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Inspection on 30/12/05 for Brendoncare Chiltern View

Also see our care home review for Brendoncare Chiltern View for more information

This inspection was carried out on 30th December 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Resident`s general physical and healthcare needs are met, although greater attention should be paid to the assessment of mental health and to developing appropriate care plans. Overall the medication management systems are good ensuring that residents receive their medication in a safe and timely way.

What has improved since the last inspection?

A permanent home manager has now been appointed following a lengthy period of acting arrangements.

What the care home could do better:

The recruitment procedures should be improved to ensure that all staff have the required documentation before beginning work. The induction programme for new starters should be delivered within the timescales set by the organisation if staff are to have the initial knowledge and skills that they need to care for residents. The training programmes should be applied in a more systematic manner to ensure that all staff have the necessary skills and knowledge to care for this vulnerable group of residents.

CARE HOMES FOR OLDER PEOPLE Chiltern View Nursing Home St John`s Drive Stone Aylesbury Bucks HP17 8PP Lead Inspector Christine Sidwell Unannounced Inspection 30th December 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000019197.V275747.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. DS0000019197.V275747.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chiltern View Nursing Home Address St John`s Drive Stone Aylesbury Bucks HP17 8PP 01296 747463 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) The Brendoncare Foundation 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) DS0000019197.V275747.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2005 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. DS0000019197.V275747.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection undertaken on the 30th December 2005. The purpose of the inspection was to inspect the remaining core standards, which were not assessed at the inspection undertaken on the 25th April 2005, and to assess compliance with the requirements arising from that inspection. Policies and procedures were examined. The manager was interviewed. All residents in the home were seen and a number of residents and families were spoken to. A number of care staff were also interviewed. 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. DS0000019197.V275747.R01.S.doc Version 5.1 Page 6 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 DS0000019197.V275747.R01.S.doc Version 5.1 Page 7 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): These standards were not assessed at this inspection. They were met at the inspection undertaken on 25th April 2005. EVIDENCE: DS0000019197.V275747.R01.S.doc Version 5.1 Page 8 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): 8 and 9 Resident’s general healthcare needs are met, although greater attention should be paid to the assessment of mental health and to developing appropriate care plans. Overall the medication management systems are good ensuring that residents receive their medication in a safe and timely way, although some improvements could still be made. EVIDENCE: The healthcare of three residents, selected at random, was assessed. They all had care plans which had been reviewed on a monthly basis by a qualified nurse. The residents seen were well groomed and had been helped with their general hygiene. Some resident’s hair, whilst clean, was long and untidy. The home should ensure that all resident’s hair is cut and styled regularly. The care plans seen had evidence that residents are assessed as to their risk of developing pressure damage. The staff said that no residents had pressure damage at the time of the inspection. Resident’s continence needs are assessed and the appropriate aids are provided by the Primary Care Trust. The residents seen had had a nutritional assessment and there was evidence that residents are weighed regularly. There was evidence in the care plans that the local general practitioner and specialist dementia care consultant sees DS0000019197.V275747.R01.S.doc Version 5.1 Page 9 residents where appropriate. Only one of the care plans seen had evidence of a comprehensive mental health assessment or that the resident’s dementia care needs had been assessed. This aspect of care needs to be developed. There is a medication policy. Pre-packed dosette systems are supplied by the local pharmacy. The medication administration charts were completed correctly although several did not have photographs of the resident. There was an incident earlier in the year when some controlled medication could not be accounted for. An investigation was undertaken and the policies and procedures were amended to require that controlled medication is checked at the end of every shift. This is now in place and there have been no further incidents. Records are kept of medication entering and leaving the home. The staff said that medication was not administered covertly and that if this became necessary then it would be as a result of a multidisciplinary team meeting. There was evidence that a local pharmacist audits medication management on a quarterly basis. A specialist