Inspection on 30/01/07 for Chilterns End

This inspection was carried out on 30th January 2007.

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 17/08/06

Chilterns End 05/01/06

Chilterns End 21/07/05

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 Ruth Lough Unannounced Inspection 30th January 2007 10:45 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 Chilterns End DS0000013154.V322632.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. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilterns End Address Greys Road Henley On Thames Oxfordshire RG9 1QR 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) 01491 574066 01491 574633 manager.chilternsend@osjctoxon.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust Mrs Pauline Anne Krason 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), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (46), Physical disability over 65 years of age (13) Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons that may be accommodated at any one time must not exceed 46. 21st September 2006 Date of last inspection 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. The fees for this service range from £484.00 to £695.00 per week. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection visit that was generated from deficits identified from the previous visit in August 2006 followed by a Random inspection visit carried out in September 2006. The Random inspection visit was focussed on concerns about medication administration practices. This inspection process included information provided prior to the inspection by the home, consultation with service users and health and social care professionals and a one-day visit to the home. Service users, their visitors and relatives, staff and visiting professionals were able to give further information during the visit to the home. Records for care provision; employment and administration were also reviewed. Nine service users and six health and social care professionals responded to questionnaires sent to them prior to the inspection process. One outstanding previous requirement regarding the assessment and care planning to meet service users health and personal care needs has not been met. What the service does well: Some of the positive comments about the home given by service users and relatives were: “All staff I have contact with are pleasant and will always talk with me in passing even from the other residential units here.” “ I like it very much.” “My mother is very happy at Chilterns End and I quote “I could not be in a better place.” “ We would appreciate a little more time given to my father but we do understand the lack of staff at times.” “ Over all the home is very good. My father gets quite confused at times and I think the staff do their best.” Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 6 The records seen for the routine maintenance, servicing and the fire safety checks were an exemplary example of good practices for ensuring that health and safety regulations are met to protect service users, staff and visitors whilst in the home and the upkeep of the fabric of the building. What has improved since the last inspection? What they could do better: Some service users and relatives less positive comments were: “I think it is good however some to the staff are more caring than others.” “ We would appreciate a little more time given to my father but we do understand the lack of staff at times.” The home must improve how it assesses service users needs before they are admitted. They need to ensure that it has good information about their health care needs, how these will affect the care that is required to be provided and the lives of the service users. The care plans should equally reflect these identified needs and should be give detailed instructions of how the care is to be provided to service users by the staff. They still need to make sure that staff are using the medication administration records to record and monitor that prescribed topical creams, lotions and applications are given as directed. They need to continue to implement a programme of regular supervision for all staff and make sure that new staff are given the appropriate induction training at the beginning of their employment. Chilterns End DS0000013154.V322632.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. Chilterns End DS0000013154.V322632.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 Chilterns End DS0000013154.V322632.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): 2 and 3 Quality in this outcome area is adequate. The service users consent to changes in their contractual agreements should be recorded. The quality of the assessment process is varied and is not always carried out effectively to ensure that service users needs have been identified. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and relatives gave comments about the information they were provided with and their experiences, before making a decision to live in the home. “I had been coming to the day centre unit twice a week for a couple of years so had a good idea of how the home was run and would be a good place to come to live.” Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 10 “We were shown around everywhere including the kitchen and laundry. Everywhere was spotless. We then took Mum to see the manager and show her around, which we all agreed was good.” “Had a few weeks trial period that was successful prior to contract.” “My mother was in hospital at the time, but I was shown round and given a lot of information.” The care records of three service users living in the home were reviewed. One service user had been admitted to the home within the last 6 weeks and others had been living in the home for longer. The service users survey confirmed that all had had a contract of agreement to stay in the home. The contract of the most recent service user admitted to the home was reviewed as it was identified through discussion that they had moved from one room to another to accommodate another service user who wished to be close to their partner who was also living in the