Inspection on 02/08/06 for Chilton Croft Nursing Home

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chilton Croft Nursing Home 24/11/09

Chilton Croft Nursing Home 29/04/09

Chilton Croft Nursing Home 14/10/08

Chilton Croft Nursing Home 02/10/07

Chilton Croft Nursing Home 26/04/07

Chilton Croft Nursing Home 18/01/06

Chilton Croft Nursing Home 25/08/05

Chilton Croft Nursing Home 11/03/05

Chilton Croft Nursing Home 09/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN Lead Inspector Jane Offord Key Unannounced Inspection 2nd August 2006 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.V306364.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.V306364.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 chiltoncroft@hotmail.com Chilton Care Homes Limited Mrs Anita Jayne Feeley 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.V306364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 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 recent 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 home is a family run business. The fees for care in the home range from £331 to £650 depending on the accommodation, the funder and the dependency of the resident. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection, looking at all the core standards for care of Older People, took place on a weekday between 9.00 and 15.30. The manager was not available on the day but two directors of Chilton Care Homes Ltd. were able to assist with the inspection process during the day. The files, care plans and daily records of two new residents were seen, as were the files of two new staff members, the policy folder, the duty rotas, menus and some maintenance records. A tour of the home was undertaken, part of a medication administration round was observed and the medication administration records (MAR sheets) were inspected. A number of residents, visitors and staff were spoken with in the course of the day. Care practice was observed and training was discussed with some staff. The kitchen and laundry were both visited and the lunchtime meal serving was seen. The home had only two vacant places on the day of inspection. Residents seen were mainly in their own rooms and looked comfortable and well dressed. Staff were friendly and had a good rapport with residents. Help was offered sensitively and at a speed the resident could manage. Although there were some unpleasant odours in the entrance hall and on the first floor as residents were helped to get up these dissipated in the course of the day. The home was clean. What the service does well: What has improved since the last inspection? An application for a variation to registration has been made to the Commission for Social Care Inspection (CSCI) to allow the home to care for some residents with a diagnosis of dementia. The problems with the water temperature and pressure in the new extension have been resolved and hot water is now available in all residents’ rooms. The dining room has been decorated a lighter colour and is much more welcoming. Jugs of squash seen in the dining room were suitably covered and Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 6 there is a lockable container in the dining room refrigerator for medicines that need to be stored at a lower temperature. The duty rotas show the people working in the home and the hours they work. What they could do better: The responsible individual has still not processed a Criminal Records Bureau (CRB) check on themselves to meet the requirement of the Care Standards Act 2000 (commencement No. 9 (England) and Transitional and Savings Provision) Order 2001. There is no regular programme of activities for residents and many of them spend long periods in their rooms with little stimulation. There is no formal system for ascertaining the views of residents or relatives about the service. The dependency of residents has increased and observation on the day of inspection confirmed staff and visitors comments that there are times when staffing is inadequate to meet needs fully. The nurse call system in the home does not have an effective emergency mode. There is also a shortage of some essential equipment to help staff meet residents’ needs. Some assessed needs are not covered by interventions in care planning. Staff files do not contain evidence of all the required checks being made prior to employment. There remains a problem of employing cleaners to cover weekend positions. Some moving and handling techniques are putting staff and residents at risk. Staff do not receive supervision and staff meetings are not held regularly. The protection of vulnerable adults (POVA) reference folder is not the most recent and the home’s own policy is not up to date. Some areas of the home need some urgent attention. The downstairs bathroom has a grab rail beside the toilet that is not attached to the wall, the food store cupboard shelving is held together with cardboard and gaffer tape. In the kitchen the fly screen is also attached with gaffer tape and the hot cupboard is awaiting a spare part but poses a risk to kitchen staff in the meantime. Fire doors to some residents’ rooms are wedged open during the daytime. Medication is not secured at all times when the trolleys are in use and the clinic room is not always locked so medication is on view and available to anyone passing the room. Medication prescribed for one resident was seen to be used for another. The code ‘F – define’ for use on the MAR sheets is used but not always defined. Some people spoken with felt there was an issue of possible bullying by a member of staff that was not being addressed at any level by the management team. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 7 Meals transported around the home to residents’ bedrooms are not always suitably covered to ensure they remain hot and prevent cross contamination. The Statement of Purpose and the Residents’ Handbook need to be updated to reflect the change of name for CSCI and the change in registration for Chilton Croft. A recommendation made by a gas engineer about the ventilation in the kitchen should be fulfilled and approved by the engineer. 