Inspection on 08/06/07 for Chilterns End

This inspection was carried out on 8th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Chilterns End 11/06/08

Chilterns End 30/01/07

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 Delia Styles Unannounced Inspection 8th June 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.V338391.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.V338391.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.osjct.co.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.V338391.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. 30th January 2007 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.V338391.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 to see how well the home is meeting the national minimum standards for care homes for older people - those aspects of care and facilities provided for residents considered by the Commission to be the most important for people’s health and well being. The inspection process included information provided prior to the inspection by the home; survey/questionnaires completed by residents, health and social care professionals and GPs, and a one-day visit to the home. Two residents, 4 relatives/carers/advocates, 2 care managers, 2 health and social care professionals and 8 GPs representing 3 different health centres, responded to questionnaires sent to them prior to the inspection. Residents, their visitors and relatives, staff and visiting professionals were able to give further information during the visit to the home. Samples of records of residents’ care, staff employment and training records, and other administrative records were also looked at. 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: ‘The staff are courteous and friendly and the home is a welcoming place’. ‘Chilterns End is an extremely comfortable and presentable environment, reflecting the fact that it is the residents’ home. The attitude and approach of the staff is inspirational’. ‘The environment is excellent and the routine appears to meet individuals needs. Visitors are always welcome and it appears an open and friendly establishment’. ‘The extensive gardens are excellent – interesting and well kept. The home is well presented and looks attractive and well decorated’. The attention to maintenance, safety and cleanliness in the home is very good so that residents live in a very pleasant and comfortable environment. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The standard of written records of care – assessment of residents’ care needs and plans of care – has not improved since the last inspection and the requirement made at the last 2 inspections has not been met. The care records do not provide enough information about how care staff should assist residents in a way that meets their preferences and needs, and there is a risk that important information and changes in residents’ health and wellbeing will be missed. The homes systems for the safe storage and administration of residents’ prescribed medicines are satisfactory overall, but recommendations are again made about improving the record keeping system so that staff can show that any prescribed tablets, topical creams, lotions and applications are given as directed and staff are checking with residents how effective their medications are in relieving their symptoms. The home does have a programme of regular entertainments and activities for residents to join in with if they wish, but some relatives’ and a care manager’s comments suggest that the social and recreational life of residents could be better. More staff should be available to remind residents about what activities are organised, and also to have time to spend with residents in assisting them in informal ‘ad hoc’ activities in and around the home. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 7 Many of the residents are more reliant on staff for care and assistance than formerly and the staffing numbers and skill mix do not always allow enough time for staff to provide the level of care to meet residents’ physical and social needs effectively. Staffing levels should be reviewed and increased as necessary so that residents receive consistent care. Some negative comments were received from 2 GPs and a health care professional about the standard of care and communication with some of the home’s staff. The home should improve the supervision and monitoring of all staff to make sure that they are competent and confident when caring for residents and communicating with doctors and health and social care professionals about residents. 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.V338391.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.V338391.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): 1, 2 and 3. Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is adequate. Information about the home is satisfactory and is regularly reviewed. The home encourages service users and their representatives to visit and spend time at the home to help them make an informed choice about whether the home is likely to meet their needs. The quality of the assessment process is varied and the written information is not always sufficiently detailed to ensure that service users needs have been identified in a way that enables the staff to have enough guidance on which to base the care plans. This judgement has been made using available evidence including a visit to this service. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 10 EVIDENCE: Residents and relatives’ comment cards indicated that they felt they had enough information about the home before coming here. The homes Statement of Purpose and Service User Guide were being updated. A copy of the revised information documents should be sent to the Commission when completed. A sample of 4 residents care needs assessments were looked at. The home assesses all service users before they come to stay including those who wish to have a period of respite care. The assessment of prospective new residents is done by the home manager, who then completes the ‘resident long term need assessment and care plan’ front sheet in the commercially produced system of care records used for each resident. The home also includes information from the referring social services and other professionals during the assessment process. The home also uses a system of assessing new residents’ need for staff assistance for physical, moving and handling, psychological and challenging behaviour needs. This is a simple check list tool that is used to assess the level of fee, which is based on residents’ dependency level for care, but provides very limited detail of of the specific need of the individual. The inspector concluded that the care staff responsible for drawing up the subsequent care plans once the resident is admitted, do not routinely have access, or refer to, all the other assessment information upon which to base the resdient’s initial care plans. The documents seen showed that the quality of the process is variable with sufficiently detailed information in parts but insufficent recorded about residents’ health needs and how they affect their lives in some cases. Examples of this included the instruction that a resident should have their blood pressure recorded twice a week and in another, information regarding a resident’s physiotherapy and self-care abilities following a fracture prior to admission to the home were not included in the assessment record or in the care plan generated. The home should review the way in which relevant pre-admission information is documented and shared with the care staff who are responsible for drawing up the care plans, so that there is sufficient accurate information for staff to assist residents in an effective way that meets their assessed care needs. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The quality of the care records has not improved since the last inspection. The records do not always provide staff with sufficient information of how the staff are to support the residents and so residents cannot be sure that their health and personal care needs will be fully met. The homes systems for administration and storage of medicines are satisfactory overall but there is scope for improvement in record keeping and monitoring the effectiveness of any self administration or any topical applications of residents’ prescribed medications. Residents and their families and representatives are treated with respect and their right to privacy and dignity is upheld. This judgement has been made using available evidence including a visit to this service. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 12 EVIDENCE: Residents and their relatives’ comments in their questionnaires about whether they received the care and support they needed were largely positive. One person commented that there has to be ‘give and take in a community’ and that sometimes a resident’s preferred care ‘routine’ is not followed, ‘probably because other residents’ need urgent attention’: ‘Basic care is very good…X feels there should be enough spare staffing capacity so that her routine is never put out. However, I can see this is not always possible. Occasionally, someone new (staff) has had difficulty in realising how to communicate with X - as she is extremely deaf, she does not always understand what is said, so misunderstandings can then arise. Staff are kind to those with far worse disabilities – very patient with those whose memory is failing’. The inspector examined a sample of 4 residents’ care records – one from each unit of the home. The standard of record keeping has not improved since the last inspection. The records reviewed showed significant gaps in the planning and monitoring for personal care, health care needs, and the nutritional status of the residents. The manager acknowledged that the record keeping is poor and explained that the OSJCT is taking action to introduce a better system that will reduce duplication of information. Also, the new Head of Care will be able to monitor and help staff improve the way in which care is recorded and evaluated. The standard of record keeping must be improved so that care staff are fully aware of the care needs of residents and can update and adapt the care provided to match the changing needs of residents. There were several very positive comments about the way staff care for residents in practice, for example – ‘the obvious improvement in my relative’s general health, appearance and demeanour has been quite remarkable [since coming to live in the home]’. ‘Staff have a good knowledge of residents’ health needs and are open to discussing anticipatory care for patients with chronic conditions’. 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 changed the pharmacy service that supplies to the home in January. The medication records for 5 residents were reviewed and the medication system discussed with senior care staff and the manager. The records showed that most residents are receiving their (oral) medications at the prescribed times. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 13 Staff explained that a small medicine pot containing mixed tablets in a medicine cabinet seen by the inspector, were tablets that staff had found in one resident’s room - tablets that the individual chose not to take and had concealed in their room. However, staff had signed that the medication had been taken. It appeared that staff were aware that this resident ‘picked out’ medication that s/he would take, and that the resident were aware of the purpose of the tablets. A GP had been informed and had reviewed the person’s medication with them that day and had amended their MAR chart accordingly. There was no record in the resident’s care plan or MAR sheet to indicate that staff were aware that s/he was not taking some prescribed medications or the reasons for this had been discussed with the resident. The home had started to record the application of prescribed ointments, creams and lotions in a separate record book. One resident was prescribed a pain-relieving gel for arthritis to be applied three times a day. The MAR sheet indicated that the resident was applying this themselves (although the person has poor eyesight) and the chart indicated it had been applied once a day. However, a care leader and the manager thought that care staff applied the gel. This indicates some inconsistency about the resident’s treatment, and staff did not know whether the treatment was relieving the resident’s symptoms. The requirement made following the last inspection has not been fully implemented - there is still no formal monitoring process that prescribed topical applications have been administered correctly and are effective. The manager said that the home carries out a monthly medication audit. According to the records seen, this had last been undertaken in February 2007. The inspector noted that one resident had been prescribed a short course of steroid medication. The instructions had been handwritten by a carer in the person’s Medication Administration Record (MAR) sheet but had not been countersigned by the GP. If care staff have to copy medication orders into the MAR sheets the GP should ideally check and countersign this in person as soon as possible. Alternatively, the staff member should enter the name of the doctor who ordered the change have a second competent care staff member witness and countersign the MAR chart, to reduce the risk of errors. There was evidence that care staff have received induction training in the safe administration of medicines but it was not clear whether this is accredited training to ‘Level 2’ (basic) standard that is required for all staff responsible for giving out medicines. The manager confirmed that two care leaders are due to attend further medication administration training. The staff were seen to be carrying out all personal care in the privacy of the residents’ rooms, bathrooms and toilets. Any consultations with visiting healthcare professionals take place in residents’ own bedrooms and this was confirmed by questionnaire responses. Staff were seen knocking on resident’s Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 14 room doors before entering and using resident’s preferred terms of address. None of the bedroom accommodation is shared. As in many other care homes, there is more cultural and ethnic diversity represented in the staff team than amongst the resident group. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individual residents of various religious, racial or cultural needs. Chilterns End DS0000013154.V338391.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. Residents are offered a variety of activities that they enjoy and are given support to continue with their interests. There is scope to improve the way in which residents are informed about the range of activities on offer and to have sufficent staff available to assist and encourage residents who wish to participate in activities sutable for their individual interests and capabilities. The staff need to ensure that their care plans reflect how residents are enabled to do this. Residents’ family, friends and representatives are made welcome and residents can access the local community and facilities. The planned meals and menus are varied and nutritious. This judgement has been made using available evidence including a visit to this service. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 16 EVIDENCE: The home arranges regular entertainments and activities for residents to join in and the activities calendar is displayed on notice boards in each of the units. There is a varying activities programme that includes some physical and mental stimulation for service users such as exercise classes, games and quizzes. The sample of residents’ care plans and assessments looked by the inspector had very little information about the residents’ preferred daily routines or their social and recreational interests and there was no indication about how staff could help residents maintain and develop their interests. During the morning of the inspection, six residents were playing Bingo and a card game in the dining room, with a carer (the day centre co-ordinator). The majority of residents were in the unit sitting rooms with the television on. Two or three residents went out into the front gardens for walks during the day. One resident talked about his enjoyment of a holiday organised by the home last summer. The manager said they are trying to find another suitable holiday venue for this year. The home has adopted 2 cats who are much appreciated by most residents – one relative wrote about the very positive effect having pets around – ‘my [relative] is certainly far more content now and spends many happy hours with ‘their’ cat. The home is set in its own grounds and gardens and the gardens are beautifully maintained and very attractive with different areas of interest – a beach theme area complete with a boat planted with flowers, a sensory garden and pergola-covered path with climbing roses and clematis. There are plenty of seats, garden tables and sunshades around the grounds. Birdbaths and bird tables attract birds, including pheasants and other wildlife. Residents and their families are very appreciative of the gardens. However, comments from relatives and a care manager indicate that the home could do more to encourage residents to be more involved in activities and the facilities provided by the home: ‘Many residents seem to sit around doing nothing all day. I think the residents should be encouraged to spend more time in the gardens, as there are plenty of seats and the atmosphere is very good. It seems a pity that more residents do not wish to join in the activities available – perhaps they could be encouraged more positively to do so – more participation would also help the residents get to know each other and maybe make more friends. My [relative] and probably others would benefit from gentle keep fit exercises, but although Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 17 this is available s/he generally forgets to go. Perhaps someone could remind them more determinedly. My [relative] would also like to go on more trips just a boat trip on the nearby river would, I am sure, please many residents, once persuaded they’d like to go. When X first lived there they went on more trips than now’. ‘I feel Chilterns End does not offer very much stimulation for the residents. They are often found just sleeping in their chairs. Other homes offer keep fit for the elderly, reminiscence therapy, taking residents around the garden and many more stimulating events’. Residents 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 and a weekly church service. The manager acknowledges that ‘residents often like more external trips – there are limits with staffing and funding these’ and also that staff intend to try to spend more ‘one to one’ time with residents. Residents spoken with all enjoy the food and written comments reflected this too. 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 residents’ requests. Residents 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 kitchen areas of the each unit in the home have been refurbished and are equipped with facilities for making hot and cold drinks, and a microwave. Residents are able to select their choices for meals the day before and any changes and specific diets are recorded in the main kitchen. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 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. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes complaints policy and procedure is provided to residents in the Statement of Purpose and Service User Guide. In addition there is information about the OSJCT complaints procedure and other independent advocacy services that residents and relatives can access, in the front reception hall where visitors sign the visitors’ book. The home has received 2 formal complaints in the past 12 months, one partially substantiated. The Commission has not been in receipt of any concerns or information about the home during this period. Residents and relatives’ questionnaires showed that they were confident about how to complain and about how concerns and complaints are handled by the manager and staff. One person wrote ‘it is difficult to imagine having to make a formal complaint because the manager and staff are so willing to engage Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 19 with one’. None of the GPs or health care professionals who completed questionnaires had received any complaints about the home. In relation to the question in the residents’ survey about whether residents knew who to speak to if they were unhappy, both responded, ‘usually’. The home has systems in place to protect residents 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 manager and proprietor monitor all concerns, complaints and allegations routinely for quality assurance purposes. