Inspection on 26/04/07 for Chilton Croft Nursing Home

This inspection was carried out on 26th April 2007.

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

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

Other inspections for this house

Chilton Croft Nursing Home 24/11/09

Chilton Croft Nursing Home 29/04/09

Chilton Croft Nursing Home 14/10/08

Chilton Croft Nursing Home 02/10/07

Chilton Croft Nursing Home 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 Cecilia McKillop Key Unannounced Inspection 26th April 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000024358.V337735.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. DS0000024358.V337735.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilton Croft Nursing Home Address Newton Road Sudbury Suffolk CO10 2RN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01787 374146 01787 374333 chiltoncroft@hotmail.com Chilton Care Homes Limited Position 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 DS0000024358.V337735.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2006 Brief Description of the Service: Chilton Croft is situated about one mile from the centre of Sudbury. It offers nursing care to thirty-one residents in a large two-storey house that has been developed for the purpose. A recent variation to the registration allows the home to offer care to up to six residents with a diagnosis of dementia. The home has two large lounges that both have a conservatory, which overlook garden areas. The gardens are secluded and have level access and wheelchair ramps to allow for resident usage. There is a separate dining room. There are twenty-seven single bedrooms and two shared rooms. Eleven bedrooms are on the ground floor with eighteen on the first floor. There is a passenger lift between the floors. Nineteen rooms have en-suite toilet facilities and there are toilets and bathrooms situated on both floors. The home is a family run business. The fees for care in the home range from £331 to £650 depending on the accommodation, the funder and the dependency of the resident. DS0000024358.V337735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows a key unannounced inspection, which was undertaken, over three days. Mr Mark Andrews the pharmacy inspector conducted an inspection of the medication arrangements at the home on the 28th of April and Ms Cecilia Mc Killop inspected the care and management arrangements on the 29th of April and 2nd of May 2007. As part of the inspection a sample of records were examined, care observed and a number of staff, residents and visitors were interviewed. The last key inspection was undertaken in August 2006, and significant concerns were identified. Since then the home has been the subject of a change in ownership. The new company directors took over responsibility for the home in December 2006 and a new acting manager has been in post since January 2007. Since December 2006 three random inspections have been undertaken. The pharmacist attended on two of these three inspections and the findings have were appropriate been used as evidence and incorporated into this report. The home’s management had previously agreed with the Commission not to increase the numbers accommodated to above 26 until concerns, which had been identified at the random inspection, had been resolved satisfactorily. On the day of the key inspection there were 24 residents living at the home What the service does well: What has improved since the last inspection? The new management have responded to the random inspections in a positive manner and have made efforts to raise standards. The home’s management has reviewed staff recruitment and has taken steps to ensure that the staff working at the home have a Criminal Record Bureau check in place. DS0000024358.V337735.R01.S.doc Version 5.2 Page 6 The statement of purpose and resident handbook has been updated to reflect the change in ownership. Food, which was being transported around the home, has been covered. New carpet has been fitted at the entrance to the home. The communal areas have been redecorated and look clean and bright. Staff have begun to organise activities for residents in the afternoon. Fire safety measures have been improved and magnetic door closers have been fitted on resident’s bedroom doors. Window restrictors have been fitted on the first floor windows. A health and safety review has been commissioned by the new owners to identify and address any weaknesses. Staff have begun to receive supervision from the homes management. The acting manager and two of the nursing staff have started a training course on dementia care. What they could do better: The home’s management have agreed not to admit any new residents until some of the issues, which have been identified, have been addressed. At the inspection benefits were noted in that there were more staff around to meet residents needs and residents did not have to wait for a hoists to be available. However, these positive developments must be sustained over a reasonable period of time and the Commission will have to have confidence that standards will not drop when the numbers of residents increase. There has been some improvements in the care documentation however gaps remain. It is not always possible to obtain a clear picture on resident’s progress or how key areas as being monitored by staff at the home. Care delivery varies with some residents reporting that they were generally satisfied with the care they receive but others were less positive. Concerns remain about the how the home is meeting the needs of the more dependent residents. The support available to residents at meal times much be reviewed and residents who require assistance must receive it. Resident’s privacy and choices can be limited by the fact that some residents have to wait all morning before staff are available to assist them to get washed and dressed. Routines within the home must be reviewed to be more in line with resident’s wishes. Since previous pharmacy inspections there have been improvements in the DS0000024358.V337735.R01.S.doc Version 5.2 Page 7 management of medicines. However, a sample audit identified that there are still some medicine discrepancies arising and there are still failings in relation to the use of discretionary psychoactive (and sedative) medicines. The home is currently dependent on agency staff and this has meant that some residents have been receiving care from staff who are not fully of their individual care preferences. Efforts