Inspection on 24/11/09 for Chilton Croft Nursing Home

This inspection was carried out on 24th November 2009.

CQC found this care home to be providing an Adequate 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.

Other inspections for this house

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 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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN Lead Inspector Jill Clarke Key Unannounced Inspection 24th November 2009 09:50 DS0000024358.V378678.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chilton Croft Nursing Home DS0000024358.V378678.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.V378678.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th and 30th April 2009 Brief Description of the Service: Chilton Croft is situated about a 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 primary diagnosis of dementia. The home has two large lounges that both have a conservatory which overlook pleasant garden areas. There is a separate dining room, close to the kitchen. Corridors have been redecorated and fitted with new carpets, and memorabilia cases provide points of interest throughout the home for the benefit of the residents. The home has recently redeveloped their rear garden space with new grassed areas and gardens, and which is wheelchair accessible by access paths. 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 (as given on the 30th April 2009) range from £380 to £700 per week. Prospective residents may wish to contact the home direct, to gain further information on fees. Chilton Croft Nursing Home DS0000024358.V378678.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 1 Star. This means the people who use this service experience adequate quality outcomes. We (The Commission) visited the home unannounced, to carry out a ‘key inspection’, over ten hours, where we focused on assessing the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us gain an idea, from a resident’s view point, of what it is like living at the home, and feedback on the level of care they receive. The report has been written using accumulated evidence gathered prior to, and during the inspection. Survey feedback was also used as part of this inspection, by sending a sample of CQC surveys to the home to give out. This gave an opportunity for people to share their views on how they think the home is run. We also sent surveys to social care managers who have had contact with the home since our last inspection. At the time of writing the report seven residents, seven staff, and two social care managers’ surveys had been returned. Comments from which have been included in this report. We also looked at the home’s Annual Quality Assurance Assessment (AQAA) completed by the home in April 2009. This provides the CQC with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next twelve months. Comments from which have also been included in this report. The Manager and Deputy Manager were available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. The manager arranged for the Clinical Lead Nurse to spend time with us so they could give us feedback on care and medication issues. By looking at records together where we identified any shortfalls, it gave the nurse a chance to check our findings, discuss further, and enable them to feedback direct to the manager showing any evidence at a later date. During our visit, we spent time talking to four residents in the privacy of their bedrooms, gaining their views on Chilton Croft. We also spoke to a visiting relative, the duty nurse, and observed the daily routines of the home. To gain a view of the day-to-day management of the home, we looked at a sample of records which included care plans, staff recruitment, action plan, staff rotas, statement of purpose, service user’s guide and medication records. People living at Chilton Croft Nursing Home prefer to be described as residents, rather than service users, therefore this report reflects their wishes. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.2 Page 6 What the service does well: Prospective residents, in helping them identify if the home will be able to offer the level of support they are looking for, are encouraged to visit the home before hand. They can also choose to stay for a meal, which enables them to meet and chat with people living at the home, as well as the staff who would be looking after them. If people prefer, and are able to, they can book respite care so they can stay for a short period of time, therefore gaining a further insight into what it would be like living at Chilton Croft. Feedback given through surveys, and during the inspection, from people living at the home, their relatives and from visiting social care professionals identified people find staff ‘welcoming’, ‘friendly’ and ‘eager to please’. Residents we surveyed told us that their care needs are being met. Residents and relatives comments included ‘all nursing staff and carers do a fantastic job’. The home provides a range of activities for residents to join in with if they choose to, including more focused activities such as reminiscing to support people who have dementia as their primary need. A resident told us that the location of the home is ‘convenient for visitors’, who are invited to join in with ‘special evening dinners for residents and families’. The majority of carers and nurses in not wearing a uniform, supports a more homely, then clinical atmosphere to the home. What has improved since the last inspection? Since the last inspection the home has sent us their ‘action plan’, which confirms work they have undertaken/will be undertaking to address the requirements made following our last key Inspection (30 April 2009). Controlled drugs are now being stored safely in the correct type of wall mounted cabinet. The home informed us that their Statement of Purpose and Function booklet has been updated to ‘show all information required by regulation’, and staff training has been increased. The home is continuing with on-going refurbishment plans, which includes bedrooms being redecorated and new carpets laid, which residents confirmed they have been able to choose the colours they wanted. New residents care plans have been introduced, which holds all the information on their care needs in one place, such as activities and meals, instead of keeping them in lots of different folders. The administrator has now become the Deputy Manager, supporting the home’s manager in their day-to-day administration duties. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.2 Page 7 The home has appointed a Clinical Lead Nurse, who has experience in caring for older people with dementia, as well as physically frail older people. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chilton Croft Nursing Home DS0000024358.V378678.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.V378678.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 not applicable as the home does not offer intermediate care. