Inspection on 25/02/08 for Brendoncare Chiltern View

This inspection was carried out on 25th February 2008.

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

Brendoncare Chiltern View 18/02/09

Brendoncare Chiltern View 11/04/06

Brendoncare Chiltern View 30/12/05

Brendoncare Chiltern View 13/12/04

Brendoncare Chiltern View 19/07/04

Brendoncare Chiltern View 17/03/04

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 View Nursing Home St John`s Drive Stone Aylesbury Bucks HP17 8PP Lead Inspector Mike Murphy Unannounced Inspection 25th February 2008 10:00 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 View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chiltern View Nursing Home Address St John`s Drive Stone Aylesbury Bucks HP17 8PP 01296 747463 01296 747138 slovelace@brendoncare.org.uk www.brendoncare.org.uk The Brendoncare Foundation 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) Mrs Susan Lovelace Care Home 31 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (31) Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2006 Brief Description of the Service: Chiltern View Care Home is a purpose built home providing nursing care for up to 31 elderly people with dementia. It is managed by the Brendoncare Foundation, which is a charitable foundation. The home is situated in Stone, a village on the outskirts of Aylesbury. There are limited local facilities, although the town of Aylesbury is approximately three miles away. The majority of rooms are single, none are en- suite. There are two shared rooms. The home has been designed to provide a safe environment with room for residents who have dementia to walk freely. It is divided into two units. Gardens are safe and accessible with extensive rural views. Qualified nurses are on duty at all times. Staff training is provided. All residents are registered with a local General Practitioner and have access to the specialist healthcare services provided by the local NHS Trusts. The provider makes information about the service available to potential residents on their website and in the form of a comprehensive brochure available from the home. The fees range from £714 to £872 per week. There are additional charges for hairdressing and chiropody. The home gives families and residents support to liaise with social service departments and the local Primary Care Trust, which may contribute to fees. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 *Star. This means the people who use this service experience adequate outcomes. This unannounced inspection was carried out by one inspector in February 2008. The inspection process included consideration of information supplied by the former manager in advance of the inspection, two visits to the home, examination of records (including care plans), discussion with staff and some residents, discussion with the present relief manager, a walk around the home and garden, observation of practice, and consideration of the results of a CSCI survey in which questionnaires were sent to relatives, health and social care professionals, and staff. The home is a purpose built, single storey, medium sized home located in the village of Stone. The home accommodates up to 31 residents in mainly single room accommodation. None of the bedrooms have en-suite facilities. The home provides a good standard of accommodation for residents. A particularly good feature is an attractive enclosed garden to which residents have access and which offers views across open countryside to the Chiltern Hills. This inspection took place at a time of change. Managers and staff were addressing weaknesses in care planning identified towards the end of 2007. A relief manager was in post pending an appointment to the permanent post. A programme of staff training was addressing matters highlighted in a CSCI unannounced inspection in December 2007. At the time of this inspection good progress was being made on a number of matters. There is a strong caring ethos in the home. Residents are treated with respect and dignity. Relatives, both those spoken to during the inspection visit and those who responded to the CSCI survey, gave a favourable impression of standards of care and of liaison between the home and families. Feedback from health professionals was also positive. There is a good level of confidence that changes taking place will support improvements in the quality of the service. Residents have high care needs. It is felt that staff may not have sufficient time to meet residents’ psychosocial needs in line with the specialist nature of the service. Evidence of establishing a person centred approach to care planning and in developing staff skills in the care of people with dementia was noted but did not appear to have been progressed by managers in 2007. Developing such skills would support further improvements in what is undoubtedly a service which is valued by relatives and other stakeholders. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The current activities programme, including its level of resources, should be reviewed so that residents have access to activities designed to meet their needs. Systems of care planning should aim to develop a person centred approach appropriate to the needs of residents in this specialist service. This should be supported by staff training as required. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed by experienced staff before an offer of a place in the home is made. This aims to ensure that the home can meet the person’s needs and to minimise the chances of admitting a person whose needs it cannot meet. EVIDENCE: Referrals to the home may be made direct e.g. by a member of a prospective resident’s family, through a care manager, hospital, or from a care home where a resident’s needs have changed and the person is considered to require nursing care. The referral enquiry is considered by the home manager who comes to an initial view on whether the referral is likely to meet the criteria for admission. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 10 Where the referral is progressed the person or their family are invited to view the home and meet staff. Where a care manager is involved then a copy of the care management assessment and care plan is obtained. The home may also receive information from the primary care trust (PCT). The home then arranges for an assessment of the person’s needs by experienced nurses – usually carried out at the person’s current place of residence. The outcome of the assessment and other relevant information is considered by the manager and nurses. Where a decision is made to offer a place, arrangements are made for the person’s admission to the home. In the case of a transfer from another care home or hospital, the organisation is asked to keep a place open for a month to allow for the possibility of re-admission should the person not wish to stay at Chiltern View or the home consider itself being unable to meet the person’s needs (an example given during the inspection visit was of someone whose behaviour placed other residents at risk). A review involving the person, their family, and other professionals where involved, is held at three months or earlier where necessary. Information in resident’s files confirmed that an assessment of needs is carried out prior to admission, and that information is obtained from the NHS (including copies of the NHS decision support tool regarding decisions on continuing healthcare) and from other agencies, to inform its decision on whether it can meet the person’s needs. Assessment information on two prospective residents who had recently been assessed by staff, but on whom a final decision had not yet been made, also confirmed the home’s practice in respect of this standard. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A care plan is in place for each resident. Care plans are based on assessments by nurses and include risk assessments and evidence of liaison with health and social care agencies in the community. Together, these aim to ensure that peoples’ needs are met, that risk is minimised, and that their independence is supported. Care plans should include more information on psychosocial aspects of care to ensure that those aspects of residents’ lives are adequately addressed. EVIDENCE: A number of relatives spoken to during the inspection visit made positive comments on the way staff provided care to residents. One said the staff were “more caring” (than another home the person had visited), another responding to the CSCI survey, said that the staff “are professional, efficient and capable”, another described the home as “warm and welcoming”. These comments were Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 12 made in the context of how their own relative was treated and their observations on the care and treatment of other residents. The Standex care plan (a commercial care plan system) is the central care planning document. The system has a number of sections (20 or so), each covering an aspect of a person’s care. A care plan was in place for each resident. The plans of four residents selected for case tracking were examined. Weaknesses in care planning were noted in the report of the unannounced CSCI inspection carried out in December 2007. These included failures to fully evaluate key aspects of care, failure to seek specialist nursing advice at an appropriate time, an absence of specific care plans when pressure damage occurs, absence of suitable documentation to record the management of wound healing, and failure to regularly update care plans. These issues were being actively addressed at the time of this inspection in February 2008 (about two months after that inspection). This opinion, based on examination of the care plans of four residents, is supported by a discussion with a specialist tissue viability nurse who has had contact with the home over this period. Staff had been receptive to the advice of the nurse, a programme of training had been put into place, liaison between the home and the nurse was good, care plans had been appropriately put in place, and arrangements for documenting the management of wound healing had improved. The overall standard of care planning on this inspection was satisfactory. Care plans included details of the assessment on which the plan was based. This included risk assessments. Risk assessments covered moving & handling, nutrition, falls, use of bed rails, risk of choking (while eating), and risks associated with the lead from the nurse call system. Detailed care plans covered: personal hygiene, incontinence, pressure sores, falls, night pattern, and mental health. Care plans outlined the support required or the care to be provided under each section. For example, in one file, under ‘pressure sores’ the care plan included ripple mattress, dressings, swabs from the affected area, diet, and liaison with district nurses. Care plans include sections to be completed by other professionals – GPs and district nurses for example. Daily records mainly focussed on physical aspects of care. Whether this is due to the current focus on physical care, the structure of the care planning system, or to separate notes being kept on social activities is difficult to say. It is probably a combination of all three. Some points of detail need attention. Correspondence from an NHS service was loose filed in one case. This practice could lead to a loss of information. One ‘Mental Test Score’ had been