home. The contract document outlined the agreement to the stay and the limits of what was included in the fees, termination of agreement and the facilities available. The document had not been amended to reflect the room change and there was not a record of agreement from the service user or their representative. The home assesses all service users before they come to stay including those who wish to have a period of respite care. They do use information from the referring social services and other professionals during the assessment process. The documents seen showed that the quality of the process is variable with good detailed information in parts and insufficent recorded about the service users health needs and how they effect their lives. An example of this is that information from a health practitioner regarding treatment of an individual prior to admission was not included in the assessment record or in the care plan generated. The also use a system of rating the service users dependency for physical, moving and handling, psychological and challenging behaviour needs. This is a very simple tool that is used to assess the level of fee, which is based on their dependency level for care, but provides very limited detail of of the specific need of the individual. Chilterns End DS0000013154.V322632.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): 7,8,9,10 and 11 Quality in this outcome area is adequate. The quality of the care plans is inconsistent and does not always provide staff with sufficient information of how the staff are to support the service users. The medical and healthcare needs of service users are not always identified or recorded in the care plans in sufficent detail or evidence that the home has obtained the necessary support to meet these. The service users are better protected by the improved medication practices carried out in the home but they need to ensure that they keep good records and monitor effectively any self administration or any topical applications of service users prescribed medications. These judgements have been made using available evidence including a visit to this service. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 12 EVIDENCE: The service users were asked in the questionnaire about their opinion if they thought their care needs and support required were met by the staff. Six service users stated that their needs were always met, three said usually. They also responded with: “There is always someone in attendance in the unit to help.” “Mum is always looked after and I am told by the residents whose memories are OK if mum doesn’t like anything she will speak up. Mum is kept warm, fed well, kept clean and does get some stimulation.” “Occasionally something crops up and my mother doesn’t get her bath when she is expecting it. She quite understands that in an emergency the bath goes to the bottom of the list. However, being elderly, it does annoy her a bit.” The care to be provided to service users is recorded in a Kardex system that should give staff support to develop holistic care that meets their health and personal care needs, identifiying any risks and has monitoring tool records. However, the records reviewed showed significant gaps in the planning and monitoring for personal care, health care needs, and the nutritional status of the the service user. Parts of these care plans gave good instructions to staff of how to support the service users other parts did not show that the moving and handling, nutritional and continence needs had been assessed fully and reviewed and how the staff are to provide support to meet these needs. They do record service users consent to the care in the care plan. The staff give good information in the daily records of the outcomes of the service users day. However, they should avoid using abreviations and accronyms. Service users were asked if they thought the received the medical support they needed. The overall reponse was positive and comments given such as: “Any request for my doctor is passed on and all medication is given when needed from a medicine trolley all under strict control.” “ Mums medication is recorded and checked and I checked today to check what she is on.” “ My mother is always given her pills. When she had an ulcer on her leg, the nurse from the Dr’s surgery was called to change dressings etc. When she fell over, I was called straight away to take her for an x- ray on her swollen wrist.” On a review of the records available the service users health needs have not always been identified during the assessment process. Health needs and events that would affect the service users well being were bone fractures and Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 13 previous surgery. These were not reflected in the planned care to be provided. The home had not recorded how a service users development of a pressure sore had occurred, but do have records of the involvement of the district nurse and general practitioner for the treatment provided. The recording of service users weight has improved as these are now carried out with greater regularity than identifed during the last inspection. But service users nutritional status, where weight variation has occurred, has not been reassessed and not reflected in a change in planned care. There is recording of dental, opticians and other visits by specialist healthcare professsionals. Service users were seen to have presssure relieving equipment such as specialist mattresses and cushions in their beds and chairs. The medication processes of the home were subject to concern during the last key inspection visit and a number of deficits were identified. This generated a Random Inspection visit by a specialist pharmacy inspector that resulted in 2 requirements and 3 recommendations for good practice. The main areas of concern were that the service users were not receiving the medication they were prescribed and staff were not recording accurately any administration. The recommendations were that staff were not checking and recording the medication fridge temperatures accurately. Also closer monitoring of the movement of