Inspection on 02/10/07 for Chilton Croft Nursing Home

This inspection was carried out on 2nd October 2007.

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

The inspector 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 26/04/07

Chilton Croft Nursing Home 02/08/06

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 Claire Hutton Unannounced Inspection 2nd October 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chilton Croft Nursing Home DS0000024358.V352297.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.V352297.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 vacant post 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.V352297.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2007 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 £395 to £650 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.V352297.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that focused upon the core standards relating to Older People. It took place over two days and lasted a total of thirteen hours. The process included a tour of communal areas and viewing most bedrooms, discussions were had with six residents, one relative, six staff and the manager and owner who was present on both days, observations of staff and service user interaction, and the examination of a number of documents including residents care plans, medication records, and records relating to maintenance, health and safety, recruitment and training records. Inspection reports also draw on any other information relating to a service that has been received by the CSCI since the service’s last inspection e.g. complaints, protection of vulnerable adult referrals, Annual Quality Assurance Assessments and responses to previous inspection reports etc. An additional random inspection was carried out at the home on 24th July 2007 and information has been included from this report where it remains relevant. One completed survey was received back from the current resident group. What the service does well: People who use this home can expect to have their needs assessed before they move into the home. Changes made in catering have gone further to ensure the interest and health of residents and the home is more capable of delivering the specialist nutritional needs of elderly frail people. One resident said “the food here is always good”. People who live in Chilton Croft can expect to live in a comfortable home. People who use this service can expect staff to be adequately recruited and well trained. Staff are very friendly and approachable. One relative said “staff are very friendly – you can speak to anyone”. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The management of the home needs to produce better quality of information about the home so that people who use or wish to use the service are aware of what is on offer and what are the conditions of use. The manager of the home should also be more open and positive this will promote and maintain good personal and professional relationships within the home. The owners of Chilton Croft visit the home regularly but have failed to prepare a written report about the standards of care within the home by doing this they will monitor for themselves the quality of care provided. Care plans (which is a repeat requirement) must be reviewed to ensure the current system for care planning is effective and allows for monitoring of the situation as currently the care home cannot demonstrate that care needs are being met, specifically in the case of one resident with dementia. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 7 The current practice of manual handling of residents was observed to place both residents and staff at risk of injury therefore staff must follow the training they have received and use the equipment provided. The home needs to ensure there is a clear record of all complaints made to demonstrate that they are taking complaints seriously. The recruitment of staff needs to be more thorough and more staff need to be consistently available. Both these matters will ensure that the residents receive adequate and safe care and support. A repeat requirement has been made in relation to the call bell system being upgraded; this will ensure that residents are able to effectively summon help when it is required. 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.V352297.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.V352297.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have their needs assessed however they cannot be guaranteed that their needs will be fully met. Residents will be offered a trial period at the home that will be reviewed. There is information available but this may not be as informative as it should be. EVIDENCE: At the inspection the owner and manager gave a copy of their latest revised information about the home. This was ‘Residents handbook and Statement of Purpose’ and ‘Accommodation/Care Contract. Terms and conditions of residence.’ No document entitled Service Users Guide was available. It was pointed out during the visit that the Statement of Purpose did not meet the regulations as this sets out the minimum information that should be contained in this document. Upon closer examination following the inspection Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 10 half of what is set out in schedule 1 of the Regulations was missing from this document. One confusing element in both the contract and the Statement of Purpose is the length of time required to give notice this appears to range from one week (if behind with fees) to four weeks. The documents also speak of trial periods lasting four weeks and six weeks. The assessment for one new resident was examined. The manager of the home had visited the individual in hospital and had completed a basic nursing assessment based upon access to her medical notes. This formed the basis of the care plan developed by the home. Please see the next section ‘Health and Personal Care’ section of this report documents areas where residents needs, which have been identified have not always been met. One relative spoken to said that they had chosen the home because from the first phone call the home was very friendly. It was close to their home and was able to meet the needs of her relative. The Social Worker was visiting to review the trial period and everything had worked out well. Standard 6 – intermediate care does not apply to this home. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans in place are not used as working documents and do not consistently reflect the care being delivered. The care needs in care plans are known and clearly set out for staff to follow, however based upon the poor recording there is insufficient evidence to show that needs are being met. Medication practices have improved and therefore offer residents a better degree of protection. Residents can expect to have their privacy upheld. EVIDENCE: Care plans for three individuals were examined; one for a new person, who was very poorly, one for a person who is in a dementia care bed and one for a person who has been at the home for some time, keeping well and receiving nursing care. All three of these residents were female and they were met and spoken with. Three other gentlemen at the home were also spoken with. Care plans and associated records were examined. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 12 For the two individuals who were in their rooms both had the call bell either in their hand or within easy reach. This was the case in the morning and the afternoon. For one resident who was permanently in bed a ‘waterlow assessment’ had been completed (this assesses the risk of developing pressure areas). As a result in place were an air mattress and a care plan stating that they were to be turned at regular intervals. The current record showed that the individual had been turned at 02:00, 06:00 and 10:00. This record was read at 11:30. However previous records were inconsistent. There were two types of recording - a care plan and on a chart. There was a gap between 25th September 2007 and 1st October 2007. Some staff appeared to be filling in a mixture of recordings. A manual handling assessment had been completed that required two staff to turn the individual. A nutritional screening assessment had been completed and as a result the fluid intake (which was by drip) was being monitored. However, there appeared to be two types of recording with gaps in each. The daily statement had gaps from 16th to 20th September 2007. The record for oral hygiene had gaps for 19th to 23rd September 2007. The nursing care plan was clear about what care was required, but from the inconsistent recording no one could be sure that this particular patient had consistently received the required care. This resident was very poorly and the planning around their dying was not completed. The one piece of information available was the name of the undertakers. The manager spoke of following the ‘Liverpool Pathway’ (this is a holistic plan developed around caring for the dying patient). Another resident, who had been at the home for sometime, chose to spend their time in their room with their personal belongings around them. The resident was spoken with and said that “they were happy with the care and that the staff were all right”. In this care plan there was a manual handling risk assessment that had been reviewed this month, a falls risk assessment had been completed on 19/06/07 but there was no evidence of recent review. The individual had a nutrition assessment in place and a specific plan around their diabetes. This was reviewed this month too. The plan required that the person’s food and drink intake be recorded but this was not routinely recorded and there were gaps. There was a plan of care around the individuals hygiene needs. In the month of September there were just 12 recordings. The final resident who was tracked as part of this assessment was a person with dementia. The home has recently requested a specialist in dementia mapping to visit the home and advise them on what they could do better. This report was displayed in the hallway for all to read. This particular resident had all the care plan assessment tools as described for the two residents above. In total the individual had 10 elements to their care plan. Staff were required to know and ensure these were in place and then record the outcome each day in each element of the care plan. There were gaps throughout this system of recording. There was one element of the plan around the individuals’ Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 13 dementia. However this did not relate to how this individuals dementia had manifested itself and how staff were instructed to manage the behaviour that was presented. There was a second element on the care plan around the person’s dementia, which has led to inconsistent recording with just 3 recordings in the month of September. One element of this resident’s behaviour does impact upon all the residents, staff and visitors. We have been contacted by a visiting health professional who was concerned about this behaviour and the impact it was having. Staff stated that the CPN (Community Psychiatric Nurse) had been consulted, but no intervention could be found to support the individual. The home has an agreement with the local GP surgery whereby the GP visits the home twice a week. Other health support such as optician and dentist do visit the home. Before the inspection we were contacted by a social care professional who was concerned at the manual handling practices that they saw at the home. They were concerned that staff ‘handling techniques were poor particularly use of the under arm lift with at least two people and no evidence of any handling belts.’ Staff were observed during this inspection as to their practice, two staff were seen to use the underarm lift and not use a handling belt. The Senior on duty was spoken with and they were aware that what they did was incorrect and said that they did have handling belts available to them. Medication at the home was inspected. We followed the start of the lunchtime drug round. The nurse administered all medication. She accessed the medication that was kept secure and washed her hands before she began. The system in use is a monitored dosage system (MDS). Medication for one person tracked was examined and this was found to have an audit trail in place with signatures for when it was administered. Controlled drugs were examined along with warfarin that is administered by the nurses. These records were accurate. In place was written information as to the rational for the administration of psychotropic medication for nurses to use in determining whether to administer. Nurses were also keeping records on pain levels expressed by residents. The records upstairs had a photograph of each resident for accurate identification, however some were missing for downstairs. The nurse administering medication had a lovely approach to residents and respected their wishes. She knocked on doors and introduced the inspector. The nurse followed the correct procedure for medication administration. The response to the previous inspections tells us that all nurses are now trained in the MDS system and that medication is audited every 2 weeks. Chilton Croft Nursing Home DS0000024358.V352297.