completed but not dated, one manual handling assessment had been completed but not dated or signed, and one pressure sore assessment had not been dated. Care plans were signed as having being evaluated monthly although one nutritional risk assessment had been reviewed in November and December 2007 but not since (this inspection Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 13 took place towards the end of February 2008). A system of audit of care plans would identify these points, facilitate corrective action and support consistent conformance to good standards. The residents in this home are frail and have complex needs. These include a need for a high level of support in physical care. The home is addressing the weaknesses identified in the inspection carried out in December 200. The examination of care plans during this inspection has not raised any new concerns in respect of those matters. However, the current system of care planning does not reflect a person centred approach and it does not include the notes of social care activities. There were few references to the involvement of relatives in the care of the person with dementia. References to residents’ life histories were brief. All service users are registered with a local GP practice and evidence of their involvement was noted in examination of documents. The home was in regular contact with district nurses and specialist tissue viability and incontinence nurses. A chiropodist regularly visited the home. References to other NHS services was noted during the examination of care plans and related documents Medicines are prescribed by the resident’s GP and are supplied by a pharmacy in Haddenham. Where possible medicines are supplied in a blister pack monitored dosage system (MDS). An experienced nurse has a lead responsibility for medication. The organisation has a policy governing staff practice. A British National Formulary (BNF) dated 2005 was available for reference – a more recent edition should be obtained. The manager said that she would download a copy of the most recent Royal Pharmaceutical Society of Great Britain guidelines on medicines in social care (published in October 2007). Medicines are stored in wooden cabinets in an air conditioned clinic room. Controlled Drugs (CD) are stored in a double locked wooden cabinet. Medicines requiring cool storage are stored in a refrigerator in the clinic room. The temperature of the refrigerator is regularly checked and recorded. A contract with PHS is in place with for the disposal of medicines and it includes the supply of containers to denature the medicine. Only registered nurses administer medicines. Samples of individual signatures are recorded. Administration of medicines records include a photograph of the resident and the medicines administration record (‘MAR’ chart). Examination of MAR charts of those residents case tracked found them to be completed satisfactory. A check of Temazepam stored in the CD cabinet showed a balance consistent with records. Arrangements for ensuring the privacy and dignity of residents are satisfactory. Residents were treated with respect by staff. Personal care is provided in bathrooms and bedrooms. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 14 Healthcare professional respondents to the CSCI survey carried out in connection with this inspection expressed confidence in the service. One wrote ‘They look after the residents very well, always ensuring that they have adequate food and drink and are alert to changes in medical condition. They seek medical advice when appropriate and always treat patients with dignity and respect’. Another wrote ‘(that the home has) High quality staff, particularly good physical environment. Good at managing behavioural problems’. Another said ‘..out of nine nursing homes I visit on a regular basis this is by far the best’. Relative respondents to the CSCI survey were also positive in their view of the home. One wrote ‘After two lengthy stays in assessment units and two unsuccessful placements in homes claiming to offer dementia care – this home’s specialist care and understanding was a revelation – I no longer felt ‘guilty’ that I was giving a home a problem to deal with’. Another said ‘In view of the mental frailties of all the residents they have a very limited ‘quality of life’, however they always seem to be treated with dignity, kindliness and respect by the carers’. Another wrote ‘(the staff) Understand the complex needs of severe dementia patients without judging their behaviour. Prioritises issues which make residents comfortable and safe within the constraints of the severity of their disorder’. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ well being and quality of life is maintained through the home’s positive and caring ethos and its good relationship with relatives. However, there is a need for a more consistent approach to social activity to ensure that residents’ social needs are met. EVIDENCE: The Centre Guide states ‘At present the Activities Organiser and the care staff do most activities on a group basis, however, one to one activities are also catered for, in particular work in the multi sensory room, manicures, hand massages and spa tubs’. The home did not appear to be maintaining this range of activity on a regular basis at the time of this inspection. One element of the assistant administrator’s job involves a share in responsibility for the co-ordination of organised activities for residents. A folder for reference provides excellent guidance on social activities. Due to staff sickness, however, staff time dedicated to social activities was significantly Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 16 reduced. The manager said that the home had