are being made to recruit permanent staff and progress will be monitored at the next inspection. Programmes of staff induction and training must be further developed to meet the needs of residents. There has been some improvements in how the home manages odours but where difficulties remain the carpet must be replaced. There have been ongoing problems with broken call bells at the random and key inspections. The home must find a longer-term solution to these problems. One of the fire doors was found on the two days of the inspection to be propped open, as the automatic door closure was broken. The home’s management must ensure that repairs are undertaken as soon as possible, particularly where there are Health and safety issues. There are outstanding issues with regard to the gas supply and, while efforts have been made to resolve the issues, these have not been successful and matters remain outstanding. To conclude this is a service has a new and enthusiastic management team and improvements have been made, but there are still significant issues to address 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. DS0000024358.V337735.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 DS0000024358.V337735.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): 3,6 Quality in this outcome area is adequate. People who use this service can expect to have their needs assessed however they cannot be guaranteed that their needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager assured the inspector that he undertakes pre-admission assessments on all prospective residents and information is sought from former care providers. There was evidence in two of the residents records examined of a pre-admission assessment having been undertaken. The ‘Health and Personal Care’ section of this report documents areas where residents needs, which have been identified have not always been met. DS0000024358.V337735.R01.S.doc Version 5.2 Page 10 The statement of purpose and resident handbook has been updated to reflect the change in ownership. The home’s philosophy of care was on display in the hallway of the home. The home does not offer intermediate care. DS0000024358.V337735.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 Quality in this outcome area is poor. People who live at the home can expect their care to vary depending on a number of variables and they cannot be confident that the care provided will always meet their needs. While there have been some improvements to care planning and medication practices, people who are very dependent do not always receive positive outcomes. On balance therefore the overall judgement is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans, care delivery and medication practices have been identified as areas of concern at previous inspections. DS0000024358.V337735.R01.S.doc Version 5.2 Page 12 The inspector looked at the care records relating to four residents and there was scored assessments in place for areas such as nutrition and tissue viability. Where a high risk was identified there was a plan of care identifying the interventions needed to address the risk. In two of the files examined there was evidence of the home referring matters back to the GP for further advice. Overall, the inspector’s assessment was that the plans were much more detailed and informative than at the last inspection although it was still difficult to establish whether an intervention was successful or not. There were gaps in key areas such as weight monitoring. Staff who were interviewed were able to clarify and give a verbal update on some areas which were not clearly documented. One of the plans examined related to a resident with diagnosis of dementia and while there was a plan in place regarding agitation the plan did not address the residents wider needs regarding their dementia. Since the last inspection care plans had been moved to residents bedrooms and it is planned that staff will sit with residents and complete the daily records. On the day of the inspection residents interviewed were not aware of the contents of their plan and reported that staff did not look at their records until after the care was provided. One resident expressed concern about the home’s dependency on agency staff and said that these staff did not always know their particular care needs. The manager said that resident’s needs are discussed at handover meetings. At the recent random inspections staff were observed to be extremely busy and not always able to respond to residents request for assistance. Inspectors were told that staff would respond to the bell but would tell residents that they would return later. Resident’s were waiting excessive periods of time for assistance and their needs were not always being met or their dignity preserved. Since the random inspection the numbers of residents being cared for at the home has reduced. Observation of care practice on one of the inspection days showed that staff were generally able to respond to residents within a reasonable period of time. Overall, the atmosphere within the home was calmer than on previous visits and there were fewer call bells sounding the emergency call and less staff waiting on a hoist being available. However, all the residents were not washed and dressed until almost lunchtime. This is unsatisfactory as residents were having to receive visitors in their nightclothes. Two residents were found not to be able to summon attention. One because the call bell was not within reach but another was because the call bell was broken. DS0000024358.V337735.R01.S.doc Version 5.2 Page 13 On the third day of the inspection a resident was observed calling out for assistance. The resident was noted lying on a wet sheet on her bed, with her pudding spilt on her clothing. The main dish was cold and sitting on a tray nearby largely untouched. The inspector noted that it would have been very difficult for the resident to eat her meal given the position in which she was lying on the bed. Four visitors were interviewed about the care at the home. Three of the visitors were generally satisfied with the care but two said that they would like more up to date information about how the home are addressing some care issues as they were not able to see evidence of progress. One visitor expressed some unhappiness about the care. Two visitors expressed concern about residents calling out for assistance and this not being addressed. One visitor said that they had found that there had been