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to access a range of activities but some of their choices are limited by the homes staffing arrangements. Changes made in catering have gone further to ensure the interest and health of residents and the home is more capable of delivering the specialist nutritional needs of elderly frail people. EVIDENCE: The home does not employ an activities coordinator and care staff are responsible for organising and delivering social and leisure activities to residents. This has been an area where the home have previously been required to address and there was evidence at this and previous inspections of some progress. The manager spoke of plans for the future to employ an activities person. He also spoke of activities currently offered such as a volunteer aroma therapist who comes twice a week, bingo, and the Saturday matinee in the larger lounge, library audio books and a recent Barbeque for residents and relatives. On the hall wall were adverts for activities such as a regular music entertainer that came once a month and an activity called down Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 15 memory lane. On the second day of inspection there was a harvest festival arranged. A notice on the wall said when religious services were held. A large snakes and ladders game was played mid morning during the inspection. A visiting social care professional recently contacted us and expressed a view that ‘Residents were being left for long periods unattended.’ As currently the care staff arranges activities this is wholly dependant on sufficient care staff being available (please see the section on staffing that demonstrates the current situation). On the day of inspection there were several visitors at the home. One relative was spoken with and they were very happy with the home. Another relative has recently contacted us and feels that the new manager listens to relatives, but is unable to consistently maintain standards. Visitors are said to be welcome from 09:00 to 21:00 each day. Visitors were seen to be made very welcome by all staff, but particularly the administration assistant and the chef. In relation to catering at the home there have been improvements made through the chef who is enthusiastic about good food for the residents. The introduction of coloured trays with a code shows staff what type of meal is required and how much assistance is required to eat the meal. Types of meal may be a soft diet or diabetic. The chef was knowledgeable and evidence at lunchtime showed he knew individuals choices. Food was kept hot until it went covered with a lid to the resident. However, a relative has contacted us to say that on 14th October 2007 the food for their relative was taken uncovered to their room. The choice and range of food offered to the residents is good, 98 of the food is homemade with rotational seasonal menus and each main meal has a second option available. One choice for lunch on the day of the visit was vegetable pasta with broccoli and new potatoes. This was hot and tasty. The dessert had by most people (other choices were seen) was pears in red wine with ice-cream. The training offered to the catering staff is appropriate. The chef and the second cook were attending a training course on nutrition. The chef held several catering qualifications including, Hotel and catering City and Guilds 1, 2 and 3. The second cook was completing her NVQ 2 in catering. A person to prepare and clear away the evening meal has been appointed. Chilton Croft Nursing Home DS0000024358.V352297.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. We believe that complaints are taken seriously and responded to, however the documentation was so poor it could not be adequately audited. The management of the home understand what potential abuse may be and how to safeguard adults in their care. EVIDENCE: The homes complaints procedure had been revised and was displayed upon the wall in the hall. This was an accessible version in plain English. There was however still a formal out of date procedure on the wall (the manager agreed to remove this copy). The complaints log was examined. It was an A4 hard backed book with papers stapled into it. It was muddled and not easy to ascertain what complaints had been received and how they had been handled. Some time was spent on examining this document and it is believed that the home has received somewhere between 7 and 11 complaints in total since this record began. There was evidence that some complaints were responded to within the 28-day timescale. There was evidence that verbal complaints were responded to but this was not logged as incoming in the log. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 17 With regard to safeguarding the home has recently referred 2 incidences through the local reporting procedure. These were followed up as the inspection and were found to have been concluded by the local authority. Staff spoken with said they had been on safeguarding training. The manager confirmed that 2 staff had attended the local authority train the trainer days in order that they can train all staff at the home. With regard to recruitment staff have undergone the national protection of vulnerable adult (POVA First) checks before they start work at the home – this is said to be then followed up with a criminal records bureau check (CRB). Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 18 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, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live in Chilton Croft can expect to live in a comfortable home, where efforts are being made to upgrade the fittings and address unpleasant odours. EVIDENCE: At the last inspection there were concerns around fire safety and gas safety. In the homes improvement plan they detailed to us how they had addressed these issues and had included a copy of the gas safety certificate. The homes emergency call bell system has been the subject of previous recommendations and requirements, as it has not been fully functioning at recent inspections. At this inspection a phone call was received from a contractor who was coming to quote on a replacement system. The owners of Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 19 the home had agreed to replace the current loud alarm with a pager system that would alert staff. The ongoing management of odour control within the home is continuing. The two bedrooms identified in the last report were having their carpets replaced on the second day of the inspection. Speaking to the head of the house keeping team she was clear about which bedrooms required more attention and had logged the dates that these had been cleaned. Cleaning schedules were in place. The housekeeper did say that this job of regular carpet cleaning would be made easier if the home bought the more suitable industrial equipment. The management of the home confirmed they were looking into this. Several bedrooms were or had been painted along with the larger lounge area. These were painted in fresh light colours that helped, as some areas were rather dark. The home operates with three hoists one of which has been purchased by the current owners. The resident group is highly dependent and the majority of residents require a hoist to mobilise. At the random inspection in March 2007 the homes management were required to increase the number of hoists available. This had not been undertaken by the time of this key inspection however there has been a reduction in resident numbers. Two residents who require the hoist were spoken with, they both said that most of the time a hoist is available, but at peak times of use they may have to wait on occasion, but one said that this was an improvement on how it used to be. The other resident was relatively new to the home so therefore could not compare if the situation had improved. Observations over the two days of hoist usage did not show that residents had to wait too long for one to become free. Therefore it is believed that the current number of residents (26) can be met with the three hoists. This would have to be reviewed by the home should the number of residents increase. The laundry was visited at this inspection. The laundry has two washing machines and two tumble driers and these meet the needs of the resident group. There were hand-washing facilities available and the housekeeper was knowledgeable about handling soiled laundry – wearing gloves, apron and the use of red bags. The laundry floor was impermeable and able to be washed, however the matt paint on the walls was peeling to bear plaster and needs painting with a washable paint. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service can expect staff to be adequately recruited and well trained, however there may not be sufficient staff available for duty at all times, thereby compromising the level of care and support available on occasion. EVIDENCE: Three weeks worth of rosters were examined. When asked about how many staff were expected to work each shift the answer was given in a morning there would be a nurse and 6 carers to support the residents. In an afternoon there would be a nurse and 4 carers. At night there would be a nurse and 2 carers. However evidence showed that regularly in a morning there was only a nurse and 5 carers. There are a number of vacancies at the home and the home has tried to recruit from advertising, job fairs and increasing the wage on offer. Recruitment has happened, however 3 care staff soon gave up their positions within days of staring for a variety of reasons. This along with staff sickness and annual leave has led to the home using agency staff. In September from 27th to 30th there were 6 shifts when the home was unable to staff the home to their said staffing levels. There was no agency available and for some of these shifts (including nights) the manager and administrator had to work as care staff. The manager worked 3 additional care shifts over the Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 21 weekend and said he was tired during the inspection and felt stressed. There are 11 care staff employed in total. A visiting social care professional recently contacted us to say that in her view the home was ‘generally very short staffed without enough time to meet peoples physical let alone emotional needs’. A visiting health professional to the home called to express a view that ‘call bells were being left unanswered for long periods of time and staff seemed run off their feet’. Recruitment records for 6 staff were examined. Whilst these records were being examined that the manager became agitated and walked out of the room. The administrator was able to provide evidence that all 6 staff had a POVA first check in place. Out of the 6 staff 4 were still awaiting their full CRB to come through. The last employers reference for 2 new staff was still outstanding and the administrator agreed to action this immediately. The level of training offered to staff has increased. Staff spoken to were positive about training they had attended and records seen reflected that training was taking place for all staff. This included dementia awareness training, medication training, fire training, nutrition, food hygiene, understanding Parkinson’s disease and a session form the falls co-ordinator. She was due back to do a second session at the home. Also planned was for 3 staff to complete the infection control training through Asset. There was little evidence of up to date first aid training at the home. In relation to NVQ training for care staff: 3 of the seniors have NVQ3 and 3 staff have NVQ2 and 5 carers are enrolled on NVQ2. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 22 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, 37 AND 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service are consulted about the service and their safety is maintained through monitoring of health and safety issues, however residents and their representatives would further benefit from a management that was more professional in their conduct and closer monitoring of quality would offer a more consistent and responsive style of management. EVIDENCE: The manager of the home is Mr Tyrone Peacock. He has applied to the Commission for registration and this is currently under consideration. During this inspection Mr Peacock participated, but there was one occasion when he became agitated (raised his voice) and left the office. He did say he felt under pressure and was very tired from the additional hours he had been working at Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 23 the home as a carer. A relative spoke of a similar response by the manager to a pressured situation at a recent barbeque at the home. And the previous inspector for the home also had a similar experience with the manager. The owners of the home are very friendly and are said to be at the home frequently. During the visit one of the owners was seen visiting residents and visitors asking if everything was OK for them. However one requirement in the regulations calls for the owners to visit the home unannounced and complete a report based upon seeking the views of residents and staff and to monitor standards within the home (Regulation 26 visits). The owners have not completed these since they took over the home last December. This would have been a vital tool to know how the home is being managed and to set out what is required to be done to meet the minimum standards without the Commission having to make requirements of the home. The home have however been monitoring the quality of their service through surveys. A survey was conducted when the home was taken over and again 3 months later. A total of 30 replies were received and gave feedback on such matters as the building, environment, care, catering and laundry. Issues were identified around odour and the laundering of clothing and this has enabled the home to put matters right to the satisfaction of the residents and their representatives. The Annual Quality Assurance Assessment (AQQA) has been sent to the home, but had not been returned at the time of writing this report. It is a legislative requirement that this document is returned to the Commission. As stated earlier in the report some records that are required to be maintained, are in need of review – these include the Statement of Purpose, Service Users Guide and care planning within the home. The home does not manage any finances for residents. With regard to health and safety matters training available to staff was covered in the staffing section and was on the whole satisfactory. Evidence of servicing of equipment was seen in relation to gas, the hoists, including the baths, the shaft lift, the fire system, emergency lighting and fire extinguishers. This was all in date and satisfactory. Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 24 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 1 X 3 X 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X 3 X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X 3 X X 3 Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 25 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, 5 and 40 Requirement More information about the home must be available to offer clarity about what exactly is offered and what are the conditions of that offer. The Statement of Purpose and Service users guide must be reviewed in line with the Regulations. Resident’s care plans must be clearly documented as to resident’s needs and how their care will be delivered and monitored. This is a repeat requirement. The home must review its ability to continue to meet the needs of the one identified resident tracked with dementia and take any necessary appropriate action, to ensure the persons individual needs are met with regard to their behaviour and enhance the well being of the other residents. A safe system for moving and handling must be in place, that staff follow, to prevent injury to both staff and residents. DS0000024358.V352297.R01.S.doc Timescale for action 19/11/07 2. OP7 15 (1) & 13 (c) 19/11/07 3. OP7 12 (1) 15 (2) (b) 19/11/07 4. OP7 13(5) 19/11/07 Chilton Croft Nursing Home Version 5.2 Page 26 5. OP16 17 (2) schedule 4 6. OP22 7. OP27 23 (c)13 (4)12 (3)16 (2) (c) 18(1)(a) 8. OP29 19(1) 9. OP32 9 (2) (a) 12(5) (a) 10. OP33 26 A clear record of all complaints made by residents or their representatives about the home and the action taken in respect of these complaints must be kept in order to determine that complaints are dealt with appropriately. Residents must be provided with reliable means to call for assistance in an emergency. This is a repeat requirement. Appropriate numbers of staff, based upon the assessed need of the residents, the size, the layout and purpose of the home, must be on duty at all times. This will ensure residents receive adequate care and support to meet their needs. A robust and thorough recruitment procedure must be followed. This will ensure the protection of residents. The management of the home must be open, positive and inclusive, with the manager being of integrity and good character. This will promote and maintain good personal and professional relationships for the home. The owners or their representatives must visit the home unannounced once a month and prepare a written report of their findings this will allow them to monitor the standards within the home. 19/11/07 19/11/07 19/11/07 19/11/07 19/11/07 19/11/07 Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 27 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 OP9 Good Practice Recommendations It is recommended that photographs of the resident are made available alongside record for all people who are administered medicines to assist in safe medicine administration. Arrangements should be in place to ensure that residents who are dying, do so with comfort and care, their dying should be handled with dignity and propriety, and their spiritual needs, rites and functions observed. The laundry walls should be washable to stop the spread of any potential infection. A risk assessment relating to first aid training should be completed and then staff trained according to the outcome. This will enable all who work and reside at Chilton Croft to receive appropriate treatment in an accident. 2. OP11 3. 4. OP19 OP30 Chilton Croft Nursing Home DS0000024358.V352297.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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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