advertised locally for an activities co-ordinator but had not been successful to date. From observation of practice during the inspection visits to the home it seemed evident that nursing and care staff had little free time to spend in social activities with residents. There were points mid-afternoon or early evening where staff had time to sit with residents, but in the morning and through to the early afternoon staff were kept busy attending to the physical care of individual residents. The Standex care plan format seems more oriented towards recording physical care than psychosocial aspects of care. Person centred plans (PCPs) had not yet been established. The administrator had drawn up a plan of activities for the month. Examination of activity records showed a low level of participation in organised activities i.e. five recorded activities in one month in one case and two recorded activities a month in two cases (a Church related activity and a session run by an entertainer). Other records showed a similar recorded level of participation. It was said that the occasions when activities were offered but where the resident was unable or unwilling to participate were not recorded. People living in such services need a range of social activities, while at the same time not always being receptive to organised activity. There appeared to be a good relationship between residents and staff. As recorded elsewhere in this report, relatives confirmed this. Subject to their ability residents were able to move around the home without undue restrictions. A relative said that, through visiting so often, relatives get to know one another over time and this engenders a sense of community between relatives, residents and staff. Elements of a distinctive model of care appropriate to the needs of residents with dementia were present. Some staff had attended what they described as an excellent course on dementia in 2007, the relief manager is an approved trainer with the Alzheimer’s Disease Society and has been trained in dementia care mapping, guidance on person centred care was on display, some staff had specific responsibilities for social activities, and relationships within the home and with relatives were good. Staff were aware of the need to give more time to residents but said that they just did not have it. The majority of residents were said to be local people. This had the advantage of their families being able to visit often. There is a ‘League of Friends’ for the home and many relatives are members or are in contact with it. A pantomime was organised over the Christmas period. A member of staff observed that residents gain particular enjoyment from music. The home books an entertainer once a month. The manager would like to develop more reminiscence and sensory approaches and to integrate these into day-to-day care. She was also considering how a pet scheme might benefit residents. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 17 Menus are based on a four-week cycle with quarterly updates. The latter taking account of seasonal factors among others. Breakfast consists of cereal, toast and hot drinks with porridge on offer alternate days and a cooked breakfast on Sundays. Lunch is a two-course meal and is the main meal of the day. The menu includes a meat and non meat choice each day. Samples from the menus around the time of this inspection included: Honey Roast Gammon or Nut Cutlet served with Roast Potatoes, Broccoli and Cauliflower, followed by a dessert of Black Forest Gateaux; Battered Haddock or Beef Burgers served with Chips and Mushy Peas, followed by Rhubarb Fool; and, Beef Lasagne served with Chips or Cheese and Tomato Quiche served with New Potatoes, followed by Cherry Flan. Supper is again a two-course meal. Samples from the menu included: Vegetable Soup with Bread and Butter or Selection of Sandwiches, followed by Chocolate Sponge and Chocolate sauce; Cream of Broccoli Soup with Bread and Butter or Selection of Sandwiches, followed by Plum Crumble and Custard; and, English Fry Up or Selection of Sandwiches, followed by Peach Mousse. Tea, Coffee and Biscuits is served mid-morning. Tea, Coffee and Cake is served mid-afternoon. Special diets are prepared where necessary. The advice of a dietician is sought on an individual basis according to need. Some residents were restless and constantly on the move. Nurses said they took account of the nutritional implications of this and that such residents did not miss out if they were unable to sit and eat their meals at regular times. Residents are weighed monthly. Care staff and relatives make selections from the menu for residents who are unable to do so. Pureed meals are served in separate portions on the plate. Nursing and care staff are available in the dining room and lounges to assist residents where necessary. Lunch and supper were indirectly observed on the first day of the inspection visit. Staff were noted to sit beside the resident and to assist at a pace which suited the person. Residents were not hurried. A relative respondent to the CSCI survey wrote ‘(the staff) Treat residents with dignity all the time, looks after nutrition and health needs well. Keeps a clean and tidy home’. Comment on the food included ‘Food could sometimes be better, particularly puddings – a hot traditional pudding would go down well with most residents. Fridays fish in soft form is very unappetising, too glutinous – very difficult to swallow. Puddings can sometimes be just a low fat yoghurt. Something higher in calories would be more appropriate’. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has procedures for recording and investigating complaints. It has a framework of policy, reporting arrangements and staff training with regard to safeguarding vulnerable adults. Together, these aim to protect service users from abuse and to ensure that complaints are investigated. The complaints policy needs updating and reconsideration of some sections to protect the dignity of residents and ensure impartial investigation of complaints. EVIDENCE: The complaints procedure is displayed on the wall in the entrance to the home and is outlined in the ‘Centre Guide’ (service user’s guide). The policy advises a person who wishes to make a complaint to talk to the ‘Head of Home’, one of the unit managers, or one of the registered nurses. It goes on to say that if the matter is not resolved ‘please write to the Head of Home’ – even though the person may have already spoken to the Head of Home? It then states that if matter remains unresolved or not ‘handled appropriately’ the matter may be raised with the chief executive of Brendon Care or with CSCI. In fact a complainant may refer a complaint to CSCI at any stage. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 19 The procedure includes the words ‘It is always unfortunate to receive a complaint regarding the service we provide, however, it also provides us with an opportunity to identify and understand areas, which are of concern to Service Users’. The first part of the sentence raises the question as to why it is ‘unfortunate’ to receive a complaint since, as acknowledged in the second part, they offer managers an opportunity to look at matters of concern. The wording may also deter some people from making a complaint. The procedure in the guide opens with the words ‘As the majority of our residents are unable to voice their opinion clearly, we encourage friends and relatives to play an active advocate role’. While this may be true for many residents one wonders if it needs to be stated in such terms in the home’s documentation - might it not be considered somewhat demeaning? Relatives undoubtedly have a key role in such settings, although they may not always be able to act in ‘an active advocacy role’ if that implies a need for a high degree of impartiality. In some circumstances the involvement of an independent advocate may be preferable and information on access to such a service should also be available to residents and their families. The name of the home manager and contact details for CSCI are now out of date. Systems are in place for recording complaints. None have been recorded since the last key inspection in 2006 The home’s policy on safeguarding vulnerable adults ‘Elder Abuse’ is dated 2003 – to be reviewed in September 2009. The policy outlines an internal process of investigation. It does not appear to involve early notification to Buckinghamshire Social Services or to CSCI (‘CSCI to be informed on Reg 37 form’). Such notification seems limited to ‘…alleged abuse by a family carer which shows apparent substance, and where the contract for providing the resident’s care is commissioned by the local authority…’. The policy does not include reference to guidance from the Department of Health on the POVA list (latest guidance issued in May 2006). A copy of the Buckinghamshire Inter-Agency Policy and Procedures on Safeguarding Vulnerable Adults (latest issue 1 March 2007) was not accessible at the time of the inspection visit. This has since been obtained by the relief manager. The organisation does have a whistle blowing policy. The random focussed inspection in December 2007 found that 16 members of staff had not had safeguarding training. The relief manager reporting to this inspection said that the majority of staff have now had such training and there were just a few staff left who still needed to attend. Care is provided under the supervision of registered nurses who have had a specialist training in mental health care. Such nurses would have had training and experience of dealing with aggression and other challenging behaviours. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 20 The training programme for 2008 includes staff training on challenging behaviour. The home has a policy and procedures for dealing with resident’s monies. The implementation of this is overseen by the administrator. Records of all transactions are recorded, receipts are retained, and statements issued monthly. Where cash is required it is obtained through the home’s petty cash system and recharged to the resident’s account. Payment for services such as chiropody and hairdressing is made through internal transfer. The system can be monitored through computer links with head office. The administrator said that the accounts manager visits the home monthly and that the system is audited annually. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a well designed, accessible, pleasant, clean and wellmaintained environment. It provides residents with a comfortable and safe place to live designed to meet their care needs. EVIDENCE: The home is a medium sized home which was purpose built in 1992. It is located in a quiet residential area in the village of Stone. It is approximately three and a half miles from Aylesbury and just over six and a half miles from Thame. Buses to Aylesbury, Thame and Oxford serve Stone. The nearest rail station is Aylesbury. Parking is provided to the front of the building. There are views over open countryside from the rear and one side of the building to the Chiltern Hills. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 22 Entry to the home is controlled by staff. The entrance lobby leads to an open area: part circulation, part seating. Corridors lead from here to each of the two wings – the ‘East’ and ‘West’ wings. The dining room, kitchen, administrative and other staff offices are located off this area. The wings provide accommodation for 16 and 15 residents respectively. Each wing includes bedrooms, a lounge, a ‘nurses station’, bathrooms, WCs, and storerooms. The size of the bedrooms is adequate for residents who are mobile. However, their size can present a challenge to staff where a resident’s needs increase and equipment is required to provide care. None of the bedrooms have en-suite facilities. One wing has a twin bedroom. WCs are located within reasonable walking distance of lounges and bedrooms. Bathrooms have a bath, chair lift, pedal operated bins, and WC. The home has portable hoists – new slings for which have been purchased since the focused inspection in December. The manager said that hoist slings are not now shared and that the home is conforming to relevant guidance on this matter. The home has acquired other equipment such as pressure mattresses as required. A well-designed, safe and enclosed garden to which residents have direct access almost surrounds the home. The garden is on level ground on a sloping site. The slope is particularly steep in one area but access to this is prevented by a fence and locked gate. A pathway facilitates wheelchair access around the garden. The garden has been landscaped with areas of lawn, flowerbeds, shrubs, trees and an area bordered by mature hedging. It includes benches and garden chairs. In one section a pergola leads to a pebbled area and summerhouse. Nearby is a bird table. In another section a stone or concrete feature has been planted with flowers. Views extend over open countryside to the Chiltern Hills. Even on a cool February day a resident was observed to enjoy walking around the garden. Residents did not appear to make much use of the lounges on either wing during the day of the inspection visit – albeit one lounge was given over to staff training on the first day. They seemed happier sitting in the central seating area where most activity took place. Pictures have been fixed in the lounges and on some bedroom doors. For some reason a high proportion of these have been fitted above eye level. This was noted in particular on some bedroom doors, where the resident’s name and photograph, were sometimes fitted at a height above eye level. The manager said she intends to consider how the environment could be improved for the particular needs of people with dementia. The laundry is compact but is considered adequate for current use. When inspected mid-afternoon it was clean, tidy and in order. It was equipped with two washing machines, two dryers, a sink and iron. There was sufficient Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 23 storage. The laundry assistant said that she was due to attend a training session on infection control in April 2008. The laundry door is normally locked. The kitchen is adequate but in need of some refurbishment. The chef manager said that a new cooker was on order and that the wall on one side was scheduled to be re-tiled. A new refrigerator had been obtained and a chain link screen fitted to an exterior door. It was noted that practice in labelling perishable foods when opened seemed variable. On the day of inspection some opened cooked meats had just passed their best before dates and an opened carton of cream had not been labelled. This was discussed with the manager and chef manager at the time. The chef manager said that food contracts are with reputable suppliers – meat, vegetables and dairy local where possible, other products from a large supplier. The chef manager said that the temperature of meat is checked with a probe thermometer on delivery and that he occasionally makes spot checks of the truck. Records of food and cold storage temperatures are maintained as required. The dining room is adjacent to the kitchen and central sitting area. Its size is adequate for current needs. Residents dining there had sufficient space and staff provided assistance as needed. There appears to be sufficient office space for staff (although this is spread around a number of small offices, one of which doubles as a hairdressing room). Facilities for the secure storage of information are good. Overall, the home provides, a safe and comfortable environment for residents. Standards of cleanliness are good and no untoward odours were noted at any time on either of the two visits - one of which was unannounced. Residents who are able have space to move around as they wish. Residents also have direct access to the garden. The home provides a number of seating areas where residents and their visitors can sit on their own, be with a few others, or sit with a larger group as they wish. The size of some bedrooms is likely to pose a challenge to staff caring for highly dependent residents – particularly where moving and handling equipment is required. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate and procedures for the recruitment of new staff and for staff training and support are good. These aim to ensure that there are sufficient numbers of appropriately trained and supervised staff to meet the needs of residents. However, on occasions residents’ psychosocial needs may not be fully met because of pressure on staff time. EVIDENCE: In the AQAA submitted prior to the inspection, the previous manager wrote on behalf of the organisation that ‘Staffing levels are maintained to dependency levels over a twenty four period…’. The present manager said that the dependency levels of residents were reassessed in January 2008. It was noted that the care plans for residents include a dependency measure – each of the residents were in the high dependant category. The manager and staff had concluded that dependency levels had increased over recent years and that more residents now require higher levels of support. It was unclear