controlled drugs could be recorded by staff when they are removed by the pharmacist from the home and that any training provided by the responsible district nurse for drawing up insulin for service users to self administer is recorded. These topics had been addressed by the home and they had reviewed the current processes in place and implemented changes to improve how they manage administering medication. During this inspection visit a staff member was observed carrying out administering medication at lunchtime with some service users. The medication records were reviewed and discussion with staff and service users were undertaken. The records showed that service users are receiving their medications at the prescribed times and that staff are recording these effectively. This was confirmed by service users and relatives. But it was evident that any prescribed topical ointments or lotions that the care staff use during bathing or otherwise with the service users is not recorded when administered. There is not a formal monitoring process that these have been administered correctly. Included with these administration records are photographs of the individual and brief information of any allergies that service users have to medication. The manager provided information of the new policy, procedures and documents for the administration of medication that has been implemented by the organisation. These included document tools for self-administration by service users, assessment records and reviews. The manager was not able to provide evidence of these for one service user who is supported with the administration of insulin. However, these were available for other service users who are able to self-medicate. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 14 The recording of any controlled drugs administration was reviewed and staff have been adherent to the set protocols to ensure safe practices. These could be improved by writing in capital letters their full name next to their signature in the controlled drugs register and that the manager records there also when a random audit check is carried out. The medication is stored securely and staff are using record tools to provide evidence of the movement of medications in and out of the home. The home has recently changed the pharmacy service that supplies to the home. The staff were seen to be carrying out all personal care in the privacy of the service users rooms, bathrooms and toilets. Any consultations with visiting healthcare professionals occur within the service users own bedrooms. Staff were seen knocking on service users doors before entering and using service users preferred terms of address. None of the bedroom accommodation is shared. Information about service users choices for the care after their death is taken where possible during the assessment process or at admission. What is not recorded is the service users or their families wishes for their care for their final days of life. Service users are cared for at the home during their end stages of life and but some are transferred for treatment at hospital. The manager has recognised that they would like to improve their care of service users for this part of their lives and is obtaining training for staff and support to implement strategies for this from the provider organsation. Health and social care professionals who come in contact with the home regularly gave some comments about the staff working in the home. This was in regard to them making the appropriate “sometimes hasty” decisions, when they can no longer manage the care needs of the service user. Another comment was about passing information on, “ information given to staff has not always been implemented.” Chilterns End DS0000013154.V322632.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 good. Service users are offered a variety of activities that they enjoy and are given support to continue with their interests. The staff need to ensure that their care plans reflect how service users are enabled to do this. The planned meals and menus are varied and nutritional but they should look at improving service users confidence in meeting their choices for meals and the presentation of their food. These judgements have been made using available evidence including a visit to this service. EVIDENCE: Service users, relatives and staff were spoken to during the visit to the home. The individuals care plans and activities records were reviewed. Service users gave their opinion about the activities on offer in the home. They were asked if there were enough activities for them to join in. The majority confirmed that there was usually things they wanted to join in with, one stated sometimes. Comments were: Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 16 “Some of the things I can’t join in because of eyesight problems, but I enjoy all the singing entertainment that is put on and have just had a 4 day break Monday to Friday at Butlins, Bognor Regis which was a huge success as I am 98 years old lady they made certain I enjoyed all on offer.” “I like the singing.” “The trouble with lots of old people they are arranged but they don’t always join in. They should be more physical activities as Mum gets bored and wants to do things. I or the family are not there all the time so she may not to join in.” “ I am partially sighted and wear a hearing aid, so I cannot always join in” “My mother particularly enjoys the little church service held on Thursday mornings. She also enjoys the handicraft sessions. She likes to go to the periodic meetings where residents can put views to the staff, make suggestions, etc. She enjoys the occasional tea – parties where the residents from all four wings get together.” The care plan documents evidence that some information is sought about service users preferences and their previous interests before coming to live in the home. These are recorded in variable depth and very little is noted about how staff are able to help service users achieve maintaining their interests. The usual practice is to record in a central record who wished to take part in activities that have taken place