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be given opportunities to visit Chilton Croft to support them in identifying if the home is able to provide the level of service and environment they are looking for. However, people cannot be assured that the written information supplied by the home will give them all the information they require. EVIDENCE: During our last key Inspection in April this year, we identified the Statement of Purpose did not give all the required information. The management confirmed in their ‘Action plan’ that by 12 August 2009, ‘the Statement of Purpose will be amended to show all information required by regulation’. During the inspection Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 10 we were given a copy to take away with us to read, which had been last updated on the 4th November 2009. The twenty-three page booklet provides prospective residents information on the home, written in a clear font, on the level of service the home is able to provide. The home’s AQAA does not say if the home is able to provide the Statement of Purpose and Service User’s guide in any other formats, to support people with their individual communication needs. The document did not fully describe the current management structure, or the experience and qualifications of the manager. There is no information given, taking into account the manager is not a qualified nurse, who is providing the manager with clinical leadership and advice. The booklet gives information on how many bedrooms they have, but not how big the rooms are, and if they have en-suite facilities. This could be important information for people looking to see if the room size would meet their mobility and privacy needs We found the information on the home’s complaints procedure was not fully accurate and could be confusing to the reader over whose responsibility it is to investigate complaints (see complaints and protection section of this report). The copy of the ‘Service User’s Guide’ we were given, showed that it had been last updated ‘30th January 2009’. It is also written in a large clear font, and has an index of contents at the front. The booklet gives the reader information on the home’s admission procedure, and views from people living at the home, which included ‘likes the staff and has made friends at the home’. The AQAA informs us ‘our brochure and statement of purpose’ contains clearly written information on ‘the fees charged’, this had not been included. Lack of information on fees was also evident at the last inspection. The Service User’s Guide, does not provide ‘localised’ information to the reader, which a resident moving into the home may find useful. For example information on meal times and visiting services such as the hairdresser, chiropodist, and how much it costs. When we asked the residents surveyed if they had received enough information to help them decide if the home was right for them, five people said ‘yes’, and one ‘don’t know’ (one person had not answered this question). When we asked a resident if they had been given any written information on the home, they replied “no”. The manager said they would have been given the booklets, but sometimes relatives take the information away with them. The Service User’s Guide gives people information on the home’s admission procedures, which includes having an ‘initial assessment’ of their needs being undertaken. By doing this it enables the staff to identify if they will be able to meet ‘the prospective resident’s needs’, and the ‘perceived impact of the Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 11 placement on the other residents and the Home and any staffing considerations’. Prospective residents are also offered the opportunity ‘to visit the home, join current residents for a meal and move in for a trial basis’. By doing this the home is supporting people to get a feel of what it will be like living at Chilton Croft, prior to making the decision if they want to move in permanently. The Statement of Purpose also informs the reader that if the staff feel ‘the home is not suitable for a particular person’, that they ‘will try and give advice on how to look for an alternative residential home’. The two care plans we looked at, showed that a pre-assessment had been undertaken before they moved into the home, which gave staff information about the person’s physical care needs. As the manager does not hold a care or nursing qualification, we asked who is undertaking the home’s preassessments. The Clinical Lead Nurse confirmed that they are doing this. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be consulted on how their physical care needs are to be met, and have trained staff to monitor their nursing needs. However, it cannot be assured that staff are following safe medication practices, which may put people at risk. EVIDENCE: At the time of the inspection twenty-three residents were residing at the home. The AQAA informs us that the home ‘have a comprehensive care plan for each resident, which covers their personal, social and health needs and is updated monthly and will be reviewed 6 monthly or when required, by the care staff and management’. During the inspection we were shown the care plans, which are in a new format that has been recently introduced, and are now held in the office. A relative informs us in their survey that ‘residents care plan and daily diaries used to be kept in their rooms and I found this very useful’ especially Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 13 as their next of kin was no longer able to communicate with them. When the care plan was held in the bedroom they ‘could see how (the resident) had been from day to day without bothering the staff all the time for minor enquiries’. The relative felt ‘it would be good to see the return of these’. During the inspection we spent time talking to two residents in the privacy of their bedroom, who give us feedback about their care. They spoke positively about the “marvellous carers”, and felt their care needs are being met. They felt they are able to tell staff how they wish to be looked after, and make decisions on how they spend their day. When we asked residents surveyed if they feel they receive the care and support they need, six residents replied ‘always’ and one ‘usually’. Comments included ‘all nursing staff and carers do a fantastic job and are very friendly to both residents and families’. We looked at feedback the home had received in August 2009 from a relative of a new resident who had written, ‘we cannot fault anything or anyone here (resident’s name) has improved a hundred times over – its all down to the staff here, we could never thank you enough’. A relative confirmed that they are being ‘kept up to date with all my mother’s care plans and health issues. The staff are always welcoming, friendly and eager to please.’ Feedback from social care managers who have undertaken two reviews at the home since our last inspection, when asked if they feel ‘peoples’ social and health care needs are being properly monitored, reviewed and met by the service, they replied ‘sometimes’. Their concern being that although ‘the home is focused on the social aspect of residents lives that they must ensure that the basic levels of care are being met consistently’. When we asked staff surveyed if they are being given up to date information about the needs of the people they care for (which includes information given in the care plans) five replied ‘always’ and two ‘usually’. Discussions with nursing staff identified how they are treating and monitoring a resident who has pressure sores. This included taking photographs and measurements to enable nursing staff to monitor the healing process. Whilst visiting two very frail residents in their bedrooms, paperwork kept in the room showed that they are being regularly repositioned in bed, to reduce the risk of their skin breaking down and developing into pressure sores. For one of the residents we noted they had a ‘mouth tray’ by their bed, but we could not see on the care records kept in their bedroom, when staff were carrying out mouth care. When we asked another resident if they are being given enough drinks during the day, they confirmed they are, and a drink was brought in for them whilst we were talking. We spent time going through the care plans of two other residents, who have dementia, looking at how their care needs are being addressed. Due to their Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 14 mental health needs, we used a mixture of observation, looking at their care records, and discussing their care with a member of staff, to gain a view of the care they are receiving. There was information on their physical care needs, and records showed that their nutritional needs are being regularly monitored. Where staff had noticed the residents were losing weight, they had changed from monitoring their weight monthly to weekly, to keep a closer eye on it. The last weight recorded, showed that they had started to put on weight again. We asked the nurse, if they have other strategies in place such as offering finger foods, as supplementing the diet for residents, who are slim and use up a lot of calories walking around all day. The nursing staff said “no”, however the manager said “yes”. The Statement of Purpose informs the reader that the home provides ‘varied and nutritious finger food’. Discussions with the manager identified that they had a different understanding what is meant by finger foods. We asked the Clinical Lead Nurse if they provided guidance to the catering staff, and were informed that they did not come under their line management. Care records showed when the home had contacted healthcare professionals to support the residents with their physical and mental health needs. Discussions with a resident confirmed that their family had made arrangements for them to see a dentist. The AQAA also confirms that staff will ‘arrange support from health professionals’ including ‘physiotherapist, opticians dentists, chiropodist etc’. For one of the resident’s whose care we were tracking, staff had identified as having challenging behaviour. There was no information on potential triggers, supporting staff to identifying any situations, or changes in body language that could show that the person is becoming anxious. In the ‘action’ section of the care plan, which gives staff guidance on how to manage the resident’s ‘verbal aggression and keep (resident’s name) calm’ there was no individualised information on what they have found out promotes well-being for this person. The daily records kept by staff, often described the resident as being ‘very aggressive’ and mentioning the negative aspects of their behaviour. There was no evidence to show if they had looked at their own interaction / communication / approach to see if this had an affect on the resident’s behaviour. Although on one occasion when staff mentioned that the resident had been physically aggressive, a nurse had written they that the anxiety may have been caused by the resident being woken up by a member of staff ‘cleaning their carpet’. This also brings in privacy and dignity issues, with staff going into to clean a resident’s room whilst they are asleep, when this could have been undertaken at another time. The Statement of Purpose, states that ‘staff should knock on the residents door and wait for a response before entering unless there is an emergency’ or they are concerned over the welfare of the person. Whilst sitting with a resident, whose bedroom door we had closed to ensure privacy, four times staff knocked Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 15 on the door, and each time we noted that they entered the room, before the resident could respond. We asked if this was normal practice, and the resident felt it was because they had their door closed. When we asked if staff ensured their privacy and dignity whilst having a bath they said staff are “always alright”. Before leaving the home, we observed a resident being taken into a shower room by two members of staff, and could see the male resident’s top being removed before staff had closed the door. The April 2009 key inspection identified that some medication ‘practices may put people at risk’. The home in their action plan informed us that ‘we currently audit medications twice weekly and any discrepancies identified are dealt with immediately’. When we asked two residents if there had been any problems with their medication, a resident told us that staff had “run out” of their medicated cream the previous night, so it had not been applied. On looking at the medication administration records (MAR) chart for the person, it had been signed as being applied for the previous evening and the morning of our visit. We asked the nurse if they would double check our findings, which they did, and having spoken to the resident themselves confirmed that the cream “had run out last night”. The nurse showed us paperwork to confirm that the cream had been reordered an hour earlier. A sample check of two residents who take Warfarin showed that the home had safe systems in place to ensure the correct dosage was being given, and regular blood tests undertaken. However, we did note where staff had written a list of the dates and dosages on a ‘post–it’ note, as further confirmation of the different dosages to be given each day. We fed back that we saw this practise as potentially confusing to staff, especially as the dates originally written on the detachable note, had since been altered as they were wrong. We were told that staff is using the code ‘M’, when they had run out of medication, which had been used on the MAR charts. The nurse said that they had recently changed their re-ordering of medication systems, as it did not allow time for them to ‘chase up’ any medication not received. However, there had been a further ‘hic-up’, where the nurse on nights who checks the medication