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Inspection on 14/10/08 for Chilton Croft Nursing Home

Also see our care home review for Chilton Croft Nursing Home for more information

This inspection was carried out on 14th October 2008.

CSCI found this care home to be providing an Poor service.

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.

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

What the care home does well

Feedback received a relative said, `The staff are always helpful, and friendly, although often work under pressure`, and a care manager said, `I feel the service provided has improved and continues to improve`. People who use this home will benefit from having their needs assessed, before they move into the home. Improvements continue to the homes catering services with improved menus that usually meet the residents` nutritional needs. People who live at the home are benefiting from continued improvements to the fabric of the home including, redecoration and carpeting to some of the bedrooms and hallways, which provide them with comfortable accommodation. People who use this service can expect staff to be adequately recruited and trained. Staff are helpful towards the residents and who support their physical care needs. Peoples` complaints and concerns would be investigated and the home would resolve these to the residents` satisfaction.

What has improved since the last inspection?

This inspection showed us that the home has made improvements to some of the areas that have caused us concerns, at previous inspections. These include improvements to the home`s care planning processes, and how they manage complaints and concerns. The owners are investing in improving the environment with the redecoration of some bedrooms and hallways, the provision of new furniture, and a new call bell system. The owners have now replaced all thermostatic safety valves, which ensure that hot water is delivered safely to the residents. The staff recruitment processes, which had caused us serious concern, have now been improved to ensure that only suitably checked and cleared staff are employed at the home. Some key staff training, for example safeguarding, has now been provided for all staff.

What the care home could do better:

This inspection showed us that four of seven outcome groups are operating at an `adequate` level, with two outcome areas assessed as `good`, which is positive. However, due to a number of ongoing management concerns, `management outcomes` have been assessed as `poor`. Management concerns included the following issues. The provider must complete the process of appointing the responsible individual, which has been outstanding for some time. The home must ensure that a suitably qualified and experienced manager is appointed to oversee and run the service. The home must ensure that there are appropriate quality assurance processes in place that identify shortfalls, for example, shortfalls in the auditing of medicine practices. At this inspection we also raised concerns around the management and monitoring of medicines, which showed us that some of the residents were being put at risk by unsafe practices. An immediate requirement notice was issued to the home, which must ensure that the medicine practices are improved for the safety of the residents. Recommendations included that the home should ensure care plans should reflect more detail around the residents` emotional and social care needs, to ensure that their choices and preferences are recorded, so that staff can meet these needs. Staffing levels should be appropriately maintained to ensure that there are sufficient care staff to meet the changing needs of the residents. Staff training should ensure that all core and NVQ training is completed for staff, to ensure that staff have the skills, and training to meet the complex needs of the residents.

CARE HOMES FOR OLDER PEOPLE Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN Lead Inspector Kevin Dally Unannounced Inspection 14th & 15th October 2008 09:00 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 Chilton Croft Nursing Home DS0000024358.V372793.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. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilton Croft Nursing Home Address Newton Road Sudbury Suffolk CO10 2RN 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) 01787 374146 01787 374333 tyrone.peacock@chiltoncroft.co.uk Chilton Care Homes Limited Manager post vacant Care Home 31 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (31) of places Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th August 2008 Brief Description of the Service: Chilton Croft is situated about one mile from the centre of Sudbury. It offers nursing care to thirty-one residents in a large two-storey house that has been developed for the purpose. A variation to the registration allows the home to offer care to up to six residents with a diagnosis of dementia. The home has two large lounges that both have a conservatory, which overlook garden areas. The gardens are secluded and have level access and wheelchair ramps to allow for resident usage. There is a separate dining room. There are twenty-seven single bedrooms and two shared rooms. Eleven bedrooms are on the ground floor with eighteen on the first floor. There is a passenger lift between the floors. Nineteen rooms have en-suite toilet facilities and there are toilets and bathrooms situated on both floors. The fees for care in the home range from £450 to £630 per week. This figure was obtained from the provider of the home. A sample contract shows that this does not include the cost of medication, clothing, hairdressing, newspapers, toiletries and other items of a personal nature. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This key unannounced inspection was undertaken by Mr Kevin Dally, lead inspector, and Mrs Jill Clarke, inspector, over two days on the 14th and 15th October 2008. The inspection focused on the main standards that applied to older people. Mr Diwan, the provider, and Mr Tyron Peacock, the clinical nurse manager, assisted us and provided relevant information about the service. The report has been written using all the information gathered before and during the inspection. At the last key inspection in October 2007, the home was assessed as a ‘poor service’. This was because the health and personal care outcomes for residents were not being met, and shortfalls were shown in the staffing, complaints and concerns, and the management outcomes of the home. Therefore additional random inspections were undertaken in March, June and August 2008 to ensure the home had complied with the standards, and had improved these outcome areas for the benefit of the residents. At the June inspection, the home still failed to adequately meet the staffing outcome area around recruitment. Therefore a statuary requirement notice was issued, which required the owners to improve the recruitment processes, or face legal action. This standard was now found to be met at this inspection. Since the last key inspection, Mr Peacock, the manager, had applied to the CSCI to become the registered manager, but was refused registration. During this inspection the owner advised us that Mr Peacock had been offered a new post of ‘clinical nurse manager’, and would step aside from management responsibilities. Mr Diwan told us that he would temporarily ‘act as manager’ until a new home’s manager was recruited and appointed by the owners. At this key inspection we focused on the key