recent improvements in that there were now some activities and the home was cleaner. One resident who was interviewed said that the care “comes and goes” and that it varied depending on the staff on duty. Another resident said that the care had been delivered satisfactorily on the day of the inspection but other days it could be poor. Three other residents spoke positively about there care one said that staff would come in now and again and another that staff would come if not seeing to somebody else. A number of residents spoke warmly of staff and expressed some concern about the turnover of staff. Medication findings as reported by Mr Mark Andrews (Pharmacy Inspector): On arrival for inspection the morning medicine round had been completed therefore residents prescribed medicines for morning administration receive them closer to the scheduled time. This is an improvement when compared to previous pharmacy inspections. The home has put in place resident identifying photographs alongside records of medicines administered (MAR) charts to assist in the safe administration of medicines but at the time of inspection, some were missing. Ophthalmic medicines considered of limited life on opening are routinely dated at their time of opening, however, one container available for administration in one of the medicine trolleys was found to have exceeded its expiry time. Since previous inspections the home keeps some care note records indicating the circumstances in which sedative psychoactive medicines are administered at the discretion of registered nurses, however, many were still omitted and many did not specify the exact circumstances leading to such decisions being made. There are mostly no written resident-specific guidelines in place for these medicines to which registered nurses can refer to when considering their DS0000024358.V337735.R01.S.doc Version 5.2 Page 14 administration. The need to provide these is set out in the home’s medicine policy document. The inspector found there to have been an overall improvement in the home’s medication record-keeping practices. There were fewer omissions in records for the administration of medicines, however, there were some medicines prescribed for external application in particular where records were incomplete indicating that they were not being applied as prescribed. For example clobetasone butyrate cream is prescribed for twice daily use but is recorded as applied once daily on some mornings only. There were improvements in the recorded prescribed dose directions against which medicines could be safely selected for administration. There was evidence that medicine dose changes were being recorded along with records of the authorising doctor and their date of change. The home has put in place audit trails for all medicines, however, the use of the audit was found to be sometimes confused by staff by duplicating records of the receipt of medicines. On using the home’s audit trails of medicines to conduct a sample audit the inspector found some improvement but there were still some discrepancies occurring (e.g. a deficit of one warfarin 1mg tablet). These findings were confirmed by the home’s own internal audit which Mr Peacock said was being undertaken on a weekly basis. The findings of the inspection audit were discussed with Mr Peacock and Ms Ninan as there is still some concern that medicines may still not be administered in line with prescribed instructions as not all medicines can be accounted in full. Training is planned for 08/05/07. Mr Peacock stated that all members of nursing staff authorised to handle and administer medicines will be attending. Subsequent to inspection, the home’s medication policy document was examined and found satisfactory. Since previous inspections the home has obtained a second medicine trolley which is located in a ground floor locked walk-in cupboard when not in use. Medicines stored within the trolley are administered to residents living on the ground floor. The second medicine trolley provides improved working arrangements for medicines and reduced risk of errors. The home has also conducted a risk assessment for prescribed external medicines (creams, ointments etc) stored in 14 residents rooms. The risk assessment considers these arrangements to be currently safe. DS0000024358.V337735.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. People who use this service can expect to receive well-presented meals and to maintain contacts with their friends and family. They can access a limited range of activities but some of their choices are limited by the homes staffing and equipment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ an activities coordinator and care staff are responsible for organising and delivering activities to residents. This has been an area where the home have previously been required to address and there was evidence at this inspection of some progress. There was a list of activities on the display board in the entrance to the home. The planned activities included events such as music and cards. On the third day of the inspection a member of agency staff was observed playing a board game with 2 residents. Music was playing softly in the background. DS0000024358.V337735.R01.S.doc Version 5.2 Page 16 In the residents records examined there were no records available on activities and how the needs of the residents such as those with dementia could be met. The inspector observed visitors coming and going throughout the day and spending time with residents in their bedroom or in one of the lounges. Visitors who were interviewed reported that staff were welcoming and accommodating. Observation of care practice on the day of the inspection showed that some residents are not washed and dressed to lunchtime. This has been picked up as an issue at the home over the last 4 inspections and relates to staffing levels and availability of hoists rather than residents choice. Residents were observed being given a mid-morning drink and jugs of water were placed in residents rooms. The meal served on the day of the inspection looked appetising. There was a choice available and some meals were pureed. One of choices was battered chicken, which one resident had left and reported that it was difficult to eat. Meals were covered while being transported to resident’s bedrooms and while there are plans to purchase a hot trolley this had not yet been actioned. Residents interviewed generally spoke highly of the food and one said that it was one of the best aspects of the home. DS0000024358.V337735.