company deals with the disposal of unwanted medicines. DS0000019197.V275747.R01.S.doc Version 5.1 Page 10 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): These standards were not assessed at this inspection. They were met at the inspection undertaken on 25th April 2005. EVIDENCE: DS0000019197.V275747.R01.S.doc Version 5.1 Page 11 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): These standards were not assessed at this inspection. The core standards were met at the inspection undertaken on the 25th April 2005. EVIDENCE: DS0000019197.V275747.R01.S.doc Version 5.1 Page 12 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): These standards were not assessed at this inspection. They were met at the inspection undertaken on 25th April 2005. EVIDENCE: DS0000019197.V275747.R01.S.doc Version 5.1 Page 13 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): 28 and 30 The recruitment procedures do not fully protect residents from unsuitable carers. The induction programme should be delivered within the timescales set by the organisation if newly appointed staff are to have the initial knowledge and skills that they need to care for residents. The training programmes should be applied in a more systematic manner to ensure that all staff have the necessary skills to care for this vulnerable group of residents. EVIDENCE: The files of the four members of staff who had started since the last inspection were examined. They did not contain all the required documentation. The letters from head office are confirming that Criminal Records Bureau checks are undertaken are kept in a separate file. It is recommended that these are kept in the main file. Risk assessments are undertaken if staff members start work with a POVA first check and are awaiting a full Criminal Records Bureau check. Two references were taken up for all staff although one staff member’s references were not from her previous employer but from a former employee and work colleagues. One file did not have a full copy of the staff member’s passport and their work permit where appropriate. There was evidence that the registration status of all qualified nurses has been checked. It is recommended that the manager undertake a recruitment file audit to ensure that all members of staff have the required information in their files and to ensure that all members of staff who require one have a valid work permit. DS0000019197.V275747.R01.S.doc Version 5.1 Page 14 There is an induction process which meets the standards recommended by Skills for Care. New staff are allocated a mentor and are given an induction booklet to complete during the first six weeks of their employment. Part of the initial induction contributes to the Skills for Care Foundation course and. The induction booklets of the two staff members who started in September 2005 were seen. Neither staff member had completed the induction programme, nor had they had manual handling training. Brendoncare run a corporate training programme. Local training programmes complement this. The training records are kept in paper files and are gradually being transferred to a computerised system. It was not possible to assess whether all staff had had basic mandatory training with annual updates although there was evidence that a variety of training sessions had been undertaken, which some staff had attended. The staff have not yet had dementia care training. A training needs assessment for the home should be undertaken and a baseline audit of the training that current staff have undertaken should be done to ensure that all staff have the necessary knowledge and skills to care for this vulnerable group of residents. DS0000019197.V275747.R01.S.doc Version 5.1 Page 15 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): These standards were not assessed at this inspection. The core standards were met at the inspection undertaken on 25th April 2005. EVIDENCE: DS0000019197.V275747.R01.S.doc Version 5.1 Page 16 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X DS0000019197.V275747.R01.S.doc Version 5.1 Page 17 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 2 3 Standard OP8 OP8 OP8 Regulation 12 12 12 Requirement Where possible, resident’s hair should be cut and styled on a regular basis. All resident’s care plans should contain a photograph. All residents should have a comprehensive mental health assessment and a relevant care plan be developed. The medication charts should have photographs of residents attached to them. The recruitment files must contain the information specified in Regulation 19, schedules 2 and 4 of the Care Homes Regulations 2001 All staff must have Dementia Care awareness training and senior staff should have in depth training in the care of residents with dementia. This is an unmet requirement of the previous report and a new timescale has been set. A training needs analysis should be undertaken. An audit of the current training that staff have undertaken DS0000019197.V275747.R01.S.doc Timescale for action 31/03/06 31/01/06 31/03/06 4 5 OP9 OP29 13 19 31/01/06 28/02/06 6 OP30 18 30/06/06 7 8 OP30 OP30 18 18 28/02/06 28/02/06 Version 5.1 Page 18 9 OP30 18 should be done. All staff must have basic mandatory training with annual updates. 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000019197.V275747.R01.S.doc Version 5.1 Page 19 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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