and note some feedback about the service users enjoyment and involvement. There is a varying activities programme that includes some physical and mental stimulation for service users such as exercise classes, games and quizzes. The staff do support service users to learn new craft skills and enjoy visiting entertainers. A recent regular visitor is a local dog from the Pat a Dog scheme which the majority of the service users said they enjoy. Service users were very complimentary about the member of staff responsible for maintenance and safety. Through his support they were able continue with a little light gardening and hobby of watching and feeding the visiting wildlife to the garden. Six service users have been supported by the home and staff to go on a holiday break, since the last inspection visit, to Bognor Regis. This is unusual for care homes to be able to do this and shows that they have made very positive steps to enable some service users to have interesting and fullfilling activities. The care plan seen of one of the service users who took part in this holiday did not provide enough documentary evidence of how this had been arranged or the risk assessments carried out to achieve this. Service users are still able should they wish, to visit local clubs and activities that they had previously enjoyed to living in the home. The home has regular visitors from the local churches. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 17 The service users are either able to join services that take place in one of the communal areas or meet in the privacy of their rooms. The home enables service users to have contact with other local religious organisations should they wish. The home employs a member of full time staff to be responsible for the development and implementation of the activities programme. The same member of staff is responsible for the support for the visiting service users to the day centre facilities in the home. Service users and the relatives responded to the question if they thought that they were listened to and staff acted upon what they said. Eight responded with “yes”, one with “no.” Other comments were: “In most instances they will act on behalf of me through my daughter. They are always willing to listen.” “There are times they seem to become deaf.” “Always, they make a note and it is always actioned.” “Sometimes.” “Usually though sometimes there seems to be a lack of continuity and staff do not always know what is going on.” “Generally yes. However, when the lunchtime routine of all the residents (for example, from all the four wings) having lunch together in the dining room was changed to each wing dining separately, I understand the residents disliked this. My mother said she liked the opportunity to meet the residents of the other wings. The ‘segregation’ has continued – I presume for some valid reason. My mother seems resigned to it now.” The home has a four week rotational menu plan for the provision of meals for service users. The plan is currently developed by the provider with professional nutritional advice, although the chef does change this to meet service users requests or supplies. Service users are able to have a cooked breakfast every day should they wish and there is usually a choice of 2 savoury dishes and a selection of desserts each day. The evening meal is usually a light hot or cold snack and there are sandwiches or cheese and biscuits for supper or snacks in between meals. The home is able to provide to service users who require a specific diet to meet their religious or cultural needs. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 18 Service users written comments about the food and mealtimes was that, two service users always enjoyed the food, five usually and two, sometimes. They also stated: “They go to a lot of trouble with the menus and there is always a choice.” “I like the food.” “Mum tends to eat them. She has never been a fussy eater, and from what I have seen they look good.” “Food does need to be liquidised and fed to my Father.” “She likes the fact that there is choices so she can usually have something she likes and in the rare case she does not like either dish, she can always have a salad. She particularly likes the usual cook, who also makes good cakes for tea. Some of the stand-in cooks are more variable.” Service users are encouraged to eat their meals in the dining areas of the home but are still able to have their meals in their rooms if they wish. Staff give support where required. Service users and family did state during the inspection visit that occassionally where a service user requested something different to beef on the menu this was not always replaced by a suitable alternative. They also stated that the quality of the meals was varied at times, care not always taken by some staff with presentation and there were incidents of occassional poor communication with service users about choices and wishes for their meals. The dining areas of the home are equipped with facilities for making hot and cold drinks and a microwave. Service users are able to select their choices for meals the day before and any changes and specific diets are recorded in the kitchen. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 19 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 and 18 Quality in this outcome area is good. Complaints and concerns are listened to and acted upon effectively. The home has suitable policies, procedures and provides training for staff to safeguard service users from possible abuse. These judgements have been made using available evidence including a visit to this service. EVIDENCE: Service users and their relatives gave comment that they knew who to go to if they were unhappy. They also said: “The care leaders and staff will always listen or take note.” “ Every member of staff is very nice.” “We know and I’m sure mum knows but she is one to complain about things only to the family and mum has never complained about anything.” The homes complaints policy and procedure is compliant to the regulations and provided to service users in the Statement of Purpose and Service User