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 Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality for this outcome area was adequate. People who use this service can expect to have their needs assessed and assurance given that they can be met prior to entering the home however they cannot be assured that the information provided to help them decide about the home will be up to date. This judgement was made using information available including a visit to the home. The home does not offer intermediate care. EVIDENCE: Previous inspections have found that pre-admission assessments take place and records are kept in the residents’ files. Information from former care providers, such as social care or NHS services is sought and used to inform Chilton Croft staff of the potential resident’s care needs. The Statement of Purpose makes a commitment to assessing prospective residents’ needs prior to making a decision to reside at the home. Areas of need covered have been communication, personal hygiene, continence, mobility, diet, night needs and social interests. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 10 The Statement of Purpose and the Residents’ handbook still contain reference to National Care Standards Commission (NCSC) not Commission for Social Care Inspection (CSCI). There are also no details about caring for residents with dementia after the recent variation to registration was agreed. One visitor spoken with said they had visited some homes on behalf of their relative before they were admitted, and chosen Chilton Croft. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality for this outcome area is poor. People who use this service cannot be assured that their care plan covers their assessed needs, that the medication administration procedures will protect them or that the staffing levels allow residents to receive care in a timely way meeting their personal needs. This judgement has been made using information available including a visit to the home. EVIDENCE: Care plans and assessments for two new residents were seen. The assessments on admission covered areas of need such as communication, personal care, diet, continence, pain, night needs and working and playing. The night needs assessment looked at preferences of the number of pillows, whether the resident liked a milky drink before settling down and whether they liked their curtains open or closed. There were scored assessments for nutrition, moving and handling, falls and Waterlow for tissue viability. One file looked at had a Waterlow score of 26, making the resident ‘very high risk’ and a falls assessment that scored 19, again ‘very high risk’. The care plan did not have any interventions for skin care or strategies for reducing the risk of falls. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 12 The daily records seen recorded that the resident needed ‘thick ‘n easy’, a thickening agent, added to their fluids to aid swallowing but the care plan had no interventions for swallowing difficulties. The file of another resident did not have the moving and handling assessment or the nutrition assessment filled in. The transfer letter from the hospital where this resident had been noted that they had a red sacral area on discharge, there was no Waterlow score completed or any pressure area care interventions on the care plan. The home’s care plan procedure states that care plans should be reviewed every four weeks or sooner if changes are needed. There was no evidence of review seen in the care plans looked at. One care plan had an updated intervention following a visit to Accident and Emergency for treatment to a lacerated arm. There was a care plan for a dressing to the arm. Previously staff in the home had said that a GP from the local surgery visited the home twice a week routinely and in between if required. On the day of inspection the nurse in charge confirmed that the arrangement was still in place however they had concerns for some residents that day and had asked the GP to make an extra visit. The doctor was in the home before midday that day. Observation of care practice on the day showed that residents were kept waiting for attention as there was a shortage of hoists available. One resident asked to go on the commode and had to wait five to ten minutes before a hoist and two carers were free. The resident’s buzzer was observed to be ringing a few minutes later but no carer went to the room. Twenty minutes later two carers with a hoist went to the room and said they were sorry to have been so long but no hoist had been free to help the resident off the commode. There was an assumption that the resident had rung to get off the commode not that there could have been any other reason, such as a fall from the commode or that the resident felt unwell. As there were other buzzers ringing at the same time the emergency ring would not have been identified as the emergency ring is over ridden when other buzzers are used. One resident expressed unhappiness that they had been left to last to be washed that morning and were not dressed until after mid day. A visitor said they had arrived to find their relative in bed with bed rails up and a cold cup of tea and biscuit left out of reach on a table. No one had been free to help the resident with the drink. The nurse explained that the morning medication administration round could take up to two and a half hours if only one nurse was on duty. That has a knock-on effect making some medication late and reducing the time between doses for the lunchtime round. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 13 In an effort to improve the situation a change to routine has meant that if an adaptation nurse is on duty too the round is divided between the two nurses upstairs and downstairs. However as the adaptation nurse would have been rostered as a carer this arrangement means the care staff work one down for part of the morning. The home only has one medicine trolley so one round is done with medication on a dressing trolley. This means medication is unsecured if the nurse is called away. The lockable medicine trolley was not always secured when the nurse left it and the clinic room was not locked each time staff left it. One resident needed help to take their medication but they were lying down in bed when the nurse arrived. The nurse and carer moved the bed away from the wall so one person could access either side. The brakes were not applied to the bed and the carer reached over the bed rails to lift the resident, with the nurse, up the bed into a sitting position. The bed was observed to move during the procedure causing potential risk to the staff and the resident. The MAR sheets were seen and there were occasions when the code ‘F – define’ was used instead of a signature but the code was not defined so the reason why the medication had not been given was not recorded. Syrup that belonged to one resident was used to ‘top up’ the dose of another resident when their bottle ran out. The administration of two doses of controlled drugs (CD) were observed and the procedure was correctly followed. The stock was checked against the CD register records and tallied. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14, 15. Quality for this outcome area was poor. People who use this service can expect to be offered a well balanced diet, but cannot be assured that meals that are served in their rooms are at a suitable temperature or hygienically transported around the home. Residents are encouraged to maintain contact with family and friends and have access to a limited range of activities. This judgement has been made using information available including a visit to the home. EVIDENCE: The home does not employ an activities co-ordinator. There is a limited programme of activities. Staff and residents say that Bingo takes place fortnightly in the lounge and that was happening on the day of inspection although there were only four residents participating. There are occasional reminiscence sessions and entertainers who visit the home, staff said. Some staff said that they used to be able to spend time with residents offering hand care and conversation but the care needs of residents means there are always demands on their time. Both the residents’ files seen had records of the next of kin, their relationship and their contact details. Visitors spoken with said the staff gave them information about their relative if they asked them. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 15 During the day a number of visitors came and went. They visited residents in their own room or in one of the lounges. One visitor spoken with said they were unhappy at the time it sometimes took for carers to help their relative to the toilet due to the lack of hoists. They said they could visit at any reasonable time and usually came each day for some time. Observation of care practice on the day showed that some residents were not washed and dressed until lunchtime, which restricts their choice about how to spend their morning. Staff confirmed that the dependency of the residents and the lack of hoists have meant that the morning routine is intense and they struggle to meet all the needs of each resident. The menus were seen and work on a six-week rotation. There are two options each lunchtime and on the day of inspection the choice was chicken curry and rice or chicken in red wine with greens and carrots. The dessert was poached pears and ginger sauce. The supper menu offered scrambled eggs on toast and a selection of sandwiches or soup. During the morning some breakfast trays were observed being delivered to residents’ rooms. Some had cereal or porridge and some had a cooked breakfast but the dishes were not covered to keep the meal hot or prevent cross contamination. Residents spoken with said they enjoyed the meals. A number of residents needed help with the meals and staff were observed sitting with them and offering help sensitively. Staff said that there were now so many residents who needed help that some meals were kept in the hot cupboard for nearly an hour before staff could get round to each one. This means the meals could be quite dry and puts the kitchen staffs’ routine out as they are due to go off duty at two o’ clock and there are times when it is a rush to get the kitchen cleared and the washing up done. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 16, 18. Quality for this outcome area is poor. People who use this service can expect to find a complaints policy in place but cannot be assured that the guidance for staff about Protection of Vulnerable Adults (POVA) is up to date with the most recent guidelines for Suffolk or that management will take steps to investigate possible bullying. This judgement was made using information available including a visit to the home. EVIDENCE: CSCI have not received a complaint about this service since before the last inspection. The home’s complaints log was unavailable on the day of inspection so the information about complaints to the home could not be verified. The complaints policy for the home was displayed in the entrance hall and offered a written response to any complaint. The procedures and guidance issued by the Vulnerable Adult Protection Committee of Suffolk in June 2004 are the most recent guidelines for staff to access in relation to abuse. The home had a copy of the 2001 guidance, which has been superseded. The home’s own policy does not reflect the up to date guidance and is not cross-referenced to the official folder. Staff spoken with said they had had instruction about POVA and were clear about their duty of care. Several staff and a resident talked of a particular member of staff who had a bullying approach. The director said they were aware of the concern but did not know how to proceed to deal with the issue. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19, 22, 26. Quality for this outcome area is poor. People who use this service can expect to live in a fairly well maintained home but they cannot be assured that the home will be odour free or that there will be sufficient special equipment available to meet their needs. This judgement has been made using information available including a visit to the home. EVIDENCE: The home employs a dedicated maintenance person and on the day of inspection they were replacing old putty in external window frames and painting them in preparation for the winter weather. One of the directors said that they encouraged the maintenance person to work on outside jobs during the good weather and had a list of inside jobs to be done during bad weather. One of those was the replacement of the shelving in the food store cupboards that were held together with cardboard and gaffer tape. The home has attractive garden areas that are accessible for wheelchair users and have ramps and rails for security for residents who have mobility problems. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 18 On arrival at the home a strong odour of urine was noted that diminished during the day. One visitor said they were aware of the odour in the entrance hall every time they visited. Soiled linen is transported to the laundry in special bins and the washing machines have a sluice programme. Staff have protective clothing for managing tasks that have a potential infection risk. Liquid soap and paper towels were seen at hand washing facilities. The domestic staff spoken with said they had received instruction about infection control procedures. Residents clothing is washed at lower temperatures using a system that adds ozone to the washing machines to ensure cleanliness without damaging delicate fabrics. The home recently had a hoist that was condemned after a failure and this has meant there are only two hoists available. Staff said all but two residents need the use of a hoist regularly. The situation is making it difficult to meet residents’ needs in a timely way. This was noted in an earlier section of this report. Residents’ rooms were individually furnished with evidence of personal items of furniture and ornament being brought in by the resident or family. Bathrooms and toilets seen were clean but there was a grab rail in the downstairs bathroom that was propped against the wall and needs re-attaching properly. The fly screen in the kitchen was attached to the window frame by gaffer tape. The hot cupboard was not functioning correctly. The director said they were waiting for a new part to arrive but in the meantime staff were at risk of burning themselves. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality for this outcome area is poor. People who use this service can expect to be cared for by staff who undergo an induction programme and training updates but they cannot be assured that the correct recruitment checks are made on potential staff or that there are sufficient staff to meet their needs. This judgement was made using available information including a visit to the home. EVIDENCE: The duty rotas were seen and showed that the usual staffing was one trained nurse with six carers or two nurses with five carers to cover a morning shift. Staff said that recently they had worked two carers down as people had gone sick and agency had been unable to cover the gaps. From Monday to Friday there are two domestic staff rostered to clean the home. At weekends there is no domestic cover and carers have to manage any ongoing cleaning or laundry but the staff numbers are not increased to meet the additional workload. Two new staff files were seen and both contained a job application, a work history and two references. One had a copy of a driving licence for identification (ID) purposes but no second ID document and the other file had no evidence that ID documents had been seen at all. Neither file had evidence of a criminal records bureau (CRB) check nor a recent photograph of the member of staff. A director calculated the number of staff who have achieved NVQ level 2 and above as sixteen out of the twenty care staff employed. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 20 In discussions with some staff they said they had received training in fire awareness, moving and handling, infection control, POVA and control of substances hazardous to health (COSHH). Other staff confirmed this and said there had also been some teaching on care of people with dementia and kitchen staff had had food hygiene training. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality for this outcome area is poor. People who use this service can expect it to be managed by a person with experience in the field of care management but they cannot be assured that all the required checks will be done on the responsible individual, that their views will be sought, that staff are supervised and that all practices in the home protect their welfare. The home does not manage any personal monies for residents. This judgement was made using information available including a visit to the home. EVIDENCE: The registered manager has a diploma in the Management of Care Services and is a qualified nurse. They have held the post of manager at Chilton Croft since 1988. They have achieved an NVQ level 4 in management of care and are an NVQ assessor. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 22 The responsible individual has still to process a request for a CRB check on themselves to meet the requirement of The Care Standards Act 2000 (Commencement No. 9 (England) and Transitional and Savings Provisions) Order 2001. This matter was referred to in the last inspection report and remains outstanding. At a previous inspection the manager said they did not manage any personal monies for residents. This was confirmed by one of the directors as still the case. Residents and visitors spoken with said they had not had a formal opportunity to give their views about the care home and the service they received. Staff confirmed that surveys do not happen and that staff meetings are not held regularly or may be cancelled at short notice. There is a policy on staff supervision with supporting paperwork such as a supervision agreement and supervision notes within the policy folder. Staff say they have not had supervision. The director said they thought supervision had been happening but staff did not recognise it as supervision. There were no supervision records seen in staff files. Records were seen for lift and hoist maintenance and repairs done recently. Labels on fire extinguishers show they were checked by Suffolk Fire Protection when they did their annual test and maintenance in February 2006. There was a record of weekly fire alarm tests. It was noted that the corridor fire doors have a magnetic automatic release but a number of fire doors to residents’ rooms were wedged open contrary to present fire service advice. A gas inspection was undertaken on July 24th 2006 and the report says that the kitchen ventilation is inadequate. It recommended that air vents be fitted to alleviate the problem. One of the directors said that a piece of casing has been removed and that the problem has been resolved but this has not been confirmed by the gas engineer. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X 1 X X X 2 STAFFING Standard No Score 27 1 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 1 X 1 Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 6. Requirement The Statement of Purpose and service users guide must be updated to reflect the change of name from NCSC to CSCI and the variation granted to the home’s registration. Assessed needs of residents must have appropriate interventions for care on the care plan and these must be reviewed and updated on a regular basis. Nutritional and tissue viability assessments must be completed on all residents and the appropriate interventions added to care plans depending on the scored outcome. Steps must be taken to ensure medication is kept secured at all times. Medication prescribed for one resident must not be used for anyone else. When code ‘F – define’ is used to explain why medication ahs not been administered a definition must be included on the MAR sheet. DS0000024358.V306364.R01.S.doc Timescale for action 31/08/06 2. OP7 15 (1) 13 (c) 02/08/06 3. OP8 13 (4) (c) 13 (5) (6) 02/08/06 4. 5. 6. OP9 OP9 OP9 13 (2) 13 (4) (c) 13 (2) 13 (4) (c) 13 (2) 13 (4) (c) 02/08/06 02/08/06 02/08/06 Chilton Croft Nursing Home Version 5.2 Page 25 7. OP12 16 (m) (n) 8. OP12 16 (m) (n) 9. OP15 16 (2) (i) 13 (4) (c) 13 (6) 10. OP18 11. OP18 13 (6) 12 (5) (a) (b) 23 (2) (b) 12. OP19 13. OP22 23 (2) (n) 13 (5) 16 (2) (k) 14. OP26 15. OP27 18 (1) (a) A programme of regular and suitable activities must be established to ensure residents are stimulated. This is a repeat requirement. The daily routine, equipment needed to meet needs and staffing levels must be reviewed and appropriate action taken to enable residents to have the choice of how they spend their time. Food that is transported around the home must be suitably covered to keep hot and prevent cross contamination. The most up to date POVA guidance must be obtained for staff reference and the home’s policy cross-referenced to it. Any concern that bullying is taking place for staff and residents must be investigated and resolved. Maintenance to internal areas such as the grab rail in the bathroom and the food storage shelves must take place. Adequate numbers of suitable hoists must be available to meet the dependency needs of the residents. Steps must be taken to identify the cause of unpleasant odours in the home and an action plan developed to manage the problem and eradicate the odours. A review of present staffing levels, including domestic cover at weekends, must be urgently undertaken to ensure there are sufficient staff rostered to meet residents’ needs. The review must take account of the dependency of residents, staff routines and the requirements that must be met concerning DS0000024358.V306364.R01.S.doc 30/09/06 30/09/06 02/08/06 30/09/06 30/09/06 30/09/06 30/09/06 31/08/06 30/09/06 Chilton Croft Nursing Home Version 5.2 Page 26 16. OP29 17 (2) Sch 4 cleanliness in the home. A report of the levels of staff required to meet residents’ needs and the contingency plans to cover sickness and annual leave to maintain staffing levels must be forwarded to CSCI by the 30/9/06. Evidence must be kept that all the required recruitment checks have been made on all new staff prior to commencement of work. 02/08/06 17. OP33 24 (3) 18. OP36 18 (2) 19. OP38 Sch 2 20. OP38 13 (5) A system for obtaining residents’ views about the home and the service they receive must be established and results made available to CSCI and the residents. An action plan to show how a programme for regular supervision of all staff is to be implemented must be forwarded to CSCI. This is a requirement that has been repeated twice. The responsible individual must process the CRB check on themselves urgently to ensure the home is functioning within legal boundaries. The staff must use proper moving and handling techniques to prevent risk to themselves and residents. This is a requirement that has been repeated twice. 31/10/06 31/10/06 31/10/06 02/08/06 21. OP38 23 (4) (a) 13 (4) (c) The recommendation made by the gas engineer about the ventilation in the kitchen must be met and approved by the DS0000024358.V306364.R01.S.doc 30/09/06 Chilton Croft Nursing Home Version 5.2 Page 27 22. OP38 23 (4) (a) 13 (4) (c) engineer. Fire doors that need to remain open during the day must be fitted with self closure devices. 31/10/06 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 OP22 Good Practice Recommendations Consideration of updating the nurse call system to offer an effective emergency mode should be given. Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chilton Croft Nursing Home DS0000024358.V306364.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!