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. People who live at Chilton Croft can expect to find a complaint procedure in place and that their concerns will be investigated. Protection issues are taken seriously when drawn to the attention of the homes management, but residents would be better protected if staff were trained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure was on display but was out of date and referred to the previous home’s management. The acting manager said that he was aware of this and was due to address it. CSCI have received two complaints about the service since the last key inspection, which were forwarded to the home’s management for investigation. There were shortfalls in the investigation undertaken by the previous owners and these were followed up at the random inspection in December 2006. The home complaints log was examined as part of the inspection and there was some evidence that the acting manager was taking complaints seriously and investigating matters, which had been drawn to his attention. The acting manager said that he had now obtained the latest guidance regarding vulnerable adults and had made contact with the local authority DS0000024358.V337735.R01.S.doc Version 5.2 Page 18 regarding the provision of training to staff. Staff have not all undertaken POVA training. The new owners are aware of their responsibilities in relation to the safeguarding and protection of residents. When they became aware in the December 2006 inspection that there were staff working at the home without all the required checks they acted swiftly and asked staff to return home until the recruitment process was complete. DS0000024358.V337735.R01.S.doc Version 5.2 Page 19 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): 19,22,26 Quality in this outcome area is adequate. 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. However people cannot be assured that there will always be sufficient and reliable equipment available to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and the entrance hallway had been painted. New carpet had been fitted. The home’s management have put into place a plan for addressing odours, which has included a new cleaning rota. There has been some progress and the odours had reduced since the last inspection. The entrance and communal areas smelt fresh but there remained a strong odour in one of the bedrooms visited. A crash mat was in use for one resident but this was stained and unattractive. DS0000024358.V337735.R01.S.doc Version 5.2 Page 20 Resident’s rooms were individually furnished with evidence of personal items of furniture and ornaments. The laundry was not visited as part of this inspection as the standard was found to be met at previous inspections. Liquid soap, aprons and paper towels were seen to be in use. There was a problem with the hot water on one of the days of the unannounced inspection and staff were having to transport hot water to residents bedrooms to wash residents. The inspector was informed by the acting manager that this was a temporary problem as the result of the gas engineer visit the previous day and should be resolved within a short period. The home operates with three hoists one of which has been purchased since the last key inspection. The resident group is highly dependent and the majority of residents require a hoist to mobilise. In the mornings the hoists are continually in use and this has meant that residents have had to wait for a hoist to become available before they can be assisted for example to use the commode. 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. One resident whose care was tracked had required a commode to mobilise but had been reassessed and was now mobilising with staff assistance. 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 one resident was found to have the call bell out of reach and in another bedroom the cord was sitting on a table and the inspector was informed that the bell was broken. Neither resident were mobile. The acting manager said that residents could be moved while matter was being repaired however this is not fully satisfactory. The inspector was subsequently informed that the broken call bell had been repaired however concerns remain about the overall viability of the system. DS0000024358.V337735.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. People living at Chilton Croft cannot be assured that permanent or trained staff will always care for them although steps are being taken to improve recruitment and training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Shortfalls in staffing levels have been identified at the last key inspection and at random inspection visits. Following the last random inspection in March 207 the home’s management agreed not to admit any more residents until some of the outstanding care issues were addressed. On the day of the inspection there were 24 residents living at the home 16 of whom required a hoist to mobilise. The duty rotas were seen and showed that there was 1 trained nurse and 6 carers on duty to cover the morning shift. The trained nurse was a permanent member of staff but three of the carers were from an agency. The inspector was informed that the home was making efforts to recruit permanent staff but there had been delays in the recruitment process and some staff who they had planned to appoint had gone elsewhere. As outlined earlier in the report staff were observed to be busy on the day of the inspection although fewer bells were ringing on emergency than on DS0000024358.V337735.R01.S.doc Version 5.2 Page 22 previous inspections. However all the residents were not washed and dressed until 12.30pm. Both residents and staff informed the inspector that the home was experiencing considerable staffing turnover. The home’s recruitment procedures were not examined at this inspection as they had been inspected the month preceding the inspection and requirements were made. The home has indicated in their action plan that this has been addressed. This requirement will be followed up at a future inspection of the home. The inspector was informed that three senior staff have undertaken NVQ 3 but the home does not have 50 of care staff with a NVQ level 2 qualification. Three members of permanent staff and one agency carer were interviewed as part of the inspection. Carers had been provided with manual handling training and wound care. Food handling and hygiene was planned but one of the