in, had been on leave, and no one had checked it in their absence. This will also now be addressed, by having more staff trained up in the checking in of medication. Together with the nurse, to enable them to offer any evidence or explanations if needed, we checked a sample of resident’s medication records. This identified shortfalls which included where medication had been signed as given, but was still in the ‘blister’ pack. We also identified where medication was missing from the ‘blister’ pack the drug was supplied in, but had not been recorded on the MAR chart as being given. Where a frail resident was having Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 16 pain control patches applied every three days, we identified that on one of the three day cycles they had not been given their pain relief. There was no information given on the MAR chart as to the reason why it had not been given. The nurse remembered it had been very busy that evening The home’s action plan, informed us that they had ‘ordered a new controlled meds cabinet that complies with the misuse of drugs act. We were provided recently with a small sized version, however, we have asked our supplier for a larger one’. This inspection identified that as they had not received the larger cabinet, they have now bolted the smaller cabinet to the wall, which they are currently using, to comply with the requirement. As part of tracking a resident’s care, who is written up for ‘as and when required (PRN)’ medication, to reduce anxiety, we found there was no set protocol for staff as to when the medication should be used, and what other actions they should try first. A visit by the GP identified the resident’s medication needed to be reduced, staff had written ‘from doctors point we can’t sedate dementia patients with high sedation’. However, on reading the resident’s MAR chart, we noted that the person had been given two doses of the PRN medication within a short timescale (6pm and 10pm) a week later. The daily notes gave insufficient information why staff had given the medication, or what action they had taken to reduce the person’s anxiety. There was only mention of the person grabbing and twisting a member of staff’s hand, and at 10.00 pm the resident was found sitting on the floor in the lounge. We looked at a medication audit undertaken by the home on the 9th November 2009, which identified shortfalls where one resident had one more tablet then they should have, and another resident, one less than they should have. As both residents were on the same medication, and had the same surname, we asked if staff may have mistakenly taken two from the same container. We were informed “no” as the residents lived in different parts of the home. The manager confirmed that they would bring any shortfalls identified in the audits to the attention of the nurse concerned, during their supervision. Prior to leaving the home, we noted that the nurse was giving out medication, leaving the trolley for at least two minutes unlocked and open, with the keys still in the lock. We were concerned that any residents walking around the home could access the medication, therefore observed the trolley until the nurse came back. We then made the senior nurse aware of the situation, so they could monitor and discuss the security of medications with staff. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can invite their visitors to take part in planned social activities and meals at the home. People can also be assured that staff will make their visitors feel welcome. EVIDENCE: Our last report identified the improvements made by the home in providing a range of social activities for residents to take part in, and occupy their day. When we visited the dining room in the afternoon, nine residents were waiting to start the afternoon ‘bread tasting’ activity. One resident thought it was going to be a “wine tasting” session, and staff quickly informed the resident that could be an idea for a future tasting session. We noted the bread was being sliced and buttered in the kitchen, and had not involved residents in preparing the samples. The atmosphere whist residents waited was friendly and jovial. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 18 In the corridor music was playing loudly, and we noted when visiting a resident watching TV in the lounge, we could not hear the television they had on. Shortly after sitting in the lounge, staff came round inviting residents and their visitors, who were not involved in the main ‘bread tasting’ session in the dining room, if they would like to sample a slice of the four different types of bread. When we asked residents surveyed if the home arranges activities that they can take part in if they choose to, three people replied ‘always’ and four ‘usually’. When we asked two residents if they had been on any of the trips out, one said “don’t know – never been asked”, another said they preferred to spend time in their room. The manager showed us the individual photograph albums they had made up for residents showing activities they have joined in with, such as birthday parties, and themed restaurant nights. We asked if the residents kept their photograph albums in their bedrooms so they could look at them and share with their visitors. The Manager said they are currently keeping them in the office, which enables them to be kept updated. Also from our observations and feedback, shown to people visiting the home, as evidence of the work they are doing. A relative told us that the ‘the special evening dinners for residents and families, and themed days like the food tasting and music afternoons are really good’. Staff surveyed also told us activities, are an area that the home does well ‘with so many activities for the residents’. Positive feedback was given in a social care manager’s survey who had seen photographic evidence of ‘residents enjoying Polish day, wine tasting and various other activities’. They felt the ‘service is clearly concentrating on improving the social aspect of the home by introducing theme activities’. The second lounge has been decorated and furnished with items that residents may have used, or owned during their lives, such as an old fashion type writer. We did not see the room being used during our visit. When we asked a member of staff how often the residents used the room we were informed that they “don’t” tend to “come in on their own – but come in for entertainment”. We felt during our visit, it was equally important to observe the level of interaction with residents living upstairs, who are unable to communicate their views, or complete our surveys. We asked how the residents remaining in their bedrooms, through choice or due to being physically or mentally frail, are being involved in the activities. The manager said staff would involve the residents in the activities such as bread tasting, by going around with the tray and offering residents a chance to taste the bread. During the time we spent