Inspection on 21/07/05 for Chilterns End

This inspection was carried out on 21st July 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 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

Chilterns End 11/06/08

Chilterns End 08/06/07

Chilterns End 30/01/07

Chilterns End 17/08/06

Chilterns End 05/01/06

Chilterns End 17/02/05

Chilterns End 30/09/04

Chilterns End 03/02/04

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Chilterns End Greys Road Henley-on-Thames Oxfordshire RG9 1QR Lead Inspector Delia Styles Announced 21 July 2005 09:30 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 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. Chilterns End Inspection report OP.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chilterns End Address Greys Road, Henley-on-Thames, Oxfordshire, RG9 1QR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01491 574066 01491 574633 manager.chilternsend@osjctoxon.co.uk The Orders of St John Care Trust - Ms Dawn Matthews-Smith Ms Pauline Krason (Manager Designate) Care Home 46 Category(ies) of Past or present alcohol dependence over 65 registration, with number years of age (3), Dementia - over 65 years of of places age (21), Learning disability over 65 years of age (3), Old age, not falling within any other category (46), Physical disability over 65 years of age (13). Chilterns End Inspection report OP.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17 February 2005 Brief Description of the Service: Chilterns End is a purpose built care home that was purchased by The Orders of St John Care Trust from Oxfordshire Social Services in the latter part of 2001. The home provides accommodation and care for a maximum of 46 older people over the age of 65, some of whom may be mentally or physically frail. The home also provides day care and respite short stays for a small number of people. The accommodation is provided in single rooms in a one storey building. Chilterns End is set in its own grounds on the outskirts of Henley-on-Thames and is close to local health centres, shops and Townlands, the community hospital. The home has four units, each with its own kitchenette, dining and sitting rooms and there is also a large main dining room. Each unit has assisted toilets, bath and shower facilities The building surrounds a central garden with a sensory area, planted with herbs and aromatic plants and a water feature. The garden and grounds have a range of garden seating and shaded areas, with easy access for residents from most areas of the home. Chilterns End Inspection report OP.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced, started at 9.30 am and lasted for seven and a half hours. The inspector toured the building, spoke to 3 visitors, 10 residents, 6 staff and the home’s manager designate during the day. A sample of residents’ care records and staff records were also inspected. Comment cards were received from 3 relatives, 4 care managers and 5 general practitioners before the inspection. What the service does well: What has improved since the last inspection? The gardens have been further developed, with one area dedicated to the former, retired manager, and a new themed ‘seaside’ area at the front of the home, complete with small boat and sand. Ideas for a design for another new flowerbed were being discussed at the time of the inspection. Hanging baskets and plant containers give the residents very attractive outlooks from their rooms. New equipment for the sluice rooms has been installed. The Orders of St John Care Trust have reviewed and updated all the policy and procedure documents for its care homes and employ a senior manager to make sure that good standards of care and record keeping are achieved throughout all the OSJCT care homes. The computer systems used by the homes helps the organisation to share and update information with managers and staff and to have accurate information about any concerns or complaints that need to be acted upon. Chilterns End Inspection report OP.doc Version 1.40 Page 6 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. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 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 standard(s) 1 & 3 The home’s Statement of Purpose and Service User Guide lack some of the information required for prospective residents or their representatives to be clear about the services the home provides. Some residents’ assessments were incomplete so that it would not be possible to assure residents and their representatives that the home can meet their needs. EVIDENCE: The manager, Mrs Krason, said that a new Statement of Purpose was being written and should be available shortly. Residents’ care needs are assessed, and the scale of fees charged depend on how much help the resident requires from staff (‘banding’) and is done using a detailed assessment form with fee rates agreed with Oxfordshire Social Services. There was a lack of assessment detail in the paperwork for some of the privately funded residents. All residents should have an assessment of need prior to admission and each person’s needs should be reviewed and updated. Residents and their representatives should have written confirmation that the resident’s needs can be met by the home on the basis of up to date assessments. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 The standard of written records of residents’ care has not significantly improved since the last inspection. The care plans do not contain enough detail to provide staff with enough information to be confident that they are satisfactorily carrying out the care needed by residents. The health needs of residents are well met, with evidence of good communication with doctors and other social and health care professionals. EVIDENCE: A sample of care plans for six residents was inspected. The care plans lacked sufficient detail and updating. Many of the care plans had not been reviewed since April 2005: there is an expectation that staff review care plans at least monthly, to check that they are still up to date and that the written instructions about care are accurate to give staff enough information about how to meet the needs of the resident. The assessment of residents’ nutritional needs is not consistent and does not accurately identify those at risk because of poor appetite or diet. The use of an assessment scheme recommended by the community dieticians, and that is being introduced across Oxfordshire, should be started in the home. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 10 However, through talking with the manager and staff, and seeing staff at work with residents, it was clear that staff do have a good knowledge of individual resident’s care needs in practice, and that there is a good, caring relationship between staff and residents. This was supported by the questionnaire responses from doctors, visiting care managers and relatives and visitors. There was evidence of the home arranging for occupational, speech and physiotherapists to assess residents who had particular health problems, following referral by the resident’s doctor. Mrs Krason acknowledged that the standard of care-planning had not significantly improved, but The Orders of St John are organising further training sessions for staff about how to write care plans Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Links with the local community are good and support residents’ social life within and outside the home. There are plans in place to expand the opportunities for activities and outings for residents. The meals in the home are good, offering choice and variety. EVIDENCE: The home provides a day care service on two weekdays for up to 10 service users. Transport to and from the home is provided by special transport. There was a programme of planned activities and outings for residents, with posters on each unit. Several residents attend other local day care groups or clubs in Henley. There were no organised activities or entertainments on the afternoon of inspection, but residents spoken to were content with watching TV, listening to music or resting in the lounges. The member of staff who is employed to organise activities had been off sick, so there had been some disruption to the programme of planned activities. The manager is keen to involve residents in planning future outings and activities and is inviting suggestions. A lot of work and enjoyment had gone into the planning and creation of three new garden areas around the home and staff and residents were being asked by the gardener for ideas about a theme and planting scheme for a further Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 12 new flower bed. The home’s gardens and grounds were due to be judged as part of an OSJCT competition between all its homes. A Holy Communion Service was held in the morning – a weekly service to which residents of any Christian denomination are invited. The meals in the home are good, offering a choice from a range of traditional dishes. Residents confirmed that they liked the food and the variety overall. OSJCT is involved in getting residents’ opinions about meals by making questionnaires available to residents, and through employing a catering manager to visit homes and advise local catering staff about the menu choices and meals service in each home. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 The home has a satisfactory complaints system. There was evidence that residents and their relatives are informed about how to raise concerns and that the organisation has a commitment to listen to and act on residents’ complaints. EVIDENCE: The OSJC Trust has a clearly set out complaints policy. The homes’ managers are required to inform a senior manager for the OSJCT of any formal complaints and looks at the way in which complaints are investigated and acted upon. The complaints procedure and information is displayed prominently on notice boards in the home, and is included in each resident’s guide/brochure pack. An advocate from Age Concern visits the home regularly to meet with residents. Two complaints about the home had been received since the last inspection. One relative had not been satisfied with the way in which their concerns had been dealt with, and had contacted the CSCI (this was before the current manager Mrs Krason was appointed). The complainant had not confirmed his/her satisfaction with the outcome of OSJCT’s investigation and responses at the time of writing this report. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 20 & 26 The standard of the indoor and outdoor environment of this home is good providing residents with an attractive and homely place to live. There is evidence of regular maintenance reviews and future planning to maintain and improve facilities for residents. EVIDENCE: The standard of cleanliness and décor is very high overall. There is evidence of forward planning for any improvements, such as re-carpeting the lounge and corridor leading into Hambledon unit. Worn kitchen units in the kitchenette areas for each wing are also said to be scheduled for replacement and upgrading: this work is outstanding from two previous inspection visits. Also, improved access to the sensory garden for residents from Hambledon unit, as recommended at previous inspections, has not been achieved. However, an alternative plan to move the staff room to another underused room in the home, and to convert a bathroom to a shower room is currently being considered. The proposed changes, if agreed, would improve the garden access and provide a more suitable additional assisted shower room for residents. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Staffing levels are maintained at the level agreed with CSCI in 2002 but there is evidence that the needs of residents admitted since have increased significantly, so that staff are finding it difficult to maintain the high standard of care for residents that they want to give. The systems for recruitment and induction of staff are satisfactory. The training and supervision programme for staff shows that the organisation is committed to helping staff to develop their skills and competence in their jobs. EVIDENCE: The numbers of staff just meet the recommended levels agreed with the CSCI (formerly National Care Standards Commission) in 2002. A number of the comment cards received showed that people felt that there were not always sufficient staff on duty – though this did not affect the standard of care given to residents. Staff on duty said that they felt that they were not able to always do the ‘extra’ things for residents that they would like, such as having enough time just to have a chat, or be involved in some of the activities with residents. Residents are generally more dependent on staff for care, many needing help from 2 carers. One carer commented that there was too little time to update residents’ care records as they are required to. The manager confirmed that the care needs of all residents were being reassessed and that staffing levels would also be adjusted accordingly. The manager said that 7 care staff are working towards achieving National Vocational Qualifications (NVQ) Level 2, whilst 2 of the senior care leaders are working to achieve Level 3. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 16 A new training manager has been appointed by the organisation, so that the frequency and availability of training courses has improved. Individual staff training record forms have been provided so that all staff are aware of the training that they must attend and have annual updates in, such as fire safety, health and safety and infection control. The home has a number of residents with short-term memory problems. Staff have not had specific training in caring for people with dementia, though this is being organised by OSJCT. Two staff files were looked at and were complete with the exception that the interview schedule in one had not been signed by both interviewers and a second reference was not on file. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 & 38 The manager provides clear leadership in the home, with staff demonstrating an awareness of their roles and responsibilities. Formal supervision of staff is not yet in place The manager, staff and residents have a good relationship, creating a caring and supportive environment for residents. There is clear development and budgetary planning so that improvements and maintenance are ongoing. EVIDENCE: The manager said that the system of formal supervision of care staff was not yet in place. New paperwork for keeping records of supervision topics had been produced by OSJCT, and training of senior staff about the purpose of supervision has been provided. It is good employment practice for all care staff to have time allocated for individual time with the manager or a senior carer to discuss their progress at work and any training needs or concerns they may have. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 18 Residents spoke highly about the manager and staff and it was evident that staff have a good understanding of residents’ support needs. Comment cards from relatives, visiting doctors and health and social care professionals also rated the competence and caring values of staff highly. Staff are required to have training in health and safety topics and to attend regular updates so that they follow safe working practices. Senior care staff (‘Care leaders’) are allocated specific additional responsibilities by the manager, for example, health and safety in the home, medication issues, supervision and training. There was evidence that planned maintenance and repairs had been budgeted for and work was underway – for example, new sluice disinfecting machines had been installed and work to repair water damage to a room ceiling. Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x 2 x 3 Chilterns End H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? 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 Regulation None. Requirement Timescale for action 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 1 Good Practice Recommendations Complete the updating of the Statement of Purpose and Service User Guide information so that it contains the information required in an accessible and clear format for prospective and current residents and their representatives. Ensure that residents who are self-funding have a full needs assessment undertaken by the registered person and that this is regularly reviewed and updated. Improve the written records of residents care - the care plans - so that there is sufficient detail about their care needs, the actions staff need to take to meet those needs, and to record to what extent the care plan has been successful. Care plans should be reviewed at least every month and rewritten if residents care needs change significantly. Residents nutritional status should be assessed on admission and regularly reviewed, using a recognised assessment tool: the Malnutrition Universal Screening Tool (MUST) is recommended. Ensure that the number and skill mix of staff is reviewed H57-H08 S13154 Chilterns End V228158 210705 Stage 4.doc Version 1.40 Page 21 2. 3. 3 7 4. 27 Chilterns End 5. 30 and meets the assessed needs of residents at all times. Staffing levels should allow for the additional time needed for training and supervision of all staff. Care staff should receive additional training in care of people with dementia. 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