CARE HOMES FOR OLDER PEOPLE
Chilton Court Residential Home Gainsborough Road Stowmarket Suffolk IP14 1LL Lead Inspector
Jo Govett Unannounced 16th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Chilton Court Residential Home Address Gainsborough Road, Stowmarket, Suffolk, IP14 1LL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01449 675320 None None Stowcare Limited Post Vacant CRH 47 Category(ies) of OP - 47 (Chilton Court 33 & The Courtyard 14) registration, with number of places Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25 February 2005 Brief Description of the Service: Chilton Court is a private residential home for older people. The home was first registered in 1986 to accommodate 19 service users. In April 1998, the original building was converted to accommodate an increased registration of 23 service users with an additional extension to the home completed in January 2000, increasing the registration of the home to 32.The owners of Chilton Court have further extended the service provision by the creation of The Courtyard, a care Housing complex on the same site as Chilton Court, which was completed in May 2000 and officially opened in September of the same year. The Courtyard enables people to receive support and assistance with personal care in the comfort of their own homes and can accommodate and 14 service users. This increased the home’s registration to 47.Chilton Court and The Courtyard are situated on the Gainsborough Estate, approximately one mile from Stowmarket town centre. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on the 16 May 2005 over a 5 hour period. We spoke with staff, residents, the newly appointed Deputy Manager and General Manager, Mr Simon Gibbs. A wide range of documentation was also seen including care plans, risk assessments and policies and procedures. What the service does well: What has improved since the last inspection? What they could do better:
General information and communication needs to be improved. Feedback from staff and general observation indicates that the delegation of duties and responsibilities needs to be reviewed. Care planning and risk assessments need to be further developed to evidence that the needs of residents are being met They need to be more detailed, including reasons for action and how it should be done. All Plans and risk assessments are kept together. The home will need to ensure that residents have access to all records about their care and involve them in agreeing it. To avoid issues of confidentiality, the home may wish to consider keeping individuals care records separately. During the inspection it emerged that some residence at Chilton Court/The Courtyard have dementia. The home is not currently registered to provide care for those individuals. An immediate requirement was made for the home to identify all those people affected and apply for a variation to their registration, and demonstrate that their needs can be met. The needs of people must be
Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 6 taken into consideration when looking at the homes environment. The old part of the building (Chilton Court) is well decorated with plenty of communal space. However for those residents who’s mental health has deteriorated it does not offer stimulation or encourage them to find their own way (clear, bright signage etc). Although the home has planned activities comments made by staff and residents evidence there is a lack of information available to remind residents or keep them informed. Staff said that they wanted to “sit and talk” people living at the home or take them for short walks, however they said that they had “no time”. Although the complaints procedure had been updated since the last inspection it still does not comply with regulation. A repeat requirement was made. Other requirements and recommendations have been made covering: meeting needs, medication, and staffing levels. This is a significant change to the feedback from previous inspections, and this new report has identified several areas where outcomes for residents have not been met. The home has worked well in the past with the CSCI. It is hoped that the requirements and recommendations are viewed positively and the home works towards meeting the outcomes, evidencing that Chilton Court and The Courtyard are run in the best interests of it’s 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. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 4, 5, Standard 6 is not applicable. Lack of information and detail for, and about, potential and existing residents, puts them and staff at risk. Without this there is no assurance that their needs can be met EVIDENCE: The home has a Statement of Purpose and Service User Guide. The information needs to be updated to reflect the fact that the previous Registered Manager has left and new arrangements are in place. Mr Gibbs talked about the owners changing role, and the possibility that they will not be at the home as much as they used to be. (see Management and Administration) The information also states that the home can provide care for people with “mild dementia”. Chilton Court and The Courtyard are not registered for dementia care (see Health and Personal Care). There is no information available on how needs are to be met, or the qualifications and training of staff. The Statement Of Purpose also states that emergency admissions are usually organised by the persons GP “ and they understand our limitations of
Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 9 care so would not refer anyone to use who we could not deal with”. The home needs to ensure that it can meet the individual needs of each person living there under its registration. Residents are able to have visitors at anytime, people spoken with commented that their families and friends were made to feel welcome and could just “ pop in”. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 Lack of detail and resident involvement in care planning, (including action to be taken and outcomes to be achieved), does not ensure that all the needs of residents are identified and met on a continual basis. This potentially place staff and residents at risk. A review of some medication processes would benefit staff and ensure that residents are safeguarded. EVIDENCE: The home uses computerised care planning. It prompts information to be added for a large range of needs including the following: General Health Feeding Drinking Bladder Sleeping Habits Movement Washing Bathing Dressing Walking Sight hearing Communication Verbal/Physical Aggression Co-operation with staff Bowels Pressure Areas Speech Anti Social Behaviour Each includes a sentence regarding the Care, Aim and Objective for the resident. The Care Plan covers; Physical, Psychological and Social Aspects.
Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 11 However information was minimal and there was no instruction for carers on how goals or objectives are achieved. Care Plans are kept together with a monthly review sheet for Managers. Some plans have no changes. For example one resident admitted in 2003 had no changes noted to their care or needs since then. Risk assessments linked to care plans are kept together in a separate file. Areas of concern are highlighted in the plan but there is no related risk assessment or guidance for staff. Two “wander” mats are used to alert staff to residents who may be at risk if they leave their bedrooms. There was no risk assessment for this. Some people were described as “incontinent” but there are no related risk assessments linked to it i.e. skin tissue viability, toilet routines and nutritional screening. A general risk assessment and policy is available for those people who self-administer medication. However some relevant information is missing including security arrangements and storage. When checking the file of a resident who self medicated the risk assessment was not there. There was no information provided that confirms the homes position regarding selfmedication and the framework where it is allowed or not. There is no evidence that residents and /or their representatives are included in agreeing the care plan, or that it is accessible to them. Two residents said they did not know what a care plan was, although one had agreed the day they would prefer to have a bath. Mr Gibbs said that “Life Books” were to be introduced as an activity, to gain more information and insight into the life of residents before they moved to the home. Policies and procedures are in place for the control and administration of drugs. The Deputy Manager said that the only people who give medication are herself, the Manager and the senior staff who have all had “Monitored Dosage System” training. Staff talked knowledgably about how medication was recorded and disposed of. Records seen were accurate and up to date. Some recommendations are made to increase the information about prescribed drugs, the reason they are being given and any side effects they may have. Medication is currently transported on an open trolley. The Managers said that if the person dealing with medication is called away, a member of staff would stand guard over it or, it would be locked in the nearest toilet/bathroom. There was no risk assessment available for this procedure, although there was a policy. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Residents who need minimal assistance and are more independent have good experiences and enjoy their leisure time that they, the home, or their families organise. Those people who require more assistance have varying experience, which affects their levels of choice. A lack of information does not ensure that all residents’ individual needs are recognised or met. EVIDENCE: The home does organise activities although the information board in the entrance hall of Chilton Court only has minimal information written on it. Residents talked with are not aware of the timetable or special events. One person said that they had attended craft sessions but “most people couldn’t join in because they needed more help”. When asked if 1:1 help was needed they replied “yes”. Another person said that they would like to go out more, but relied on their family, as the carers were “too busy”. Another said that they were “very lonely” because there was no one to talk to. As detailed in Health and Personal Care details about individual’s interests and social needs are limited, although the home is going to introduce “Life Plans”. Some people who live at the home stated that they were “bored” and that there was “not enough going on”. Others were happy to be left alone to do their own thing. Staff comment cards received by the CSCI raise concerns that there is no time to sit with residents to talk or find out how they are.
Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 13 Residents talked about communion being made available and that if they asked the staff would request extra visits. People can choose whether they have meals in a communal dining room or in their own bedroom/house. Residents are free to make a choice from the menu. Nutritional value and assessments were not fully assessed at this inspection. Water glasses were filled and left on tables in the dining room for at least 20 minutes. This meant that when people sat down it was not fresh and could have been touched/drunk or removed by other residents. A recommendation was made to put water jugs on each table closer to meal times in order for people to help themselves to as much as they want. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Lack of formal recording and monitoring of complaints and concerns does not ensure that residents and staff are protected. EVIDENCE: The complaints policy and procedure commits the home to provide a “verbal response” to complainants within 1 month. There is no logbook of complaints or compliments and therefore no trackable themes for quality assurance. The home does not always provide a written response. One person said that some items had gone missing from their room. However they did not feel that they could approach anyone at the home to discuss it saying, “these things happen”. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25, 26. Residents enjoy pleasant surroundings and are safeguarded by a good level of cleanliness and infection control. Some residents may be at risk from harm if they wander into unsecured areas, inside or outside the home. EVIDENCE: Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 16 All areas are well maintained, clean and tidy. Both Chilton Court and The Courtyard are sited in well-kept grounds that provide very pleasant areas for residents to spend time, including a sun lounge, outside decking area and pond. A member of domiciliary staff talked about the routines for cleaning bedrooms and bathrooms, and was able to discuss issues about infection control. Residents are able take their own furniture into the accommodation or the home provides it. As detailed in Health and Personal Care “wander” mats were in place in two bedrooms. There were no environmental risk assessments seen for those who may be at risk from wandering, or decoration/signage which may help them place themselves in the home. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Concern over communication, information and staffing levels does not reassure residents or staff that needs will be met. EVIDENCE: Some staff were spoken with during the inspection. Comment cards were left for other staff who may not have been on duty. Four of these were returned directly to the CSCI. All commented that they are concerned that there is not enough staff to meet the needs of the residents or ensure “quality time” with individuals. The home does not have a Key Worker system as the owners feel that all staff should know all the residents and their needs. Mr Gibbs confirmed that this approach meant that they did not have to worry about the impact of staff holidays or sickness. Staff are concerned about the number of carers on the night shift. Two carers cover all residents from 22.00 – 07.30. Residents made general comments about “good carers” but were unable to remember specific names. Some were unsure of who was in charge. One person said that one carer had been too busy to give them a bath and had promised they would do it the next night, but it didn’t happen. Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36, 38 Lack of information and guidance puts residents and staff at risk. Residents who live in The Courtyard, benefit from the progressive environment. There is evidence to suggest that the same ethos is not felt in the main home. The owners need to provide appropriate support and guidance for staff and residents. EVIDENCE: The home has recently appointed a new deputy manager and home manager (who is applying for registration with the CSCI). Simon Gibbs undertakes the General Management and the owners are also involved. Mr Gibbs stated that they would be taking a “step back” and may not be at the home on a day-today basis. He is aware that due to this the CSCI will expect Regulation 26 monthly management reports from the owners or their representatives, to ensure that they know about progress, shortfalls and development at the home.
Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 19 Two of the four comment cards received from staff expressed concern about lack communication and organisation from management. Supervision has been introduced but it is too early to tell if this is being completed on a regular basis. There is concern over health and safety, mainly in relation to residents who may unknowingly place themselves in danger and the lack of related risk assessments to acknowledge this.. (See Environment & Health and Personal Care) Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x 2 x x x 3 x 2 Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4&5 Requirement The home must review and update the Statement Of Purpose and Service User Guide, esuring that all the elements required from Regulation 4 & 5 of The Care Homes Regulations 2001 are included. Those residents who have been refferred or diagnosed with dementia must be disclosed to the CSCI. An application for variation to the homes current registration must be applied for in resect of the above. The home must ensure that it can meet the individual needs of a person before admission. They must not rely on a third pary to make this decision. The home must be able to evidence that residence have access to thier own care plans. The care plan must be developed with the involvement of the resident and/or representative (if appropriate) and be involved with any future changes/reviews. Medication must be transported around the home securely as Timescale for action 31 July 2005 2. 1&4 4&5 Immediate 3. 1&4 4. 1&4 Care Standards Act 3(4) Schedule 4(5)(b) 14 Immediate. 31 July 2005 5. 6. 7 7 & 14 15 15 31 July 2005 31 July 2005 7. 9 & 38 13(2) 31 July 2005
Page 22 Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 8. 7, 8, 12 & 38 14 & 38 9. 10. 11. 9 & 38 16 12. 13. 16 19 & 38 14. 27 & 38 15. 27 & 38 detailed in Royal Pharmaceutical Guidlines 12, 13, 15 The Care Plan must include details about how individual health and welfare needs are to be met. 12, 13, 15 The home must ensure that all residents are able make choices and remain autonomous. Where this is not possible comprehensive risk assessments and records must be in place, and all relevant parties informed, i.e, next of kin, advocate, GP, if appropriate. 13(2) The self medication policy must be updated and include details about security and storage. 22 The Registered Persons must ensure that the complaints procedure complies with Regulation 22 of The Care Home s Regulations 2001. This is a repeat requirement 22 The complaints proceedure must be given in to all residents. 12, 13 A full assessment must be completed to ensure that the home is safe and secure for those residents who may unkowingly place themselves at risk.. 18(1)(a) The home must evidence that it completes reviews of staffing levels for all shifts. This must be clearly linked with changing dependency levels within the home. 18(1)(a) Staff numbers must be of a level to ensure that if two carers are assisting one person another is available to meet others needs. 31 July 2005 31 July 2005 Immediate Immediate Immediate Immediate 31 July 2005 31 July 2005 Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 23 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. 3. 4. 5. 6. 7. 8. Refer to Standard 7 9 9 9 15 15 16 27 Good Practice Recommendations The monthly care review should reflect changing needs, current objectives for health and personal care , and action taken to address this. Medication Administration Records should include a photograph to ensure their identification. More information should be kept with the Medication Administration Records about possible side effects and the reason for administration of prescribed drugs. The home should purchase a compliant medication trolly which can be used to transport medication around the home, in line with Royal Pharmacuetical Guidlines Water jugs should be left on tables during meals for residents to help themselves. Drinks should not be prepared and left for residents unless they are going to be consumed within a reasonable time frame. Complaints and compliments should be logged officially for quality assurance, tracking and to ensure that any action taken and resolution is recorded. The home should consider deligating some responsibnility between appropriate staff members and introduce a system so residents and family have a key contact. This would improve communication and provide reassurance. The home should keep individual care plans, risk assessments and daily records together to ensure confidentiality between residents and concise, trackable records. 9. 7 Chilton Court Residential Home I54-I04 S24357 Chilton Court V227919 050516 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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