part of case tracking. Plans were based upon the homes pre-admission assessment and Care Management Assessment provided by the social work team. Plans included detailed information required to provide agreed care and based upon assessed need. They included a 24 hour plan of care for all, outlining the preferred choices and actions required from staff throughout the day and night. Risk assessments relating to prevention of falls and other aspects of risk were accurately assessed. Daily recording for all residents included 3 entries on the daily records (corresponding to the 3 staff shifts) and gave pertinent and required information to inform progress. Care plans seen, including risk assessments had all been reviewed in the home on a monthly basis. The only area of deficiency was that in the two care plans seen the social history had not been completed. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 11 This is important in providing staff with adequate knowledge about the background and social and emotional needs of residents. A requirement is made in Standard 12 in relation to activities – the social history provides a basis for knowledge of the social and activity needs of residents and must therefore be completed. There is a high staff awareness of health care needs in this home. There was clear information on the health care needs of the 2 residents tracked, with diagnosis, medication and ongoing health care support defined clearly. One person tracked said that she had become ill some 3 days previously and had to remain in her bedroom for two days. A GP had been called immediately she had become ill and a subsequent visit from the GP requested due to her known diagnosis and potential weakness – a blood test had been arranged – the person having had previous blood transfusions. The resident was having breakfast in the lounge on the day of inspection, said that anti-biotics had improved her condition and she felt sufficiently improved to be able to come to the lounge area. She was very complimentary about the swift actions and sensitivity of staff in relation to her illness. Other examples of medical interventions were identified and discussed with staff and residents during the inspection and included appropriate sight, hearing and physiotherapy interventions. One resident has hospital dialysis treatment 3 times per week and is on strict fluid intake which is monitored and recorded closely. One resident requires total care and is mainly bedfast, she has virtually no speech (staff are able to interpret her needs with special communication methods). Her dependency level has been at this stage for 3-4 years, she is moved /turned regularly and is pressure-area free. Her continued care is a compliment to staff who work closely with the District Nursing Service. Medication is provided by the Coop Pharmacy in blister packs (MDS). All records were inspected relating to medication storage, administration and disposal. They were found to be satisfactory. It was clear from tracking that the medication of a recently admitted resident was swiftly reviewed with the GP and this is the usual practice. The standard relating to Dying & Death was reviewed in the light of a recent death in the home. A serious medical condition was known but progressed swifty. The home set up a meeting with the family, nursing service and GP to review the placement. A decision was made to allow the resident to remain in the home. A plan of care with contingency plans was agreed and documented defining the actions required by all services, including out of hours actions. The resident died comfortably and peacefully in her preferred location, she had been involved in the decision making process and aware of all aspects. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 12 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 - 15 The quality outcome of this standard is adequate. This judgement is made using available evidence including a visit to the service. EVIDENCE: Discussions with residents and from written feedback from them there were indications of a high level of satisfaction with the care provided at Chiltern House, the support from staff, food provision and the physical standards at the home. Three residents did indicate in feedback that social activities provided in the home could be improved. This was borne out in discussions with residents expressing the view that some activities could be extended in the home to provide greater occupation and leisure activity. The home does arrange monthly musical entertainment and a regular music/mobility session but few people join in. Table top games are provided but only 3-4 people are involved. Clergy visit monthly and this seems to be welcomed and enjoyed. Discussions with the Manager revealed that this gap in care provision was evident. Ways of resolving some personality issues between residents and the diversity of expectation and need were discussed. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 13 The Manager will take positive steps to ascertain the specific interests and wishes of residents and provide a range of activities and recreation to occupy and satisfy resident need. Food provision in this home has been traditionally good and residents again confirmed this during the inspection. Breakfast and lunch were served during the inspection and without exception all residents spoke highly about the food provided and their enjoyment of meals on the day and generally. Contacts with families and friends area promoted, visitors always arrive during the morning of inspections, sometimes at 9 a.m. They clearly feel at home and relaxed. On the day of this inspection 3 visiting relatives were spoken to, all confirmed that they were welcomed by staff and residents, felt quite comfortable whilst in the home and were kept informed about the progress or needs of their relatives. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 14 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 quality of this outcome is adequate. This judgement is made using available evidence including a visit to the service. EVIDENCE: There is a complaints procedure in place and posted in the reception area of the home and available to all. The complaints book is also available in the reception area where entries can be made by residents and visitors. No complaints have been made to the home or to the Commission since the last inspection. In fact no complaints have been made to the home over the past 4 years. All staff have training in the procedures relating to abuse and the reporting of actual or suspected abuse. In fact the home produces an excellent booklet outlining the definitions of abuse and the procedure to be followed in reporting suspected abuse. A copy is given to all staff. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 15 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): 27 - 30 The quality of this outcome is good. This judgement is made using available evidence including a visit to the service. EVIDENCE: The home is suitable for its stated purpose. It is well furnished and maintained. Bedrooms are bright and well furnished with good personalisation. Standards of hygiene throughout the home are high with good cleaning routines in place. There are 21 domestic hours provided each week and additionally day and night staff assist with light domestic duties at other times. Facilities are good with assisted bath and walk-in shower room on the ground floor which provide alternative bathing choices. Seven bedrooms have ensuite facilities. Access to the first floor is by stair-lift and there are appropriate handrails/grabrails in relevant areas. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 16 The large lounge area divides naturally into two smaller groups allowing choice of seating and socialisation. On the last inspection residents had indicated additional lighting in the lounge area was needed and also an additional callpoint. These have been provided as requested since the last inspection. The garden area is spacious and pleasant with patio doors opening from the lounge with good access to the garden area which residents enjoy in the summer months. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 17 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 – 30 The quality of this outcome is good. This judgement is made using available evidence including a visit to the service. EVIDENCE: Staffing remains at the required levels. There are 2 Care Staff on duty plus Manager or Deputy during the day, sometimes there are more. Specific Management time is allocated to update and review care plans. The overall dependency levels of residents remain the same as at the last inspection. There is one waking night care worker plus one sleeping in an on call for 5 nights per week and 2 waking night care workers for the other 2 nights. This needs to be constantly reviewed in the light of changes in dependency levels but this was instanced recently when two waking night carers were deployed at the time of the illness and expected death of a resident. Since the last inspection the sudden dramatic death of a care assistant who had worked at the home for 9 years was a traumatic experience for both staff and residents. This has been dealt with in an extremely sensitive, caring and supportive way to the family, residents and other staff allowing the open expression of feelings and emotions as a basis for understanding and dealing with the situation. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 18 One new member of staff has been employed since the last inspection. The records of that person and another staff member were checked and all required information had been obtained prior to employment including, written references, documentation, CRB check etc. Induction was appropriately carried out and recorded. The number of NVQ qualified staff is now 38 and staff are being encouraged to train to reach again the required 50 minimum numbers of NVQ qualified staff. One further member of staff is currently involved in NVQ study Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 19 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 and 36 - 38 The quality of this outcome is good. This judgement is made using available evidence including a visit to the service. EVIDENCE: The Registered Manager has the required experience and qualification to run the home. She is also joint proprietor and provides a positive lead in the home. She works “hands-on” on the staffing rota and has an open management style informing staff of all aspects of managing the home with transparency. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 20 A policy/procedure relating to access to files by staff and residents has recently been provided discussion with the Manager confirmed that staff were aware of the rights of access to personal information by residents and the restrictions upon staff in relation to personal information available in the course of their duties. Residents meetings are not felt to be a necessary requirement in this small home, although it was acknowledged that a meeting with residents may be the appropriate vehicle for soliciting the views and preferences of residents in relation to the provision of activities and recreation in the home. Staff supervision has lapsed somewhat and the Manager will attempt to provide formal supervision for all staff at least 6 times per year. At the time of the last inspection 2-3 bedroom doors were not closing onto the door rebates and a requirement made at that time has been appropriately actioned to eliminate the problems. Risk assessments are in place for all resident activity. There have been no reported accidents since the last inspection, this was confirmed from records and discussion. Risk assessments are reviewed monthly. There is now a risk assessment in place in relation to the building following a requirement made by the Health & Safety (Local Authority) Officer, also ome radiator covers have been provided following risk assessment and restrictors have been fitted to all first floor windows in the interests of safety following the visit. Arrangements for Moving & Handling training were checked. The Deputy Manager completed an approved Trainers Course for Moving & Handling last year and is to update that training each year, the next course being on 5.6.06. This has meant that all staff receive this necessary training at the point of induction and others receive regular updated training. A recent death was not notified to the Commission and the home are aware of the need to notify the Commission under Regulation 37 of all deaths in the home. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 21 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 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 2 3 3 Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 Requirement Social histories must be completed for all residents and used as a tool to asses social needs. Deaths of service users must be notified to the Commission. Consult service users about the programme of activities & recreation provided in the home. Timescale for action 30/06/06 2. 3. OP38 OP12 37(1)(a) 16(2)(n) 25/05/06 30/06/06 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 2 Refer to Standard OP28 OP36 Good Practice Recommendations Take steps to ensure minimum of 50 of staff are NVQ trained Resume formal supervision of staff on a regular basis. Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. Extracts may not be used or reproduced without the express permission of CSCI Chiltern Retirement Home DS0000008210.V293342.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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