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. 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 4 linked units providing smaller, more homely environments, each with their own sitting and dining areas. All areas are interlinked and this allows residents to move around the building safely and use the other communal spaces and the gardens as they wish. The home is set back from the busy residential area on the outskirts of Henley, and has large open garden areas that can offer residents plenty of quiet areas to sit or walk in. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 21 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. All the questionnaire responses reflected highly on the good standard of cleanliness and décor in the home. Somd of the comments included were : ‘the home is well presented and looks attractive and well decorated’ ‘The environment is excellent – [we] find Chilterns End clean, roomy and residents apparently happy and content’ ‘Chilterns End is an extremely comfortable and presentable environment reflecting that it is the residents’ home’. There are good sized laundry facilities that have the required washers and driers to meet regulations to handle soiled and foul linen should they need to. Staff use designated clean and dirty areas to separate dirty and finished laundry work and suitable storage for the safe keeping of detergents. 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. Supplies of protective clothing – disposable gloves and aprons – are provided for staff use. All staff receive training in infection control and food hygiene topics. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 22 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. Staffing numbers and skill mix are not consistently maintained to a level that ensures that residents’ care needs are always met, especially at peak times of the day. The induction training and on-going opportunities for staff development are satisfactory, so that the long-term impact on standards of care provided in the home should benefit residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs 34 care staff and 11 ancillary staff. There have been a significant number of staff changes in the past 12 months and the manager has had to maintain staff numbers by the use of bank and agency personnel. The manager uses the services of several agencies to supplement the staff team but is able to have regular staff that have worked in the home before to ensure that continuity is maintained as much as possible. A new member of staff on secondment had just started work in the home as Head of Care. The home is actively recruiting staff and hopes to fill remaining staff vacancies in the near future. The manager confirmed that in the mornings there is a manager, care leader, Head of Care and 5 care staff. From mid- afternoon there is one care leader and 5 care staff. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 23 On the day of the inspection, the inspector noted that there were numerous changes to the duty rota indicating that three staff were off sick and another absent: 4 bank staff had been brought in to cover the morning shift, and 1 bank and 1 agency staff to cover the late shift. At about 6 pm the inspector observed that there was one care staff member on each unit, providing a ratio of 1 carer to between 10 and 14 residents. The care leader was administering medications to residents around the home whilst the care staff were giving out, and supervising residents with their teas. A resident (who was confused) was offered a bath before tea, but declined, and then was seen to wander out of the building; a staff member from another unit went to persuade the resident to come in for their tea. In the inspector’s view, given the dependency of the current resident group, the staffing levels are only just sufficient to meet the basic physical care needs of residents, and, given the geography of the building, make it difficult for staff to provide the necessary attention and supervision needed by many of the residents, especially around mealtimes. Comments about the staff were mixed. Some were very positive, for example: ‘Their approach, courtesy and attitude are quite inspiring – always seeking out ways to make each day special’ ‘Carers have always appeared well motivated and not unduly stressed’ ‘Good communication skills with family and relative’ ‘It is a kind and caring place and staff know the patients’. Feedback from 2 of the GPs and a social care professional indicated less satisfaction: ‘This home is not as good as it used to be. I feel they often have patients there who need nursing/EMI care, not residential [care]’. ‘There has been a lot of change in staff. The carers who are very experienced and know the residents well have left. New staff are in place but do not have the experience to participate in reviews of know the clients needs’. ‘Recently the quality of care has become very variable with some excellent carers but some staff much less capable’. ‘Younger, newer members of staff seem poorly equipped to do their job’. One comment card suggested that the way in which the home could improve was by ‘improving education of younger members of staff’ and’ extra training for the new senior carers to develop their skills to participate in residents’ reviews’. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 24 The proportion of care staff who have achieved National Vocational Qualification (NVQ) in care to Level 2 or above is below the 50 recommended (38 of carers have this qualification). However, a further 12 staff are working towards a NVQ currently. An external NVQ assessor was in the home on the day of the inspection, and spoke highly of the quality of care they have seen in the home. The OSJCT has a good programme of training in place for staff, though some staff said that there was sometimes short notice of training events given which makes it difficult to arrange cover for their shifts at work, and make domestic arrangements in order to attend. All staff now attend a 2-day training in caring for people with dementia and this has been very helpful to staff in influencing the way they work in practice. The manager maintains a training matrix for all staff, to ensure that they attend all the mandatory training sessions such as fire safety, moving and handling, infection control and basic food hygiene/food handling. The inspector looked at a sample of 3 staff files for staff employed since the last inspection of the home. These showed that the required police checks and references had been obtained and were satisfactory before the staff members were taken on. One staff member who started in March 2007 had yet to undertake the OSJCT induction