standards and the previous serious shortfalls, which had caused us concern during the last year. This included checking the home’s care planning and assessment processes, assessing if the home was meeting the residents’ nursing and medical care needs, and a check to see if staff were being appropriately recruited and trained. We also assessed how the home was currently being managed including checking quality assurance procedures, complaints and concerns, staffing issues, and management of health and safety issues at the home. We also toured the premises and were able to spend time with some of the residents (9) and staff (9), and talk with some of the relatives (7) visiting the home. This gave us information about what people thought about the home Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 6 and the quality of the care provided. Some residents care plans; residents’ and staff records, maintenance records and training records were also checked. The Commission for Social Care Inspection (CSCI), also sent surveys to the home and social services to distribute, prior to the inspection. Comments were received from 3 relatives, 1 staff member, 1 healthcare professional and 2 social care managers who provided us with feedback on how they thought the home was run. A selection of their views and opinions about the home are included within this report. Prior to the inspection, the management also completed the CSCI annual quality assurance assessment form (AQAA). This enables the home to inform us on how well they are meeting the national minimum standards, and allows them to say what they do well, what they could do better and any plans to improve the service. Some of the information from these documents has been used in this report. A tour of the building was completed which included checking the communal rooms including the dining room, and a sample of several residents bedrooms, with the residents’ permission. What the service does well: Feedback received a relative said, ‘The staff are always helpful, and friendly, although often work under pressure’, and a care manager said, ‘I feel the service provided has improved and continues to improve’. People who use this home will benefit from having their needs assessed, before they move into the home. Improvements continue to the homes catering services with improved menus that usually meet the residents’ nutritional needs. People who live at the home are benefiting from continued improvements to the fabric of the home including, redecoration and carpeting to some of the bedrooms and hallways, which provide them with comfortable accommodation. People who use this service can expect staff to be adequately recruited and trained. Staff are helpful towards the residents and who support their physical care needs. Peoples’ complaints and concerns would be investigated and the home would resolve these to the residents’ satisfaction. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: This inspection showed us that four of seven outcome groups are operating at an ‘adequate’ level, with two outcome areas assessed as ‘good’, which is positive. However, due to a number of ongoing management concerns, ‘management outcomes’ have been assessed as ‘poor’. Management concerns included the following issues. The provider must complete the process of appointing the responsible individual, which has been outstanding for some time. The home must ensure that a suitably qualified and experienced manager is appointed to oversee and run the service. The home must ensure that there are appropriate quality assurance processes in place that identify shortfalls, for example, shortfalls in the auditing of medicine practices. At this inspection we also raised concerns around the management and monitoring of medicines, which showed us that some of the residents were being put at risk by unsafe practices. An immediate requirement notice was issued to the home, which must ensure that the medicine practices are improved for the safety of the residents. Recommendations included that the home should ensure care plans should reflect more detail around the residents’ emotional and social care needs, to ensure that their choices and preferences are recorded, so that staff can meet these needs. Staffing levels should be appropriately maintained to ensure that there are sufficient care staff to meet the changing needs of the residents. Staff training should ensure that all core and NVQ training is completed for staff, to ensure that staff have the skills, and training to meet the complex needs of the residents. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 8 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. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 9 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 Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 10 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): 1,3,4,5, standard 6 does not apply. Quality in this outcome area is adequate. People who use this service can expect to have their basic needs assessed however they cannot be assured that their needs will be fully met. They cannot be assured that they will have access to information that accurately reflects the management situation or the facilities offered by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provided us with a copy of the residents’ handbook, which included information on the aims and objectives of the home, the organisation and management structure, and information on how to make a complaint. The handbook referred to the ‘registered manager’ as Mr Peacock, and therefore needs to be changed, to reflect the current management structure. A copy of the residents’ guide was seen in a bedroom. The home told us that they currently only have showers available to wash the residents. Therefore the Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 11 statement of purpose must include that it does not offer bath washing facilities. In the information provided by the home (the AQAA), the home told us that they ‘carry out a full pre-admission assessment, and formulate care plans according to the service users’ individual and holistic needs and wants’. Residents’ records checked showed that the home had completed basic nursing assessments for each person in order to ensure that they were aware of these peoples’ care needs. The information included a basic assessment of their care needs, and background information including a life history and daily programme. We asked two new residents if anyone had visited them from the home before they were admitted, so staff were aware of the level of care the person was looking for, and to confirm if they would be able meet their care needs. Both residents’ told us that ‘the nurse had come up and did an assessment’ which we found on their care plans. Where another new resident had been too ill to visit, their relatives had instead visited the home and told us they had ‘felt the warmth as we came in’, which they related to the friendly atmosphere of the staff. They also told us that nursing staff had come to the hospital to complete an assessment of their relative, and that a social care assessment had also been completed by their social worker who they said was ‘very helpful’. The relative said they were happy with the care being provided and commented on ‘how comfortable’ the accommodation was. The relatives also told us they were fully aware of how much the cost of the care was, and what was included in the fees. The home was able to show us that they had improved some basic care training for staff, to evidence that they could meet the physical care needs of the residents. For example, all staff had received safeguarding training, fire, first aid training, and moving and handling training. Eleven of staff had received first aid training, but most staff still required food hygiene, COSHH and infection control training. Evidence to show that staff had been trained to meet the residents’ more specialised needs was lacking. For example, five of 33 staff had received dementia care training (the home is registered for 6 people with dementia), and 1 of 33 staff had received palliative care training. One nurse’s training records checked showed they had received training, which included bereavement training, palliative care, diabetes training, deep vein thrombosis training and syringe driver training. The home recorded that 25 of their care staff (5 of 20) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 6 currently working towards this award. This informed us that a quarter of the care staff had achieved a formal care qualification, with another 25 required to meet the required standard. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 12 Surveys (CSCI) received from 2 of 3 relatives said that the care home ‘always’ meets the needs of the residents, and that staff have the right skills and experience to look after people properly. One did not did not comment on the first point, but said staff ‘usually’ have the skills and experience to look after people properly. Two of 3 relatives said their relative ‘always’ received the support and care that they expected. One relative did not say. A comment received from a relative said, ‘The staff are always helpful, and friendly, although often work under pressure’. Feedback from 2 of 3 care managers said that the home ‘usually’ respond to the different needs of individuals. One did not rate this but commented ‘the home meets my client’s needs’. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is adequate. People can be assured that their physical care needs are met however they cannot be assured that their emotional and social care needs will always be met. Some medicine practices may not keep residents safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the information provided by the home (the AQAA), the home told us what they do well. They said ‘Holistic care planning, which is reviewed at regular intervals monthly or as required, with the inclusion of the family. This assists in formulating effective care plans based on individual needs and wants’. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 14 Following our last key inspection in October 2007, the home was found not to have addressed a previous requirement to ensure that residents have a clear written plan (care plan). This should show how they want to be cared for, and will include any information on how to meet the resident’s care, support and emotional needs. When we visited in March 2008, the content of care plans had improved, but did not provide evidence that residents were being asked or are having a say on how they wanted to be looked after, including guidance for them on the residents’ likes and dislikes. Where nursing action had been identified, for example ensuring residents were given a certain amount of fluid throughout a 24-hour period, records did not evidence that this was happening. Due to the vulnerability of some residents who are totally reliant on staff to assist them with their drinks and diet, requirements were made to ensure that the residents’ nutritional intake was being monitored, and recorded. This was to evidence that staff were following instructions, so would ensure the comfort and nutritional needs of the residents. Our next visit in June 2008, showed that new care plans had been introduced, and the management informed us that because staff ‘dont read care plans’ they had now included an extra front page that sets out the residents basic care and routines for the day. The plans that had been introduced, although brief (which was the intention so staff would not be put off reading them) were more informative, clearly written, and gave an insight of what the resident wanted, and the level of support they were having. However, in the rest of the care plan, the home had used medical jargon and abbreviations, which was difficult for the resident to understand. When we asked residents if they knew what terms like ADL meant, or giving it its full name, ‘activities of daily living’ - they did not. We therefore asked the home to consider writing plans in plain English, so both the residents and staff are able to clearly understand these. At this inspection we again looked at two new residents’ care plans who were admitted in August 2008. We found that some of the same terminology was being used. Again, when we asked a resident if they knew what was meant by assess levels of ability ADLs, they said they did not. In total we spent time looking in detail at 6 residents’ care, who reflected the range of care needs the home is currently looking after. This included two residents with dementia, and four with either high or low nursing care needs. We spent time with these residents, and received feedback from them about what they felt about the level of care they were receiving, and if this met their expectations and needs. Where the residents were too ill or unable to fully communicate, we used observation, or spoke to their relatives, to gain feedback. With the information we gained from the residents, and discussions with staff about individual peoples care needs, we then looked to see if this reflected the information given in the care plan. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 15 What we found was that residents who could communicate with us, were happy with the care they received, with a resident saying ‘I like it here’, and a relative spoken with said that they ‘felt comfortable to leave the home, knowing that staff were looking after their next of kin’. A reoccurring theme from the residents, was how long it sometimes took for staff to answer call bells, particularly during busy times (see staffing section of this report). Residents’ told us that they ‘didnt blame staff’ as it ‘was the pressure of work’ they were under. From time spent talking to the residents and staff, we found that the information in the care plan now adequately covered their physical nursing needs, nutrition and pressure area care, but gave limited information on their preferences, likes and dislikes. Not all the residents had a diagram of care, which we had found made care plans a little less clinical when we read them in June 2008. However, there were some examples that showed that residents’ preferences had been included, such as ‘likes tea’, ‘able to choose own clothing - supports wellbeing. This type of information was however not consistent and did not cover all areas of the residents wellbeing. The content of the care plan reflected the staffs practice of focusing on the nursing and physical aspects, rather than the emotional and social aspects of the residents care. The focus of care plans was more aimed at what a person is unable to do - rather than what they can. This information is needed to help identify the quality of life for people on a daily basis, and be used to monitor improvements or a deterioration in their abilities. For example, new residents’ care plans looked at and focused on their physical care needs, rather than including how the resident was feeling about moving into care. Where we had concerns