carers interviewed had not undertaken training in infection control, dementia or protection of vulnerable adults. The inspection in August 2006 found induction training had been provided but there has been a period where it has not been. The acting manager said that he was in the process of developing an induction programme for new staff but this had not yet been implemented. The acting manager said that he and two trained nurses were undertaking a dementia training course on a part time basis. DS0000024358.V337735.R01.S.doc Version 5.2 Page 23 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): 31,33,35,38 Quality in this outcome area is adequate People who live at this home have begun to experience management who have started to address concerns. This strengthening of the management arrangements should improve people’s care and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been a change in the ownership of the home. A new registered person has been identified and has attended the Commission offices to undertake a Criminal Record Bureau check. An acting DS0000024358.V337735.R01.S.doc Version 5.2 Page 24 manager has started to work at the home and after some delay has begun the process of applying to be registered. The new owners met with the residents and their families in December 2007 and the minutes of this meeting were on display on the notice board. Residents and staff told the inspector that the new owners visited the home regularly. Quality assurance is at an early stage of development although there was some evidence of some audits being undertaken particularly in the area of care planning and medication. Resident questionnaires were on display in the entrance hall however the acting manager reported that none had yet been completed. The acting manager had met with the majority of staff including night staff on an individual basis to start a system of regular supervision. The acting manager informed the inspector that the home does not handle the personal allowance or monies belonging to residents and therefore no records are maintained. A sample of records were examined as part of the inspection. Accident records were being maintained, and records of the servicing of the hoist. A gas engineer had visited the home in relation to the outstanding requirement. The engineer had identified a further issue and had left a warning notice. The inspector was shown a manual handling folder which was being developed to give guidance to staff. Individual slings for service users were being purchased and it was intended that these would be kept in resident’s bedrooms. The inspector was informed that the acting manager had commissioned an independent audit on health and safety arrangements at the home and this had been undertaken in the week preceding the inspection. The home was awaiting the findings. At random inspection in March 2007 it was found that a number of the windows did not have window restrictors in place. This matter had been addressed at this inspection. Since the last inspection the fire officer has written to the home identifying measures, which must be taken to protect residents in the event of a fire. As a consequence new self closing devices have been fitted . One fire door was found to be propped open as the automatic door closer was broken. This had not been repaired by the third day of the inspection. DS0000024358.V337735.R01.S.doc Version 5.2 Page 25 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 X 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 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/a 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X 2 DS0000024358.V337735.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 12(2) Requirement The manager must ensure that residents are cared for by staff that are aware of their needs thereby ensuring that they will receive appropriate support. Resident’s care plans must be clearly documented as to resident’s needs and how their care will be delivered and monitored. Staff who work at the home must be aware of the type of food that is appropriate for residents and the amount of assistance that they need to eat. Where residents have not eaten this must be monitored. Residents must be provided with accommodation which is free from unpleasant odours. The home’s management must ensure that existing staff are trained to meet the needs of the current residents Residents must be provided with reliable means to call for assistance in an emergency Timescale for action 01/07/07 2. OP7 15 (1) & 13 (c) 01/07/07 3. OP15 12(2) 01/07/07 4. 5. OP26 OP28 OP30 16 (2) (k) 19 01/07/07 01/07/07 6. OP22 23 13 12 16 (c) (4) (3) (2) (c) 01/08/07 DS0000024358.V337735.R01.S.doc Version 5.2 Page 27 7. OP38 23 (4) (a) & 13 (4) (c) 8. OP27 12 & 18 9. OP27 18 10. OP38 23 (4) 11 OP9 13(2) 12 OP9 13(2) With regard to the visit by the gas engineer, the home management must evidence that the home is being maintained safety and residents are not been placed at risk. Residents must be assisted as far as practicable to be washed and dressed at a time of their choosing Residents must be cared for by staff who have undergone a period of formal induction in the care and conditions relating to older people Repairs to fire safety measures must be undertaken quickly to ensure resident safety in the event of a fire. People who use the service must have psychoactive medicines safely given at the discretion of nursing staff only when it is clinically justified. People who use the service must have prescribed medicines given to them in line with prescribed instructions at all times. 01/07/07 01/07/07 01/07/07 10/06/07 10/06/07 10/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that medicines considered to be of limited life on opening are frequently checked to ensure they are not in use following their expiry times. It is recommended that for medicines of a psychoactive and sedative nature that can be given at the discretion of nursing staff there are written individual resident guidelines in place on their use as per the home’s medicine policy document. DS0000024358.V337735.R01.S.doc Version 5.2 Page 28 3 OP9 It is recommended that resident-identifying photographs are made available alongside record for all people who are administered medicines to assist in safe medicine administration. DS0000024358.V337735.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000024358.V337735.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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