upstairs we found that the staffing levels was not allowing staff to just go in and sit and talk/be with a resident, unless it was to provide a care task. This left the frailer resident’s periods of time, with no interaction to support their individual communication needs. When we observed staff working upstairs in the evening prior to us leaving, we could see Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 19 they were very busy, a resident was shouting out calling out for their “mum”. Two staff were seen to be assisting a resident with a shower, and the nurse was giving out medication. We did not see anyone go to the resident who was calling out. Whilst visiting two residents we asked about the standard of the meals provided, and how they choose them, both informed us that there had been changes to how they chose their meals. Their comments included “staff used to come round and ask the day before what we wanted, that doesn’t happen now”, and “used to have two choices, but now sends what he wants”. When we fed this back to the manager, they said there had been no changes in the system, and people were still being asked to choose. There appeared to be conflicting information from what the home said was happening, and what the residents said was happening. We asked one of the two catering staff, who, due to English being a second language took a little while to understand what we were asking, but indicated that residents were being asked. Residents surveyed, when asked if they like the meals at the home, four replied ‘always’, one ‘usually’ and two ‘sometimes’. Comments included ‘enjoy the food’, and ‘meals are on time’. A relative had also commented that ‘all food is well presented and cooked to a high standard with a varied menu’. Residents we spoke with, told us that the food is “not too bad really”, but felt the tea-time meal could be improved. They said staff “just bring a tray around (of sandwiches) don’t know what’s on it”, another resident said that staff “occasionally come and ask what kind of sandwiches” they wanted at tea time, however “many I don’t like”. A member of staff surveyed, when asked what the home could do better told us that the home ‘could extend the lists of meals i.e. lunch and supper to give a wider choice to residents’. On a bedroom wall, located by the door, we noted staff had laminated a week’s menu, and underneath was a laminated ‘food preferences list’. As the menu was not dated we showed the resident and asked if it was this weeks choices. They were not sure, but could confirm that a few weeks ago they had been asked about their preferred choices. We could not identify from the resident how it benefited them having the lists stuck on the wall, as food is pre-plated before it comes to the room. We observed that the residents we visited had different jugs of cold drinks in front of them; one told us that they had been given their choice. The other said that they would prefer a different juice, but as “it’s changed during the night” staff naturally “don’t disturb” them to see what they want. When we asked residents surveyed if they felt staff listen to them and acted on what they said, all but one (who replied ‘sometimes’) replied ‘always’. Most of the staff do not wear uniforms, which promotes a homely atmosphere. However, time spent with a resident identified the lack of name badges, relied on people being able to remember staff’s names, which not all of the residents are able to do. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 20 To leave the home, residents need to input a number into the digital door lock. When we asked if the number is given to residents, taking into account that only six of their of their thirty one places are for dementia care as a primary need, they replied residents would only forget them, so they tend to give it to the relatives. By giving residents the number, would promote autonomy, and even if they did not use it themselves, they could inform their visitors. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their complaints to be listened to, and appropriate action taken to address them. However, people cannot be assured that the home will take appropriate action when safeguarding issues are raised. EVIDENCE: Residents surveyed, when asked if they know who to speak to informally if they are not happy, all replied ‘yes’. When asked if they know how to make a formal complaint three residents said ‘yes’ and four replied ‘no’. The AQAA tells us that ‘information about how and who to make a complaint to, is displayed in the building and in the Statement of Purpose’ and that ‘new leaflets have been produced explaining our complaints procedure’. On reading the Statement of Purpose which had just been updated (4th November 2009), we found the home still made reference to their regulating body as being the ‘Commission for Social Care Inspection’, instead of the Care Quality Commission which came into affect in April 2009. The Service User’s Guide also needed this information to be updated, along with address and contact numbers of the CQC to be given. Where the home had written ‘the Commission for Social Care Inspection are informed of all Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 22 formal complaints and invited to conduct their own investigation in addition to the internal response’, it does not reflect our role, as we do not investigate people’s complaints. The complaints procedure does not make clear to people whose care is funded by social care, that they can make a complaint directly to their funding authority. Instead the policy states ‘complaints are dealt with through the homes catchments local authority Councils Complaint and Representations procedures. Residents will be given a copy of this procedure on request’. By not giving information and contact details of the different local authorities associated with the home, does not support people to make a complaint directly to the people funding their care if they wish. The AQAA tells us ‘all written complaints are acknowledged within 14 days and dealt with in 28 days. A record of all complaints is kept in the home.’ We confirmed this was happening when we looked at the records, which identified how many complaints they had received, which included concerns over a ‘smelly bedroom’, ‘not happy with cold lunch’ and complaint about the laundry. They had all been recorded, and acted upon within the home’s stated timescales. Next to each complaint, staff had written what action they had taken to ensure the situation did not happen again. For example, to reduce the odour in a bedroom by arranging for the carpet ‘to be cleaned each week’. Feedback from staff surveys showed that they all knew what to do if ‘someone raises concerns about the home’. The AQAA informs us ‘all staff members receive training for pova’ (Protection of Vulnerable Adults). When we asked a new member of staff, who had undergone the training, what action they would take if a resident said that a carer had hit them, they told us that they would “check for bruises and marks” then report to the manager. We then asked what if the manager was not available, instead of telling us they would contact the appropriate authorities, they told us that they “would talk to the relatives”. Further discussion identified that they were not aware of the local protocols of reporting safeguarding issues. The ‘Service User Guide’ informs us ‘if the complaint concerns an allegation of physical assault or abuse, then immediate action will be taken under Chilton Croft’s Adult Protection policy’. Our last inspection identified that the policy provided staff ‘with information and instruction on what staff must do’. The manager confirmed that the policy was available in the home for staff to use, which identified that the level of training being given, needs to ensure staff are fully confident in knowing the correct action to take. Since we inspected in April 2009, there has been two safeguarding alerts made by a relative, and a care professional, about the standard of physical and nursing care a resident received whilst at the home. The referrals have now been fully investigated and closed. A Social Care Manager surveyed stated they felt there ‘was a poor response by the service initially following’ the Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 23 safeguarding concerns being raised, with them not attending the first meeting. They also felt that the two ‘letters of explanation for the issues raised’ were ‘inadequate’. They felt this is an area the home can ‘do better’ in. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from an on-going maintenance programme, to improve, and maintain the homely, odour free environment to ensure it meets the range of needs of the people living there. EVIDENCE: The AQAA informs us that ‘our home is well maintained, tastefully decorated with modern facilities and equipment. Resident’s safety and comfort is paramount in our mind.’ When we asked residents about the maintenance of the home, one told us that they were having new flooring put down, “said it was going to be last weekend – hasn’t happen”, and nobody had informed them why it did not go ahead. We noted where the bedroom was too small to Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 25 safely accommodate an extra chair for visitors, the home had provided collapsible ones, which could be stored behind the bedroom door. Feedback in surveys confirmed there is on-going refurbishment work at the home, with bedrooms being decorated and carpets being laid. A resident confirmed that they had been able to choose the colour of the carpet and decor of their room. Whilst sitting talking, we noted one of the windows had been sealed up with tape. The resident confirmed this was undertaken after complaining of the draft coming through. The manager confirmed that both windows had been originally taped up, but as the resident then wanted to be able to open the window for fresh air, it had been removed from one of the windows. Whilst looking out of the window, we noted broken glass lying on the roof outside, and the gutter appeared to be ‘clogged’, with what looked like a plastic sheet and plant growth. We sought the person’s permission to feedback our observations and their comments, which we did. The manager felt we were mistaken, that although they were aware of the broken glass, which had happen recently due to the bad weather, and will be removed, there was no other problems with the guttering. We said when we had asked the resident if there had been any problems when it rained, they confirmed that there had been a leak in the ceiling above their bed, and when it rained they could hear the water running outside their window was quite loud. The manager informed us that they were looking to invest “a million pounds” on the home. The AQAA informs us that they are ensuring their fire fighting and detection equipment is being regularly serviced, to ensure it is in safe working order. When we visited another bedroom, we remarked to them that their bedroom felt a little cooler, and asked if they felt warm enough. They told us “yes” saying that the staff often “come in and say its cold in here, but it’s what I like”. People we visited in their bedrooms confirmed that they found the room comfortable, and it met their needs. Time spent with a resident living in a ground floor room, showed that they had pleasant outlook to the gardens. When social care staff visited the home in August, they commented that ‘the environment looked clean and tidy when they walked in’. This reflected our findings, during the inspection, and we found no unpleasant odours. Residents surveyed, when asked if the home is being kept fresh and clean, six replied ‘always’, and one ‘usually’. We observed during the inspection that staff was wearing protective disposable gloves and aprons, as part of their infection control procedures, when assisting with personal care. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect staff working at the home, to have had checks undertaken to ensure that they are able to provide care to vulnerable people and staff to have received training. However, people cannot be assured there are always sufficient numbers of staff on duty, to be able to provide a flexible, individualised care. EVIDENCE: During the inspection we were given copies of the staffing rota’s for November 2009, which we took away with us. They confirmed what residents had told us, “sometimes they have only two upstairs and downstairs working today”, as the staffing levels during the day is four carers covering the home between 8am to 8pm. Two carers cover the night shift (8pm to 8am). The rotas also showed that they had the same amount of staff on during the day (8am to 8pm) which does not allow for any flexibility, during ‘peak’ times, to have extra staff on duty to give support. The rotas showed that they are maintaining these staffing levels, but are less then when we last visited in April, when there were twenty-four residents, the morning staffing level was five carers. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 27 In addition to the carers, there is also a nurse on duty 24 hours a day providing the clinical cover. When we asked staff if they felt there is enough staff to meet the individual needs of all the people who use the service, three replied ‘always’, two ‘usually’ and two ‘sometimes’. Comments included ‘we could do with more staff sometimes’. When we asked a resident, if when they rang their call bell did staff came straight away, they replied “eventually - but doesn’t matter unless you want to go to the toilet”. When we asked the residents surveyed if staff are available when they needed them, five replied ‘always’ and two ‘usually’. When we asked a resident during the inspection the same question, they said “I don’t think they have enough staff”, however when they had brought this up with the management, they had been informed that “there are”. Further discussion identified that they felt “rushed” with their care in the mornings, which they felt was not the night staff’s fault, but because “they are supposed to get so many up in the mornings”. Another resident felt the staff appeared more rushed when there are only two covering, but also assured us that the staff are “very good – very good”. We fed these comments back to the clinical lead nurse who confirmed that residents can get up when they wished, and it would be only those residents up at that time of day who would be assisted with their wash. Our observations upstairs during the visit identified that the two carers and nurse covering the floor, was seen to be busy throughout the shift. We could see, through completed paperwork held in bedrooms, that staff had been in to reposition residents on bed rest to prevent their skin getting sore. We could also see staff busy assisting with drinks, showers, and meals. However, the staffing levels did not enable staff upstairs to spend one to one time and enhance resident’s well-being, to the same level as was happening for some of the residents living downstairs. At our last key Inspection in April 2009, we stated that the home is continuing to improve their training programme. We said that staff are receiving ‘core training’ and where staff have received training in dementia care it has been ‘very positive so far for people with dementia’. Our findings during this inspection (see Health and Personal Care section of this report) that although the training is giving staff an ‘awareness’ of people’s dementia needs, there needs to be more in depth training, to ensure staff have the theory to backup their practice. This is especially important to support staff in knowing why a resident might act in a certain way, so they can take action to reduce anxiety and the use of medication. The report identified that staff had not yet undertaken ‘mental capacity act training’. During this inspection we were shown a certificate which confirmed a senior nurse had ‘attended Mental Capacity Act and the Deprivation of Liberty Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 28 Safeguards (DOLS) Linking Theory into Practice’ two weeks earlier. The Statement of Purpose and AQAA both state that all their staff would have achieved a National Vocational Award (NVQ) at level two, or above by 2009. We noted in the Service User’s Guide which we had taken away with us, had been altered to read 2010. As the home in achieving having ‘47 of the care staff’ having an NVQ level two or above at their last inspection, we will further look at the progress being made, when the home submits their next AQAA, which will be due early next year. When we saw a resident come in and pick up a large rag doll and give it a hug, we asked how this is being used to support individual residents well-being, as we could not find staff guidance in the person’s care plan. Further discussion about using ‘doll therapy’, as with the use of ‘finger foods’, identified that staff still need to develop further their knowledge of the activities they are introducing. As we mentioned in the Health and Personal Care section of this report, Nurses who are responsible for deciding when ‘PRN’ medication should be used to reduce the anxiety in people with dementia, require more in-depth training then the dementia ‘awareness training’ arranged by the home. This is to ensure that they have a good understanding, of why a resident might be reacting in a certain way, to try and resolve the situation without the use of medication. During the inspection we looked at two staff’s personnel records, who have started work at the home since our last inspection. Their files showed that they had attended an interview and had been asked to complete an application form. The form gave a full employment history, including information that they have worked in care before. A Protection of Vulnerable Adults (POVA) check had been undertaken before they had started work at the home. This is to ensure their names do not appear on a list of people prevented from working with vulnerable people. There was also evidence that a Criminal Bureau Records (CRB) check had been undertaken, and paperwork seen to validate the staff’s identity. The home had also obtained two written references to confirm where they have previous been employed. As one of the staff taken on is a registered nurse, there was evidence on file to show that the nurse has a current professional identification number (PIN) which is issued by the Nursing and Midwifery Council (MNC) to show they are entitled to practice as a Nurse in this country. Staff surveyed confirmed that their employer had carried out employment checks on them before they started work at the home. Staff surveyed told us that they are receiving training which is relevant to their work, and helps them understand people’s needs. Five out of the six staff also felt the training they receive keeps their knowledge updated and is relevant to their role. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 29 We asked a newly recruited nurse if they felt their induction was enough they replied “yes”. We were informed that nurses completed the same induction booklet as carers. We looked at their induction training which included coming in for a ‘½ day to observe medication round and discuss issues that arise’, followed by attending ‘for a few hours to carry out a supervised drug round and explain care plans and fire drill’, being supernumery for the morning to observe daily routines and requirements – explained some paperwork’. They then worked a night shift, with the Clinical Lead Nurse available in the building to offer support and guidance if needed. When we asked staff surveyed ‘did your induction cover everything you needed to know to do the job when you started, all had replied ‘very well’. One member of staff commented that ‘the home has improved greatly over the years .i.e. staff/training’. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that there are robust management arrangements in place, to ensure the home is run in the best interests of the people living at the home. EVIDENCE: The Statement of Purpose (4th November 2009) states that ‘we have recently re-structured our staff so as to ensure and reflect a much clearer line of accountability’. We were also informed that the ‘new administrator’, who we mentioned in our last report, and has experience as a carer has now become the Deputy Manager. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 31 At the time of our inspection the home still does not have a registered manager over seeing the day to day operations. Mr Diwan, who we identified in our last key inspection in April 2009, would be covering as manager ‘until a suitably qualified manager could be appointed’. We noted that the AQAA and Statement of Purpose does not give any information on any healthcare or management qualifications held, to support them in this role. We were informed during this inspection that both the manager and their deputy have now started on an NVQ course. During the inspection, Mr Diwan informed us that he will be submitting an application with the CQC to become Registered Manager. We were informed that they have been approaching other people, who they felt would be a suitable manager, however they “couldn’t get them” and those who had applied where “not suitable”. As they do not hold a nursing qualification, they confirmed that they have appointed a clinical lead nurse to ensure the home is meeting their clinical/nursing responsibilities. Time spent talking with the nurse, showed that they are not being given ‘clear lines of accountability for decision-making and clinical governance’ (see ‘managers of Care Home providing Nursing Care’ guidance on our CQC website for further information). The staff rota shows that the clinical lead nurse is working as part of the nurses covering the nursing rota. The rota did not show any ‘over laps’ for handovers. The manager told us that the Clinical Lead Nurse only needed to ask if they needed to come in extra. When we asked the nurses who undertakes their supervision, which should include time discussing clinical issues, we were told it was the manager. Mr Diwan showed us paperwork which evidenced that he continues to undertake monitoring visits at night, as part of monitoring the level of service being provided. When we asked staff surveyed if their manager gives them enough support and meets with them to discuss how they are working, three staff replied ‘always’ and four ‘usually’. In the Health and Personal Care section of this report we have identified shortfalls in the management of medication systems at the home. Feedback given in a social care manager’s survey (see Complaints and Protection section of this report), identified that they felt the home’s involvement in a safeguarding referral could have been better managed. Residents we spoke with could tell us who the manager is. When we asked if they see much of them, comments included “often walking around – but doesn’t come in”, “see him about half an hour each week”. Feedback (survey and verbal) from people living at, and working at the home identified that they felt sometimes the management ‘made promises’, which they did not always follow through. Further information may lead to individuals being identified, which was a worry to some people. Our last inspection identified that the ‘home has made considerable effort to improve communication with the residents, relatives and staff’, which reflected a comment we received this time Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 32 from a member of staff who told us ‘I enjoy working here now and this boss treats us much nicer’. We were shown the file of completed quality assurance feedback questionnaires, which the home uses to gain feedback from residents on the level of service they receive. This is undertaken for new residents through their ‘Admission to the home’ questionnaire to gain feedback on their admission process. For other residents feedback is gained through their ‘Living in the home’ questionnaire. and time was spent looking at a sample of these during our last visit. During this inspection we asked how the home is analysing the information they are receiving, as part of their on-going monitoring of the service. For example how are they using the information gained to structure their business plan, or show any improvements, or drops in different areas off their service over a period of time. Discussions identified that this is currently not happening. The manager said that we had not asked them during previous inspections to undertake this work. The AQAA tells us that the home ‘also seeks views from families and other stakeholders’. When we asked for more information on the ‘stakeholders’ they are consulting, it identified that this was not happening at the current time. The AQAA also informs us that the home has ‘facilities for safekeeping of service users’ money and valuables. We keep a record of all transactions.’ No concerns have been raised by people living at, or connected with the home over how the home is managing these facilities. Therefore, we did not undertake any sample audit checks at this inspection, but will look in more detail at this key standard during a future visit. When we asked for records relating to the service during the inspection they were quickly obtained, with care and staff files clearly indexed, which helped in locating information quickly. Review of medication audit sheets, and our observations during the day, identified there are still on-going shortfalls in the completing of medication records (see Health and Personal Care section of this report). The AQAA and Statement of Purpose provides information on action taken by the home to ensure a safe environment for people living and working at Chilton Croft. The AQAA provides information to confirm that equipment used in the fighting and detecting fires are being regularly serviced to keep them in safe working order. Bedrooms we visited had a copy of the home’s evacuation procedures for residents and visitors. Staff training file showed that staff receive as part of their induction manual handling training, to support them in knowing how to move a resident safely. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 X X 3 Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 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 Requirement The statement of purpose must include all the information required by regulation. This is to ensure that potential residents can make a clear decision about whether they wish to live at the home. This is a repeat requirement. The Service User’s Guide must include information on the amount and method of fees. To reduce the chance of people being isolated and becoming anxious, care plans must give staff clear guidance on how to support people with their individual communication and behavioural needs. Care plans must give staff clear instructions, based on the resident’s individual physical and mental health needs, on the use of occasional ‘PRN’ medications. Full and accurate records must be kept for both the administration of medicines and DS0000024358.V378678.R01.S.doc Timescale for action 24/11/09 2. OP1 5 31/01/10 3. OP7 13 31/01/10 4. OP8 15 10/01/10 5. OP9 13 05/01/10 Chilton Croft Nursing Home Version 5.3 Page 35 also when medicines are not administered as scheduled. 6. OP9 13 To ensure people’s comfort, systems must be in place to check medications has been given / offered as prescribed. 31/01/10 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 OP27 Good Practice Recommendations Staffing levels should be reviewed to ensure that there is consistent and appropriate numbers of staff to ensure the home can meet the residents’ needs. Chilton Croft Nursing Home DS0000024358.V378678.R01.S.doc Version 5.3 Page 36 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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