in March over lack of records to evidence that residents were being given food and drink, where they are totally reliant on staff for this, record keeping had improved. However there was still some inconsistencies in recording what a resident had been given/offered. Management and nursing staff assured us that all residents were ‘clinically hydrated’, and that they were working closely with the community nutritionist or speech therapist, to support individual’s care needs. We observed one resident being supported with their meals, as per the guidelines given by the community team. Staff confirmed there was enough specialist pressure-relieving aids (mattresses and cushions) available at the home, for those residents who have been identified at risk of getting pressure sores, to ensure their comfort. However, one resident we visited, although their care plan stated that the resident had a specialist mattress on their bed, they did not. Staff confirmed Instead it was being used as a crash mat on the floor. We asked the resident if staff put it on the bed at night and they replied ‘no - they stand it up in the corner’. We asked if they had any problems with getting sore, they replied ‘no - I get up and walk around’. Further information in their care plan, confirmed Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 16 this, which raised concerns why a resident who was able to get up and walk, had a crash mattress laying on the floor in-front of them - which could be a trip hazard. The home uses a ‘blister pack’ system that involves residents’ prescribed medicines being dispensed to the home from the pharmacist every 28 days, in individual supplies of tablets. Liquid medication, tablets/capsules that cannot be supplied in the blister packs are sent to the home in separate containers. When nurses undertake a drug round, the expectation is for them to check the information for each resident given on a medication administration record (MAR) charts, which will tell the nurse the time and dose of medication the resident should be given. To confirm the resident has been given the medication, the nurses are required to initial the MAR chart. If for any reason the resident is not given the medication, the nurse will make a note on the MAR chart, stating why it may have been omitted. We checked the MAR charts for the residents living on the first floor to check if nurses are following safe procedures. Looking at the medicine sheets we found some gaps where staff had not signed to confirm the medication had been given. We looked at three of the residents MAR charts in detail, alerted by the gaps, to check to see whether staff had given the medication and forgotten to sign, or if staff had forgotten to give the resident their prescribed medication. Our findings showed that one resident’s lunchtime medication, used to stop them feeling dizzy and sick, had on one occasion not been given and was still in the blister pack. There was no written information on the MAR sheet to state why the medication had not been given. Another resident’s MAR chart showed that staff had given the medication but not signed to confirm it. The third MAR chart showed when the medication should be given at set weekly intervals, which had been marked to make it easier for staff to remember, this had not been given on those set days. For one resident whose medication was not stored in a blister pack, we couldnt determine how many tablets they should have left as the ‘carry forward figure’ in the records was incorrect, as the person had not been in the home the previous month. We also found that the quantity of medicines brought into the home by a new resident had not been recorded on the MAR sheet. This is needed to ensure that the home have an accurate record of how much medication they are looking after on behalf of a resident. Further, this would be used as part of an audit check to ensure staff are giving the medication out correctly. We were informed by the clinical manager that they were aware staff were not always following the set guidance on receiving medication and told us that this was being addressed through staff meetings, supervision, retraining and audits. Minutes of a nurses’ meeting held in February 2008 confirmed that the clinical manager stated that there was ‘still errors occurring’ and that staff were to read the policies and guidance and ‘complete MAR sheets correctly’. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 17 We also looked at the audit sheets being undertaken by one of the nurses, the last of which was undertaken during the late August early September 2008 period. This identified that they had also found medication had been signed for and not given, as they had more tablets in stock than they should have. There was also comments querying that the amount of medication received had been inaccurate, due to nurses not recording this properly. Discussions with the nurses told us that when the audit is completed, the results are passed onto the clinical manager. However there was no evidence of an investigation by the clinical manager into these shortfalls, and what action was being taken to ensure residents received the correct medication to ensure their well-being. Due to the shortfalls we identified (this was six weeks after the last audit by the home where this showed the problems we had identified) we were concerned that nurses were not following safe procedures. Therefore we issued an immediate requirement notice to ensure the home took action to investigate, monitor, and resolve these concerns, so residents were receiving their medicines, as prescribed by their doctor. The home had systems in place to ensure medication no longer required was disposed of safely and where controlled medication was being given to residents, this was always witnessed. This is to ensure it was given to the right person at the right dosage at the right time. The clinical manager confirmed that they had taken action so nurses are not disturbed whilst giving out medication. For example, answering phones, which would reduce the risk of medicine errors being made. The clinical manager also told us that they were sourcing further medicine training for nurses. We observed one nurse giving out medication, and they were seen to check the MAR chart with the medication they were going to give. When they did need to leave the trolley, they ensured it was locked safely, so medication would not be accidentally consumed by another resident. To ensure the privacy and dignity of residents whilst receiving personal care, staff used do not disturb care in progress signs. This was seen as good practice, although on two occasions was ignored, as staff entered residents rooms displaying the sign, when they were trying to locate another member of staff to help them. To ensure confidentiality, residents keep care their plans in their bedroom. This enables residents to read their care plan at any time if they wish, and also monitor who is having access to the personal information about them. When we visited in June 2008 we found one resident’s care plan had been left on a windowsill in the hallway outside their bedroom, which could be read by anybody. During this visit, we noted the same again. We brought this to the director’s attention who informed us that they would make arrangements to ensure it was kept in the residents room. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 18 After lunch on the second day of our visit, we could hear staff giving a verbal handover to each other (which included information on personal care), whilst standing outside the residents bedrooms. We were concerned for the privacy and dignity of residents, especially for the more vulnerable residents who would be unable to ask staff not to discuss their private business this way. When we asked staff if this was normal practice, (as we had not seen this happen before), we were informed that the system of handing over information between shifts had been changed, as the management ‘didnt want staff sitting around a table’ giving a handover. The clinical manager confirmed that they had ‘instigated’ the idea after seeing it happening at the hospital. They also said it was a good way to ensure that senior staff coming on shift, received relevant information on what had occurred that day, for each resident. We raised our concerns about confidentiality, and that residents may not like any personal care issues being discussed in front of them. We also commented that the practice was more hospital related than a practice associated with somebody in his or her own home, and they were asked to review the situation. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 19 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): 12,13,14,15. Quality in this outcome area is good. People who use this service are offered a range of home cooked meals and are to receive their visitors any time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We spent time talking with three residents who confirmed that they were able to get up when they wanted, and felt the routines of the home were flexible enough to meet their needs. One resident told us that their next of kin visited daily and they went out together at least three times a week. Throughout this and previous inspections we witnessed the relaxed visiting arrangements, which enables residents to have visitors when they wish. From discussions with residents during this, and previous inspections we found residents who are quite happy and able to occupy themselves, for example by watching television, reading, listening to music, or going out on organised trips with the home, felt they had sufficient going on to fill their day. Since our last key inspection, the home has employed an activities coordinator who Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 20 works with small groups of residents, or on a one-to-one basis. Staff felt that this was a positive move forward but felt that the person wasnt given enough time to fulfil their role, leaving some residents without stimulation. During the two days we were at the home, we observed a resident, who due to their stroke, had problems communicating. Their bedroom door was left open, so they could see people walk pass, the time we spent observing staff were only seen to go into the bedroom, when undertaking tasks. During this visit the residents’ information board informed us that bingo would be taking place. When we did not see this happen, we asked staff what activities had been organised, and were informed that the activities person was on leave. We were also told that morning staff would try to arrange activities in their absence - if they have time. We observed two residents with dementia who had their bedroom doors left open, and was seen to sit in their chair throughout the two-day inspection, with little to occupy them. The main interaction for them was when staff went in to undertake a task, such as give a drink, food, personal care, or in response to the resident shouting out. The provider told us that they would look into putting a programme in place in one of the lounges, which would try to improve the activities and stimulation for the residents with dementia. Residents are able to receive their visitors when they wish, and discussions with relatives confirmed that they were made to feel ‘welcome’, and were always offered drinks at the same time as the resident, as they would have done in their own home. During a previous visit, a resident had commented how much they enjoyed the visits ‘from the pat dog’, which according to the notice on the information board was still happening. Where residents we spoke with were clearly mentally alert and able to make decisions about their care, they confirmed they were able to get up when they preferred to or go to bed ‘more or less around 9 p.m.’ when they wanted. They didnt feel pressured to join in any activities that were being organised by the home with three of the residents spoken to preferred their own company or talking to staff on a one-to-one basis or joining in with group activities. Where some residents with dementia or strokes were unable to communicate their preferences, the care plans did not always evidence how autonomy and choice was being promoted. Residents told us that the food ‘was good’ and that they were happy with the new chef. Time spent talking to residents confirmed that meals were being pureed when required to meet their individual needs. Prior to this inspection a relative had raised concerns that the portion sizes given to residents was not enough, and although they had brought this up with the management nothing had been done. When we asked one resident if they were given enough to eat and drink they told us that if they felt hungry ‘I can ask they get me something’. Another resident told us that they had mentioned to a family Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 21 member that they werent getting enough to eat, which had resulted in the family mentioning this to staff. Staff had then arranged for the resident concerned to be given bigger portions and a milky drink at night. We asked the resident if this was happening and they confirmed it was, stating we have “lovely food - no complaints there at all”. Prior to this inspection a relative also commented that staff were not always covering the meals when they were carrying them around the home. We observed the lunchtime trays being taken around the home and saw that all the hot food had plastic covers on. Where the portions looked quite small we checked with the resident if the portion was sufficient, to which they confirmed ‘yes’, it was what they had requested. The director told us that they had been encouraging residents to use the dining room rather than stay in their bedroom to eat, so they could enjoy the company of others. One resident told us that they always go down to lunch so they could meet up with the other residents, and have a chat. Menus for the week are displayed on the notice board, which is more for visitors information as the residents are given individual menu sheets to complete. We saw hot drinks being served to residents, and their visitors at regular intervals throughout the day. Residents we spoke with in their bedroom had a jug of juice or water, which they could help themselves to. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 22 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 & 18 Quality in this outcome area is good. People can expect the home to have their complaints investigated and action taken to ensure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information provided by the home (the AQAA) told us, ‘Our complaints procedure is very robust. We ensure all complains are handled properly and the policy is implemented effectively, and the feedback from staff and service users’ and families is evident’. The home’s complaint book was checked which showed they had had received 9 complaints and one safeguarding alert in the past year. These complaints had been recorded, were appropriately investigated, and an outcome provided to the complainant. Where complaints had been upheld, the home provided good evidence of how it had resolved the complaint, and the measures it had taken to ensure that the matters were not repeated. Complaints included concerns around moving and handling issues (2), food and drink problems (2), personal care concerns (2), a privacy and dignity issue (1), an environmental matter (1), and an issue around a staff member’s attitude (1). As a result of the home’s investigations, actions varied from an apology in one instance to the dismissal of a staff member in another, for inappropriate behaviour. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 23 There was company policy for the safeguarding and protection of vulnerable adults (POVA), with information and instructions on what to do. The home was aware of their responsibilities in reporting any allegations of abuse to the social care team for further investigation. One safeguarding alert had been made by the home to the safeguarding team within the last year, around the actions of a member of staff. The matter had been fully investigated by the safeguarding team, and the alert had been closed without any further action necessary. A check of the home’s staff recruitment procedures showed that new employees are appropriately checked and cleared to work with vulnerable adults. (Please refer to standard 29). Discussion with the management and staff records checked confirmed that adult safeguarding training had been provided for all staff. This was to ensure they knew what to do in the event of any allegations of abuse by a resident. When we asked a relative if they knew how to raise any concerns they said that if they want ‘any help to just knock on the (office) door’. Another resident told us, ‘I would soon let them know if I dont’. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 24 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): 19,20, Quality in this outcome area is adequate. People benefit from a comfortable home where effort continues to be made to improve the environment, although this is not yet entirely adapted for people with dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has two lounges and a dining room where the residents can gather for activities, meals or meet with the other residents at the home. However, the current system where only staff can unlock the front door to provide access to safe, stimulating areas around the home and garden, shows the shortfalls of the layout of the home, and so is not yet suitable for the current mix of physically and mentally frail residents. Relatives have also told us of their Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 25 frustrations when locating the member of staff holding the front door key, to let them out. The provider Mr Diwan had looked to address this through a planned extension, which would have provided a specialist area for people with dementia, including restricted access. This would have then left the entrance to the main home, with free access for residents to go when they wished. However, taking into account our concerns Mr Diwan said that they need to concentrate on meeting the required standard for care and environment for current residents, before looking to increase their numbers, have decided to temporarily put the extension on hold. Instead the provider would be concentrating on improving the current environment, through on-going refurbishment. We saw work being undertaken during our visit, which included the corridors, dining room, and some bedrooms being repainted in light fresh colours, and new carpets being laid. The provider also informed us that they are currently reviewing the layout of the building, and looking at keeping the upstairs areas for residents requiring nursing care, and turning the downstairs area into a more appropriate environment for people with dementia. This would include upgrading one of the attractive downstairs lounges into a purpose specific area for people with dementia. The provider also told us that they are now seeking advice from one of the directors who already has involvement in a dementia care home, and is more aware of ways to offer a more stimulating environment. We also observed that The signage throughout the building was not consistent, and can be confusing to residents. Part of this is due to the on-going redecorating throughout the building, which has led to door numbers and names disappearing. However, where they do have signs on the door for example bathroom, it is in fact a shower room. Relatives told us that residents are not given a choice of a bath or shower; they had to have a shower - which was confirmed by staff on 2 of our previous visits. Where we did find a bath this had no plug. We fed this back to the director, who confirmed that the current bathroom was not practical to use, and that they would be looking in the future to provide a specialist bathroom, which would meet residents’ physical needs. We reminded the owner that their Statement of Purpose should reflect that they currently have no assisted bath. This is to ensure residents are aware of this prior to moving in, as we saw at least one residents care plan, which stated they enjoy a bath. Since our March 2008 random inspection, the owners have refurbished 2 showers rooms. When we visited in June 2008, we found that one of the showers was out of action, and the one that did work; the water was over 55°C. Due to the potential risk of scolding, we asked the home to take immediate action to ensure hot water was supplied at a safe, temperature (41°-43°C). A visit from the Health and Safety Executive in September 2008 confirmed that the home had fitted thermostat controls to all hot water outlets, Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 26 and systems were in place to check, and take action if any of the thermostats became faulty. A check of the records and a sample of the hot water tap temperatures showed us that these are now being appropriately monitored by the home, and are within safe operating limits. When visiting some of the residents in their rooms we noted that their pillows were ‘lumpy’ on checking, due to the foam filling having broken up in the wash. We asked a resident if they found their bed comfortable and they replied not bad as beds go but not enough pillows they told us that they have asked many times to have more, but had not been given them. We looked in the laundry cupboard, where clean pillows were stored, waiting to be used, and they were found to be in a similar state. We showed Mr Diwan these, and they confirmed they would have them replaced. When we visited in March 2008 we found that the standard of cleanliness and hygiene had slipped. This has since been addressed by taking on a new housekeeping supervisor and visits we have made since March, has found the home to be fresh and clean with only minor shortfalls. For example, sticky marks were found on one residents waterproof mattress, were the mattress had been used on the uncarpeted floor. (as a safety procedure in case they fell). Good practice was seen with housekeeping staff using a lockable, mobile cleaning trolley, which reduces the risk of residents’ accidentally swallowing cleaning fluids. Some residents’ bedrooms we visited were personalised with their possessions, which staff had encouraged them to bring in, to help them settle. Room sizes vary, and as the home no longer offer shared rooms, they now only take up to 29 residents, unless there was a request to share. We saw one large vacant bedroom being tastefully redecorated, which will offer a light airy room with period features, overlooking the garden. The owner acknowledged that maintenance work needed to be done in the garden. It had been left, awaiting building work, but as this is currently on hold, the owner said they will ensure that the garden is improved. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 27 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): 27,28,29,30 Quality in this outcome area is adequate. People can expect staff being adequately recruited and trained, but cannot always be assured of adequate staff on all shifts, which may compromise the level of care and support available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During our visits to the home, we have been asking the home to constantly monitor how many staff they have on duty to ensure that they have sufficient staff to meet the residents needs. The management are able to use information provided by the call bell system, to show that residents’ calls bells are being answered within a short period. However when we visited in June 2008, a resident confirmed that staff answer the call bell - but sometime only to tell them that they are busy and will come as soon as they can. This had resulted in the resident being left for long periods waiting for help with their personal care. During this visit we asked 3 residents if staff answered the call bell, only to inform them that they would come back later. They all replied yes with staff informing them that they will be back in a minute, with 2 residents telling us but its much longer, another saying 99 out of 100 - press that buzzer and Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 28 no-one comes straight away. Whilst we talked to a resident, they urgently needed to go to the toilet, so pressed their call bell, and we observed it being answered quickly, and being informed that staff would come as soon as they could. Later we also observed another resident being informed that they would get to them, as soon as they had 2 staff free, to help with their hoisting. The staff we spoke with felt that there was just enough on duty (when they had 1 Nurse and 6 Carers on in the mornings) to meet the residents’ personal care needs, but there needed to be additional time given to help keep residents stimulated and occupied to stop boredom. With staff saying that there was just enough on duty, we were concerned when we saw a letter from the provider dated 7th October 2008 on the notice board that said as you will see from the off duty all staff have had shifts cut, resulting in 5 carers on the morning shift, and 4 for afternoon, and 2 for night duty as a short term proposal. Although the home considered this approach was justified, as they were running at 3 residents short, discussions with staff said that the current residents still required a high levels of care. When we raised our concerns with the provider, they agreed that they would stop cutting back on staff shifts, and return to the staffing levels as before. The staff levels we agreed with the home during the morning period - 7.30am to 3pm - were 1 RN and 6 carers, afternoons - 2pm to 8pm - were, 1RN and 5 carers, and night duty - 1 RN and 2 carers. These levels are vital to ensure that the residents with high care needs receive the appropriate nursing care support. Since the last key inspection in October 2007 until our inspection in August 2008, staff recruitment procedures had caused us serious concerns around how the home ensures that only suitably checked and cleared staff are employed by the service. After our inspection in June 2008, a Statuary Requirement Notice had been issued requiring the home to improve their recruitment processes or face legal action. Positively, during today’s inspection the home showed us that they had fully addressed these concerns. When we checked the staff records these now included criminal record bureau (CRB) and protection of vulnerable adult (POVA 1st) checks, reference checks and identity checks, which would ensure that staff were suitably checked and cleared to work with vulnerable adults. Records also included an application form with a record of their previous employment history, and a record of any gaps in their employment. One registered nurse’s records checked also included a record of their professional identification number (PIN), which showed they were registered with the nursing and midwifery council (NMC) of England, so were entitled to practice. Discussion with the provider and staff records checked confirmed that adult safeguarding training was provided for staff. This was to ensure that staff knew what to do in the event of any allegations of abuse by a resident. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 29 The home was able to show us that they had improved some of the key core training for staff, to evidence that they could meet the physical care needs of the residents. For example, all staff had received safeguarding training, fire, first aid training, and moving and handling training. Eleven of 33 had received first aid training, but most staff still required food hygiene, COSHH and infection control training. Evidence to show that staff had been trained to meet the residents’ more specialised needs was lacking. For example, five of 33 staff had received dementia care training (the home is registered for 6 people with dementia), and 1 of 33 staff had received palliative care training. During the inspection we were made aware that one resident was receiving palliative care. The provider told us that more dementia training was planned shortly. One nurse’s training records checked showed they had received good training appropriate to their professional learning needs, which included bereavement training, palliative care, diabetes training, deep vein thrombosis training and syringe driver training. This was in addition to all other core training. The home recorded that 25 of their care staff (5 of 20) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 6 currently working towards this award. This informed us that a quarter of the care staff had achieved a formal care qualification, with another 25 required to meet the required standard. We asked staff what positive changes they had seen in the last few months, and they replied, training, which included dementia training and manual handling. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 30 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): 31,32,33,35,38 Quality in this outcome area is poor. People cannot be assured that the home is managed in such a way that the best interests of people are consistently met, or that a suitably qualified manager is in charge. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last key inspection in October 2007, the home was assessed as a ‘poor service’. This was because the health and personal care outcomes for residents were not being met, with a number of shortfalls shown in the staffing, complaints and concerns, and the management outcome areas. Therefore additional random inspections were undertaken in March, June and August Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 31 2008 to ensure the home fully complied with the standards, and had improved these outcome areas for the benefit of the residents. At the June inspection, although having addressed most of the previous outstanding concerns, the home still failed to adequately meet the staffing outcome area around recruitment. Therefore a Statuary Requirement Notice was issued, which required the provider to improve the recruitment processes, or face legal action. At this inspection, the home was now meeting this standard. Since the last key inspection, the manager, who had applied in March 2008 to the CSCI to become the registered manager, had been refused registration. As we were unclear who was now managing the home, Mr Diwan, the provider, was invited to a meeting with the Commission in early October 2008, to clarify this position, and discuss how the home was progressing with compliance with the standards. The provider told us that he had ‘taken control’ as the manager and would be temporarily assuming some of the key management roles. The provider told us that the former manager had been offered the position as ‘nurse in charge’ of the day-to-day issues. When we arrived at the home for the inspection, the staff board and rotas still described the former manager as being in this role. Later in the inspection, we noted the former manager’s title on the staff board had been changed to ‘D’ manager. When we asked the staff who was in charge, they told us that the former manager was. The provider Mr Diwan was not recorded as the manager on either the rota or staff board. During the inspection, Mr Diwan confirmed the current management arrangements with us. We were informed that the person formerly known, as the Home’s Manager will now be the Clinical Nurse Manager, which they themselves thought was a positive move forward. This will enable them to concentrate and address the current weaknesses we were finding in the clinical management areas, for example, the auditing of medication practices. We were informed by the provider that they would be looking to recruit to the registered managers position, and were looking for someone experienced in management, to oversee the running of the home. This would been seen as a positive move forward, due to the concerns we have had in the home not meeting some of the requirements, which had resulted with 3 extra random inspections being undertaken. (see random reports dated March, June and August 2008, available on request from our office). During this inspection we evidenced that previous concerns around health and care outcomes for the residents had improved to ‘adequate’, and ongoing serious concerns around recruitment shortfalls, had now been addressed with an outcome group of ‘adequate’. The home did show us that some of its quality assurance processes were now being developed and we saw how they had begun receiving feedback from some of the residents. Some comments Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 32 included ‘I think we could do with a mirror by the road’ (for safety purposes when relatives drive from the home) or ‘staff are excellent’, or ‘the furniture is often dusty, and the floor could be cleaned’. There was clear evidence of 2 regulation 26 provider visit reports and one night inspection report. Since the last key inspection the home has largely been ‘reactive’ towards change and improving the culture, by responding to our concerns only when we raised these. So changes had been driven in part by our repeated random inspections undertaken in response to the shortfalls. During this inspection we were concerned to find new issues, which had not been appropriately monitored by the management. These included concerns and shortfalls around how the home manages its medicines practices (Please refer to standard 9), and also some concerns around reductions in care staff numbers (please refer to standard 27). As Chilton Croft is owned by a limited company they are required to have a responsible individual. Whilst is it noted that Mr Diwan has started the process of notifying the CSCI of his intension to be the Responsible Individual, this issue has been outstanding for a considerable period of time, and needs to be concluded. When we met with the provider on the 10th October 2008 we requested further financial information to confirm the home’s financial viability and we were told that this would be provided within 5 days of the meeting. This had still not been received by the time we completed our inspection. Feedback received from care managers included the following views about the management of the home. ‘I feel the service provided has improved and continues to improve. The current owners have inherited a run down establishment. I feel the main problem lies with staff response to demanding residents’. ‘The provider manages the needs of the individuals as well as supporting them within a nursing setting’. ‘I would not rank this home highly, but it seems to offer an informed atmosphere with staff who can relate to the residents. At present I would be reluctant to place people with complex needs in the home, which I find a bit scruffy. I am aware that the home will soon be redecorated, and that there are future plans to improve staff training’. With regard to health and safety matters, training available to staff was covered in the staffing section and was generally adequate, with some further training required. Previous concerns around hot water tap temperatures have been addresses, and are discussed under standard 30. Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 33 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 2 x 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 3 2 3 x 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 x 3 x x 3 Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 34 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. Standard OP1 Regulation 4(1) Requirement The statement of purpose must be amended to clarify the current management arrangements at the home, and to accurately reflect the facilities on offer. This is to ensure that people are given appropriate information and are able to make informed choices. The residents must receive their medicines as prescribed by their doctor. This is to ensure their health and welfare needs are met. This is an immediate requirement. The home must ensure adequate quality assurance processes are in place, which identify any shortfalls in the home’s systems or procedures. This is to ensure that management quickly identify and address any shortfalls, and keep the resident’s safe. The company must ensure that a suitable representative is nominated as the responsible individual. This is to ensure that the best interests of the DS0000024358.V372793.R01.S.doc Timescale for action 20/12/08 1. OP9 13(2) 14/10/08 2. OP33 10(1) 12(1) 18/12/08 3. OP32 7 18/01/09 Chilton Croft Nursing Home Version 5.2 Page 35 4. OP32 8, 9 residents are monitored and met. An appropriately qualified, 18/01/09 skilled, and experienced manager must be recruited and appointed without delay. This is to ensure that the home and residents benefits from a suitably managed service. 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 OP7 Good Practice Recommendations Care plans should reflect more detail around the residents’ emotional and social care needs. This is to ensure that their choices and preferences are recorded, so that staff can meet these needs. Staffing levels should be appropriately maintained. This is to ensure that there are sufficient care staff to meet the changing needs of the residents. Staff training should ensure that all core and NVQ training is provided for staff. This is to ensure that staff have the skills, and training to meet the complex needs of the residents. 2. 3. OP27 OP30 Chilton Croft Nursing Home DS0000024358.V372793.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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