whether this had led to any reassessment of staffing levels or skill mix. The present staffing provides for seven care staff and two nurses in the morning, four care staff and two nurses in the afternoon, and three care staff Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 25 and one nurse at night. Other staff include an administrator and assistant administrator (who also organised activities), chef, assistant chef and kitchen assistants, a laundry assistant, domestic assistants, a maintenance man, and a part-time gardener. There appeared to be pressure on staffing over the course of the two days on which the home was visited in connection with this inspection. Staff were kept busy attending to the physical needs of residents and had little time before mid-afternoon to sit with them – and even then only for brief periods. At the time of this inspection two staff, including a team leader, were on long term sick leave, two staff were on maternity leave, and there was a vacancy for an activity co-ordinator. The hours were being covered by bank staff. A staff respondent to the CSCI survey wrote ‘As with all care homes one can never rely on all staff to be free of sickness, but 99.9 of the time there is always more than enough staff on duty. Brendon Care always have a higher staff to resident ratio than the legal minimum’. The recruitment of new staff is carried out in the home with support from the organisation’s head office in Winchester. There is reported to be a low turnover of staff. The files of six staff appointed since the last key inspection in April 2006 were examined. Most included the information required under Schedule 2 of the Regulations. The examination found that in one case an applicant had provided the years of previous employment only. Such a practice can cause problems in exploring gaps in a person’s employment history. A health declaration was not on file in another case. Criminal Records Bureau (CRB) and POVA First checks were in order. Most of the care assistants have acquired NVQ at level 2 or above. A CSCI random focussed inspection (RFI) carried out in December 2007 found a lack of staff training in pressure damage prevention, infection control and safeguarding. This was being addressed by the organisation and the manager said that 21 staff had attended training on safeguarding, that the tissue viability nurse was conducting training in pressure damage prevention in March 2008, and that training in infection control was scheduled for April 2008. The organisation employs a training manager who is based at its head office. ‘Mandatory’ training is reported by the manager to be now up to date (this includes the forthcoming Infection Control training). It is noted that the list of training does not include training on the care of people with dementia. The manager said that two nurses did a five day course on Dementia in February and March 2006. The nurses rated the course highly. Two staff were also reported to have attended training on Person Centred (Care) Planning (PCP) and to be designated as Person Centred coaches. However, it was thought that one was on sick leave and the name of the second was not available at the time of the inspection visit. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Weaknesses in the quality of some aspects of the service were being rectified by the organisation. It was too early, at the time of this inspection, to assess whether the actions taken were robust enough to avoid a recurrence and ensure that all aspects of residents care needs were being fully addressed. EVIDENCE: At the time of this inspection the home was being managed by a relief manager (the manager) - the registered manager having left towards the end of 2007. The relief manager is an experienced registered mental nurse. She has over 15 years experience as a manager and has been with Brendon Care for three years. The manager is an Alzheimer’s Disease Society approved dementia care trainer and has completed a course in dementia care mapping. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 27 Events towards the end of 2007 had initiated two review processes: a multiagency review of the care of some residents, and an internal review of the service by Brendon Care senior managers. Further meetings in relation to both were scheduled around the time of this inspection. The events had also triggered an unannounced CSCI inspection. Staff appeared to be dealing with these in a professional manner, but it was evident that aspects of the process had caused stress at times and potentially an adverse affect on staff morale. In making this observation it is important to say that there were no signs, or reports from anyone spoken to over the two days of the inspection visit, of the process having had an adverse effect on the care of residents. A relative respondent to this CSCI survey wrote ‘There have been concerns about the future of the home and some changes at managerial level – although generally this has been communicated to relatives very well, via meetings etc. – this has not happened for a while now and it is not clear where this situation is now and what the future holds. Small thing but it would be very helpful to have a staff structure with photos near the visitors book – I have seen this elsewhere and found it very helpful knowing who was who without having to keep asking’. The manager carried out checks on care plans in January 2008 and on medicines in February 2008. The organisation was reported to have carried out a survey of staff and relatives in January 2008. The survey does not extend to other stakeholders – such as GPs, specialist nurses and other professionals who may be in regular contact with the home. The results were not yet