training course. However this person (an ancillary worker) had attended a moving and handling course and infection control training. The manager confirmed that a requirement made at the last inspection had been met - all new care staff complete an induction course that complies with the standards and content of the national training organisation, Skills for Care. There were no certificates in the file of one member of staff to support the qualifications and experience that were stated in their application. The manager confirmed that these would have been seen at interview. The majority of the staff training and supervision records are kept separate from their employment and personnel records and the care leader who has overall responsibility for training had the key to the locked cabinet for these records, so they were not available to the inspector at the time. The manager confirmed that a programme of formal staff supervision had started in February 2007, but said that some staff were ‘overdue’ their supervision but this would be addressed to comply with the frequency of 6 supervision meetings in every 12 months. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 25 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, promote and protect residents health and well being through assessment, care planning and review of care, and supervision of staff. Residents, their families and representatives are consulted about their opinion of the service. The systems in place for measuring the quality of the service should be improved and developed further, so that residents and health and social care workers have access to the published quality survey results. The home, its equipment and facilities are maintained to a good standard with the residents’ well being protected with safe working practices in place. This judgement has been made using available evidence including a visit to this service. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager is an experienced person who has been working in various roles in care for the Order of St John 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 3 care leaders and is in the process of recruiting to the other vacant post to ensure that there is a senior experienced member of staff on duty during the busiest periods of the day. The administrator takes the lead for recruitment and employment documentation, residents monies and the financial administration of the home. The home has recently appointed a Head of Care (on secondment) whose role will be to deputise for the manager and monitor the care standards in the home. The home has several formal processes in place for seeking residents’ opinions of the service provided. This is done through regular residents/relatives meetings, reviews of care plans and an annual questionnaire. Residents are provided with regular news letters that keep them informed of changes and developments in the home. 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 home is regularly visited, unannounced, by an OSJCT manager as required under Regulation 26 of the Care Standards Act, who then provides a report about the home to the manager, including the opinions of any residents and staff interviewed. The home should publish the results of residents’ surveys and make them available to current and prospective residents and other interested parties, including the commission. Residents’ financial interests are safeguarded by the policies and procedures for handling service users money, the facilities for storage of residents’ personal valuables and guidence given to staff. The administrator takes the lead in the management and record keeping of residents’ personal expenses where the home acts on their behalf. The records are audited by the OSJCT on a regular basis and families are kept informed of any transactions that have taken place where necessary. Residents are provided with lockable spaces in their rooms for storing their valuables. The maintenance staff member has the responsibility of ensuring that the routine monitoring and servicing of equipment and electrical, gas and water Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 27 systems occur and these are undertaken to a high standard. The inspector ‘spot checked’ the accident and the fire safety records. These were accurate and up to date. The maintenance person was putting together the new fire safety policies ready for distribution and discussion at the next staff meeting on June 14th. There was evidence of the attention paid to ensuring a high standard of health and safety around the home – for example, the non-slip surface applied to the new ramped access to the courtyard garden and consideration given to the type of seating and garden furniture outside. Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 29 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. Standard OP7 Regulation 14,15, Schedule 3 Requirement 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 31/03/07 That the administration of topical medications is recorded accurately to ensure that residents are receiving them as prescribed. This was a previous requirement to be met 28/02/07 Review and amend the numbers and skill mix of staff to ensure that there are always sufficient staff available to meet the assessed needs of residents at all times. Timescale for action 31/08/07 2. OP9 13 31/08/07 3. OP27 18 31/08/07 Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP9 Good Practice Recommendations Make the updated Statement of Purpose and Service Users guide available to prospective and current residents and their representatives and send a copy to the Commission. * Ensure that all staff authorised to administer medications have had the appropriate accredited training and are competent to do so. * If care staff make handwritten changes to residents’ MAR sheets, on a doctor’s instructions, they should enter the name of the doctor and request the doctor to check and countersign the MAR in person at the earliest opportunity. Alternatively, a second suitably trained carer should witness and countersign the first carer’s amendments. * Any changes to residents’ medications should be crossreferenced in their daily records. * Improve the way in which residents’ choices and preferences about the way they spend their day and their interests and hobbies are assessed and recorded. * Improve the way in which residents are informed about activities that are provided in the home and have sufficient care staff available to encourage and assist those residents who are able and wish to participate Make the results of quality assurance surveys available to current residents and prospective residents and other interested parties, including the Commission. 3. OP12 4. OP33 Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Chilterns End DS0000013154.V338391.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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