Guide. The home has received 2 formal complaints since the last inspection process, one partially substantiated. The Commission has not been in receipt of any concerns or information about the home during this period. The records of the Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 20 complaints investigation and any action taken were reviewed and showed that suitable intervention and action has been taken to rectify the concerns. Service users also said they knew how to complain and were happy about how concerns and complaints were handled by the manager and staff. Other comments about complaints management were: “Through my daughter, but up to date have no concerns.” “We do but though mum has told be us what to do if she had any I’m sure she wouldn’t as she comes from a generation that don’t complain a lot.” “It was one of the things we were made aware of when my mother entered the home.” The home has systems in place to protect service users from possible abuse. The staff are given instruction about the protection of vulnerable adults in their induction and during regular training that is provided. The staff spoken to, confirmed that they had a good understanding of the vulnerable adults procedure and whistle-blowing policies and that they know where to seek assistance should they have any concerns. The manager and proprietor monitor all concern, complaints and allegations routinely for quality assurance purposes. Chilterns End DS0000013154.V322632.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): Quality in this outcome area is good. The home is maintained to a very good standard and is kept clean, hygienic and pleasant to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a purpose built building on one level. It is arranged in an E shape with divisions in place that ensure that service users live in smaller, more homely environments with designated moderate sized communal areas. All areas are interlinked and allows service users to move around the building safely and use the other communal spaces should they wish. The home is set away from the busy residential area with large open garden areas that can offer service users plenty of quiet areas to sit or wander should they want to. The home has a regular programme of repair, renewal and refurbishment and the maintenance staff member keeps very good accurate records of all interventions in place. The home has been inspected by the fire authorities and Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 22 has ensured that any requirements or recommendations are carried out immediately. Service users and relatives were asked in the questionnaire about the cleanliness of the home and the laundry. They responded with: “The staff do their very best to keep everything nice. Toilets and bathroom are always clean and my own room is well looked after and my laundry is always up to date.” “Sometimes there is a slight smell but not often but again I think it is very hard for the staff to keep the place spotless all of the time.” “Bed linen, towels etc. are changed regularly. My mother’s clothes are washed and she particularly happy that her blouses, are well ironed. The general appearance of the rooms are bright and clean, and I have several times noticed rooms being decorated. My mother’s only complaint is that sometimes one of the residents has an “ accident” in the toilet, and obviously not told the staff. Once she has brought it to the staff’s notice, it is immediately cleaned.” The home has a dedicated team of domestic and laundry staff employed that are present, seven days a week. The service users and relatives were generally quite complimentary about the standard of cleanliness and the quality of the laundry service. Occassionally they stated that there were minor deficits in the cleanliness standards but these were swiftly dealt with by staff. The laundry facilities have the required washers and driers to meet regulations to handle soiled and foul linen should they need to. Staff are provided with designated clean and dirty areas and suitable storage for the safe keeping of detergents. The home has ensured that liquid soap and paper towels are placed in communal bathrooms and toilets and areas where personal care is carried out and where staff need to wash their hands frequently. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 23 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 adequate. The home has implemented strategies to ensure that deficits in permenent staff being employed impacts on service users lives. The home has a planned training programme for NVQ and has ensured that the majority of the staff team have had the required training for their roles. They do need to ensure that all staff have a full induction programme relevent to their roles at the commencement of employment. The home ensures that the required employment checks are carried out before they employ new staff, but they do need to confirm that they have the skills and competencies to carry out their roles. This should be done through making sure that they verify the qualifications of the new applicant. These judgements have been made using available evidence including a visit to this service. EVIDENCE: Service users were asked in the questionnaire if they thought the staff were available when they needed them. Their responses were that, three said always, five said usually and one, sometimes. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 24 “Sometimes they can be called away to see to someone else’s needs. But in the main, they are around the unit and there call bells to hand.” “Not so easy to see a senior staff member at weekends as she could be elsewhere in the home. But to be honest there has never been an emergency when we need to see a staff member.” “Someone will always come if the residents ring their bell. There is a system to alert staff.” The staff team employed comprises of 37 care and 13 ancillary staff. The home has had a significant number of staff changes since the last inspection process and has had to compliment its numbers by the use of bank and agency personnel. The manager gave a figure of 135 shifts that were covered in this way during the months of September and October. Of these, only 35 of the shifts were where agency staff were employed. The manager had already identified the deficits and was in the process of recruiting new staff. The manager was in the process of interviewing staff during the day of the inspection visit. Service users and relatives did indicate that the situation had improved and that a regular team of staff were working in the home now. The staff rota indicated the number of staff and their roles that were on duty in the home. However, it did not record their full names and where in the home they were to be working. The home allocates where staff are to be working in a separate document to ensure that continuity is maintained as much as possible until the staffing numbers increase and a greater consistent team are in place. The manager uses the services of several agencies to supplement the staff team but is able to have regular staff that had worked in the home before. None of the service users or relatives commented that they felt that there was an insufficient numbers of staff working in the home. However, they did state that they did not have full confidence that all the agency or bank staff had enough information of how they wished to be cared for. Two of the health and social care professionals did note that there were some difficulties with not always being able to confer with a senior member of the care staff when they made contact with the home. The manager supplied the numbers of staff with qualifications in care and those relevant to their roles. For NVQ there are 7 carers with level 2, 4 with level 3 and the manager has level 4 and Registered Managers Award. The other NVQs that have been obtained are Cleaning, level 1 and Catering level 2. The manager was able to confirm that a further training programme of NVQ was being resourced through the provider. One member of staff spoke enthusiastically about how she enjoyed working through the NVQ 2 in care that she had recently attained. The recruitment processes for new staff is carried out in the home and not with the provider organisation. The manager is responsible for the care staff and Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 25 the administrator for the ancillary staff. The recruitment and employment records of 2 members of staff were reviewed to assess that the process had been carried out appropriately. One employment record was a new care staff member the other for domestic services. The records supported that applicants are required to complete an application form, health declaration and provide proof of identification. The home ensures that 2 written references and a criminal records enhanced check is carried out before they commence working in the home. Copies of any work permits are also kept. The member of staff employed 6 months previously for domestic work part- time in school holidays, was under 17 years old at the time of commencing employment. The records did not support that they had had an induction process or that strategies were put in place to make sure that the under 18 year old is supervised and supported as is required by employment legislation. The other care workers employment records showed that they had undertaken and induction process and probationary period. The manager and senior staff have commenced a training needs analysis of all the staff. The majority of the training and supervision records are kept separate from the employment and personnel records. They have not ensured that they have verified the qualifications, training and obtained copies of certificates stated as being attained by new employees when they join the staff team. One employee put in their application form that she was a trained nurse in her country of origin and although she is not working as a registered nurse this has not been supported by evidence of training certificates. Training is provided in the home by appropriately qualified staff for fire safety, moving and handling and COSHH and other topics are externally resourced through the provider organisation. Recent training obtained by staff has included medication administration, first aid, food hygiene and equality and diversity. Care workers spoken to confirmed that they had had recent updates for Protection of Vulnerable Adults and had attended training for dementia that they felt they had really benefited from. The manager stated that there was a continual programme for mandatory health and safety training and that there was planned training for care staff, on terminal care via a distance learning process. Chilterns End DS0000013154.V322632.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 and 38 Quality in this outcome area is adequate. The home is run by an experienced manager who is supported by a core team of regular staff who need to ensure that they continue to improve to promote and protect service users health and wellbeing through the assessment and care planning and supervision of staff. Service users are consulted about their opinion of the service and there are some systems in place for measuring the quality of the service. These now need to be improved and developed further. The home, its equipment and facilities are maintained to a good standard with the service users wellbeing protected with safe working practices in place. These judgements have been made using available evidence including a visit to this service. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 27 EVIDENCE: Service users and their relatives gave the following general comments about the home. “All staff I have contact with are pleasant and will always talk with me in passing even from the other residential units here.” “I like it very much.” “My mother is very happy at Chilterns End and I quote “I could not be in a better place.” “I think it is good however some to the staff are more caring than others.” “Over all the home is very good. My father gets quite confused at times and I think the staff do their best.” “We would appreciate a little more time given to my father but we do understand the lack of staff at times.” One relative stated, “My mother feels the following are really good and make her feel that this is her home,” and gave a list positive comments about the gardens, the resident cats, the large print books and the freedom to come and go from the home. Health and social care professionals who come in contact with the home regularly, commented, “ Very friendly, caring environment. Families of service users have not given me any complaints, only praise for the staff.” The records for the management and administration of the home were reviewed. A discussion with the manager, administrator and the delegated member of staff responsible for health and safety in the home took place. The manager is an experienced person who has been working in various roles in care for the Order of St Johns Care Trust, previous to her current post in the home. She has obtained an NVQ 4 and Registered Managers Award pertinent to her role and continues to update all mandatory training for health and safety. The manager is currently supported by 2 care leaders and is in the process of recruiting to the 2 other vacant posts to ensure that there is a senior experienced member of staff on duty during the busiest periods of the day. The care leaders are responsible for the development of the care plans, duty rotas and daily supervision of the care staff. It was identified both in this Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 28 inspection visit and the previous process that there are some deficits in the assessment and development and implementation of the care planning. The administrator takes the lead for recruitment and employment documentation, service users monies and the financial administration of the home. The home has several formal processes in place for seeking service users opinion of the service provided. This is done through regular service users meetings, reviews of care plans and an annual questionnaire. Service users are provided with regular news letters that keep them informed of changes and developments in the home. They have implemented several processes for auditing their performance with new records for medication administration and the activities provided to service users. They also have a formal process to obtain feedback from visiting professionals and other stake holders and this is usually carried out by questionnaires, again on an annual basis. The proprietor has implemented regular spot visits ( Regulation 26) including catering inspections and requires a summary of events and information to be submitted on a monthly basis. Staff are consulted through supervision, apraisals and staff meetings that have occurred but these are still not as often as they should be. The manager and staff who were spoken to stated that some of this had improved since the last inspection visit with more frequent supervision. Service users financial interests are safeguarded by the policies and procedures for handling service users money, the facilities for storage of service users personal valuables and guidence given to staff. The administrator takes the lead in the management and record keeping of service users personal expenses where they act on their behalf. The records are audited by the provider on a regular basis and families are kept informed of the transactions that have taken place where necessary. Service users are provided with lockable spaces in their rooms for storing their valuables. The manager gave information that only 2 service users currently handle their own financial affairs and was unable to give the figures for those subject to Power of Attorney. One service user is subject to Guardianship. The home has systems in place for safe working practices. The staff training programme for the mandatory health and safety topics has improved since the last inspection visit. Staff confirmed that they had attended moving and handling, fire training and COSHH refreshers recently. The maintenance staff member has the responsibility of ensuring that the routine monitoring and servicing of equipment and electrical, gas and water systems occur. The records seen for these and the fire safety checks were an exemplary example of good practices for ensuring that health and safety regulations are met to protect service users, staff and visitors whilst in the home and the fabric of the building is kept to a high standard. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 29 This individual employee has been recently recognised by the provider for his good effort and performance with both the safety systems in place and the quality of the maintenance both inside and outside the home. Safety procedures are posted for staff, service users and visitors around the home. Records are kept for all accidents and incidents and referred to the relevent authority. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 30 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 2 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 31 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 2 Standard OP2 OP3 OP7 OP8 Regulation 5(b) 14,15, Schedule 3 Requirement That any service users consent to changes to their contract is obtained and recorded. Resident’s assessments of needs and their care plans must contain sufficient information in order that all needs are met appropriately. This was a previous requirement to be met 31/10/06 That the administration of topical medications is recorded accurately to ensure that service users are receiving them as prescribed. That all staff are provided with the appropriate induction programme at the commencement of their employment. Timescale for action 31/03/07 31/03/07 3 OP9 13 28/02/07 4 OP30 18 31/03/07 Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 32 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 OP12 OP13 OP14 Good Practice Recommendations That the home looks at improving how they obtain and record information about service users choices and interests. Chilterns End DS0000013154.V322632.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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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