available. They are to be presented at a road show event at the home in April 2008. The results of the 2007 survey and its effects on the home were not available at the time of this inspection. The manager maintains an overview of the quality of the service by regular checks on residents and being available to relatives and staff. The home has not carried out a dementia mapping exercise to date. There is a League of Friends who support the home. Relatives spoken to over the course of the visit were complimentary about the home. It was described as “warm” with “lots of room”. The staff were described as “very conscientious”, “all very good”. One relative expressed criticism of an earlier manager, the appointment was considered to have had an adverse influence on the home – “Things weren’t as happy”. The same person said that “..there is a core of dedicated staff who go beyond the call of duty. Couldn’t praise them more”. Another described the atmosphere as “serene” and found that there were never any unpleasant odours. The person went on to comment on recent changes “a definite change for the better – things seem more structured – I even feel better – excellent staff here now”. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 28 Supervision is not routinely established in the home and it is not currently achieving the minimum of six meetings a year in line with the standard 36 and the organisation’s policy. The manager said that it is just getting under way on a regular basis. Annual staff appraisals are also to be established in line with policy. The home’s approach to matters of health and safety are generally satisfactory. There is a health and safety policy in place. The manager said that a home health & safety group is to be established. The manager reported that independent health and safety consultants carried out a health and safety audit of the home in September 2007. The home is said to have scored 87 and the manager said that action has been taken on all matters identified by the consultants. Testing of portable electrical appliances is carried out by the home’s maintenance staff. It was not known when the home’s fixed electrical wiring was last checked. It is said to have been a former NHS facility. Staff have received training in the management of ‘COSHH’ materials and systems are in place for the safe storage of such materials. Most recent dates of testing hoists and gas appliances were recorded in the AQAA submitted prior to the inspection visit. The temperature of the hot water in areas accessed by residents is regulated. Records of checks are maintained. Checks for Legionella are carried out through bacteriological analysis of the hot water storage. Contracts are in place for the maintenance of fire equipment. A fire drill was last carried out in September 2007 and another is planned for March 2008. The date of the most recent fire risk assessment was unclear. This is to be conducted by a competent person, using an appropriate format to structure and record the assessment. Buckinghamshire and Milton Keynes Fire Authority may be able to advise if necessary. An environmental health officer inspected the kitchens in October 2007. The officer recommended fitting fly screens to the door the kitchen door which leads outside, replacing broken wall tiles, and replacing the doors to one of the refrigerators. A chain link screen has been fitted to the doorframe. The refrigerator has been replaced. One side of the kitchen is to be entirely refitted. On checking the refrigerator it was noted that some opened foodstuffs had not been labelled with date of opening. Two products had exceeded their ‘use by’ dates by a couple of days. These were discarded by the chef at the time. Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 29 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 30 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 OP30 Regulation 18 Requirement All staff must have care of the dying training commensurate with their responsibilities (New timescale set). The organisation must update the infection control policies and procedures in line with guidance issued by the Department of Health in June 2006. Residents must not share hoist slings. Alcohol hand rub must be available at the point of care and where it is safe to do so foot operated pedal bins must be provided for clinical waste. The in-house moving and handling trainers must also update their training on an annual basis. The organisation must ensure that there is an up to date fire risk assessment which has been carried out by a competent person in accordance with current legislation. Timescale for action 30/05/08 2 OP26 13(3) 28/02/08 3 OP38 13(5) 28/02/08 4 OP38 23(4) 30/04/08 Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 31 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 OP8 Good Practice Recommendations The organisation should ensure that there are policies and procedures available to guide staff in the prevention and management of pressure damage. The organisation should ensure that activities are in place to meet residents psychological and social needs and that these are integrated into care planning processes in the home. The organisation should review the complaints procedure in the home and ensure that it is up to date and conforms fully to this standard. The organisation should establish a regular process of supervision for nursing and care staff. The organisation should ensure that its policy and procedures on food hygiene provide guidance to staff on the labelling and storage of perishable foods. 2 OP8 3 4 5 OP16 OP36 OP38 Chiltern View Nursing Home DS0000019197.V357876.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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