Inspection on 29/04/09 for Chilton Croft Nursing Home

This inspection was carried out on 29th April 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 24/11/09

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN Lead Inspector Kevin Dally Key Unannounced Inspection 29th & 30th April 2009 10:00 DS0000024358.V375555.R01.S.do c Version 5.2 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.V375555.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.V375555.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.V375555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd December 2008 Brief Description of the Service: Chilton Croft is situated about one mile from the centre of Sudbury. It offers nursing care to thirty-one residents in a large two-storey house that has been developed for the purpose. A variation to the registration allows the home to offer care to up to six residents with a diagnosis of dementia. The home has two large lounges that both have a conservatory which overlook 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 range from £380 to £700 per week. This figure was obtained from the provider of the home. Chilton Croft Nursing Home DS0000024358.V375555.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. This key inspection was undertaken on the 29th and 30th April 2009 by Kevin Dally, inspector, and Mark Andrews, pharmacy inspector, and the home were not told in advance that we were coming. This inspection followed up on the previous shortfalls, specifically around the ‘management of the home’ outcome area, and the way in which medicines were managed. The seven outcome areas that apply to people who are elderly were reassessed to see if the home was meeting these outcomes for the benefit of the residents. Mr Diwan, the company director who was acting as manager at the time of inspection was present throughout and provided information as requested. At the last key inspection in October 2008, the home was able to show us that they had improved in two of three key outcome areas, ‘personal healthcare’ and ‘complaints and protection’. However, the outcome group ‘management of the home’ including management of medicines, was still assessed as poor, so was causing us concern. Due to these shortfalls, we continued to undertake additional random inspections in December 2008, March 2009, and April 2009, to ensure compliance with the regulations. At our random inspection in December, the home did not adequately meet the health and personal care outcome areas around the safe management of medicines. Therefore a statuary requirement notice was issued on the 29th January 2009, which required the owners to improve the medicine processes at the home, or face legal action. The inspection in March showed improvements to the management practices, and our inspection today showed us this standard was now met. While it was good to see the home had improved the medicine practices, we were concerned around the length of time that it had taken for the home to resolve these outstanding problems. During the inspection, we reviewed the home’s care planning and assessment processes, to assess if the home was meeting the residents’ health and medical care needs. We checked to see how the home ensured good social opportunities for the residents and if their choices and dignity was being respected. We also assessed how the home was currently being managed including checking quality assurance procedures, complaints and concerns, staffing at the home, and the management of health and safety issues. We checked to see if staff were being appropriately recruited, trained and supervised to ensure that they are supported to meet the needs of residents. We toured the premises and were able to spend time with some of the residents (10) and staff (9), and talk with some of the relatives (6) visiting the Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 6 home. This gave us information about what people thought about the home and the quality of the care provided. Some residents care plans; residents’ and staff records, maintenance records and training records were also checked. The Care Quality Commission (CQC), also sent surveys to the home to distribute, prior to the inspection. Comments were received from 2 residents and 2 staff members, who provided us with feedback on how they thought the home was being run. A selection of the residents, relatives and staff members views and opinions about the home, are included within this report. The director also provided us with the CQC annual quality assurance assessment form (AQAA). This enables the home to inform us on how well they are meeting the national minimum standards, and allows them to say what they do well, what they could do better and any plans to improve the service. Some of the information from this document has been used in this report. A tour of the building was completed which included checking the two lounges, the dining room, and a sample of several residents bedrooms, with the residents’ permission. What the service does well: Feedback received from relatives said, ‘There has been a gradual improvement at the home, with more things to do’, or ‘The staff are really good and have been wonderful to us. I feel my relative is always well cared for’. This inspection showed us that the home continued to make progress in improving the care and services they provide for the residents. Significant progress has been made in the way in which they care for people with dementia, and this was seen by a more empowering and inclusive approach towards these residents. Well planned activities ensure that the residents enjoy meaningful lifestyle opportunities, and more poorly residents gain appropriate nursing support from suitably qualified staff. People benefit from having their needs assessed, and a plan of care provided which outlines how staff should meet their particular care needs. The home provides catering services with a variety of planned menu options that meet the residents’ nutritional needs. People who live at the home are benefiting from continued improvements to the fabric of the home including, redecoration and carpeting to some of the bedrooms and hallways, which provide them with comfortable accommodation. The home has a redeveloped rear garden space with new grassed areas and gardens, and which is wheelchair accessible by access paths. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 7 People who use this service can expect staff to be adequately recruited and trained. Staff are helpful towards the residents and who support their physical care needs. Peoples’ complaints and concerns would be investigated and the home would resolve these to the residents’ satisfaction. What has improved since the last inspection? What they could do better: This inspection showed us four of seven outcome groups at the home are now operating at a ‘good’ level, with three outcome areas assessed as ‘adequate’, therefore the home now provides residents with an ‘adequate’ service. Areas that need to be resolved are that the statement of purpose must be updated to include the relevant terms and conditions of the service provision, so that residents can make an informed decision about whether to move into the home. The home must ensure that an appropriate medicines cabinet is installed to provide safe storage of medicines. Further staff training must be provided which ensures that staff members have received appropriate training so that they can meet the care needs of the residents at the home. Recommendations included that the home should ensure care plans reflect more detail around the residents’ emotional and social care needs, and end of life care needs. This is to ensure that their choices and preferences are recorded, so that staff can meet these needs. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 8 The home should put into place a further robust auditing system undertaking regular checks to account for medicines and take prompt action when discrepancies are identified. An appropriately qualified, skilled, and experienced manager should be recruited and appointed without delay. This is to ensure that the home and residents benefit from a suitably managed service. To ensure the health and safety of the residents, the following measures should be reviewed. Radiators without protector covers should be risk assessed to ensure that these pose no risk to the residents. The home should ensure that the garden pond is risk assessed to ensure that it poses no risks to vulnerable residents. 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.V375555.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 who use this service can expect to have their basic needs assessed and met by adequately trained staff to meet their care needs. EVIDENCE: The information provided by the home (the AQAA) told us, ‘We offer prospective residents our brochure (now being updated), statement of purpose, terms and conditions, including nursing and residential fees etc and a pre visit to the home’. We were provided with a copy of the ‘statement of purpose & function’ brochure, which was last updated in December 2008. This showed us that detailed and helpful information had been provided around the aims and objectives of the home, the type of service they could offer including for those Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 11 with dementia, the organisational structure of the home, and the numbers and qualifications of the staff group. The brochure referred to the managing director, Mr Sammy Diwan, as in current day to day control of the home, as the current manager’s position is vacant. There was good information around how a resident can make a complaint to the service. This said, ‘All complaints would be treated seriously and there will be a timely response to the resident whether or not a resolution has/not been found’. This brochure did not include information for the residents around the terms and conditions of the accommodation to be provided or the amount and method of fees payable. However the director told us that the brochure was currently being updated. The surveys we received from two residents told us, ‘yes, we did receive enough information about the home, before we moved in’. The annual quality assurance assessment (the AQAA) said ‘We have introduced a more in depth pre-admission assessment form, which has enabled the management to formulate a more comprehensive care plan to provide ‘person centred care’ to the resident’. Two residents’ records were checked and these both included nursing assessments, which had been completed by the home. The assessments provided adequate information around 11 areas of assessed care need and were sufficient to ensure that care plans could be produced. The information provided in one resident’s assessment, for example, around eating and drinking, told us the resident ‘has severe dysphasia so will require thickened fluids, a puree diet, and their weight fluctuates. They are under the dietician so needs dietary supplements, feeding and full supervision’. This information had been transferred to the full care plan. During the day we spoke with this relative’s family and they told us, ‘The care received at the home was really good, and staff had been wonderful’. Since the last inspection, the home was able to show us that they continued to improve their staff training programme to ensure staff had sufficient skills and training to meet the needs of the current residents. For example training records showed us that 8 staff had recently received infection control and food hygiene training, and 13 staff had received dementia training. Two staff surveys we received told us they had received training that was ‘relevant to their role, and this helped them understand and meet the needs of the residents’. One nurse’s training records checked showed us they had received training around holistic palliative care, skin and wound care training and enteric feeds training. The home told us that 47 of the care staff (8 of 17) had now achieved a national vocational care qualification (NVQ) level 2 or above, with the remaining care staff working towards this award. At the previous inspection this was 25 , although 6 staff had been working towards this award. This is a positive improvement, and tells us that the home now almost meets this standard. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 12 Surveys (CQC) received from 2 of 2 relatives said that the care home ‘usually or always’ meets the needs of the residents, and that staff have the right skills and experience to look after people properly. A sample of the feedback received from some of the residents or the relatives, made the following comments about the home. ‘We are impressed with what they do. All the carers are marvellous, dedicated staff’. ‘The care my relative receives is good. They are always in appropriate clothing, are well cared for and always included’. ‘We have had to raise a care concern with the home today which we were not happy about. However, they are always good at dealing with problems, and the home is making lots of effort to improve things’. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 receive adequately planned nursing care that meets their healthcare needs, although some medicine practices may put people at risk. People are treated with dignity and respect. EVIDENCE: The AQAA told us what they do well. They said, ‘We have a comprehensive care plan for each resident which covers their personal, social and healthcare needs, which is updated monthly. Care plans are formulated with the help of residents and their families’. At the previous inspection in October 2008 we observed that the care plans reflected the range of care needs for those residents, including those with dementia. We found that the care plans had included core information around their physical care needs but could be improved with respect to some of the information around their personal wellbeing and social care. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 14 At this inspection we looked at two residents’ care plans who we saw had very high nursing care needs. In total we spent time looking in detail at 5 residents’ care, who reflected the range of care needs the home is currently looking after. This included two residents with dementia, and three with either high or low nursing care needs. We spent time with these residents, and received feedback from them about what they felt about the level of care they were receiving. Of the residents who were unable to fully communicate with us, we observed their care, or spoke with their relatives, to gain feedback. With the information we gained from them, we looked to see if this reflected the information given in the care plan. Our observation of the care practice showed us that the residents were being adequately cared for and supported. This was also confirmed by some of the relatives we spoke with. We saw that the residents, including those with higher care needs, were well groomed, in their own clothes, and their hygiene and care needs were being attended to throughout the morning. During meal times, individual staff supported the more vulnerable residents with their meals and fluids. It was also good to see that more vulnerable residents are included within the home’s social programmes, so reducing their anxiety and isolation. Feedback from the residents able to speak with us said they were satisfied with the care they received. One resident told us ‘I cannot dress myself, so staff help me’. Their relative said, ‘The staff are always very good to our relative’. The family of another resident who had dementia told us, ‘We are impressed with what the staff do. All the carers are marvellous and dedicated’. They also told us that ‘the bell was always answered, but if staff are busy, they will explain when they would be able to return, usually few minutes later’. Another relative of a very poorly resident who was receiving end of life care, told us, ‘The staff are really good and have been wonderful to us. I feel my relative is always well cared for, properly dressed, and included, even though they are poorly’. From the time spent talking to the residents and staff, we found that the information in the care plan adequately covered their physical nursing needs, moving and handling needs, nutrition and pressure area care needs. Two more highly dependent residents had a daily record of their fluid and food intake, which had been completed, were up to date, and signed by the staff. This gave us evidence of appropriate care practice. The residents’ care records also showed us that home staff continued to work with medical healthcare professionals, for example the community nutritionist who offered advice around their nutritional needs. We observed several residents being supported with their meals, as outlined in their care plans. One relative told us, ‘I have no concerns about my relative not being fed or cared for properly or being neglected. The staff and home are great, are very supportive and they clearly explained “end of life pathways” to me.’ Although the care plans did include some information around peoples end of life care needs, this could be Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 15 improved by the addition of a section with more details around their end of life care needs. One of the care plans checked showed us their individual preferences, likes and dislikes, under the section on ‘Promotion of wellbeing’. Statements like ‘encourage clear communication to promote reminiscence and discussion’ or ‘reduce environmental excessive loud noise’ identified some preferred care. Some information around their individual preferences and choices was lacking from the care plans. The contents of the care plans we checked reflected the staffs’ practice of focusing on the nursing and physical aspects, but these provided limited information around their emotional and social aspects of the residents’ care. The focus of care plans we checked focused on the resident’s problems – rather than including what they can do. However the home provided a ‘diagram of care’ with a brief assessment of some of the person’s normal daily routines and preferences. For example, ‘daughter visits in afternoon’ or ‘likes coffee with 2 sugars, and add thick and easy 2-3 scoops’. One of the nurses we spoke with said that care plans could be improved, but informed us that the home was in the process of reviewing and changing these. Some of the improvements they were planning to include were new assessments including new cot side assessments, body charts to record any new injuries, and photographs of any wound care areas. The nurse told us that any residents being nursed on their bed were currently being reviewed and specialist chairs with reclining functions were being considered, to ensure they could better meet their specialised needs. One high dependency resident we saw was now being nursed in a specialist chair, and looked well cared for. We also spoke to the manager about the shortfalls in some of the care plans and we were shown some of the new care plans that had been developed for people with dementia. These included pictures and key statements about the persons’ background, family, previous work situations, their preferences, likes and dislikes, and were very good. Care plans for high dependency residents did not include detailed information around their emotional and social needs. Throughout the day, we saw the staff working with the residents in a positive and caring way. Staff were respectful and kind and treated the residents with dignity. Residents were given opportunities to make choices about their care or meal. One relative we spoke with told us, ‘The staff treat the residents with kindness and patience, dignity and respect’. We also saw staff knocking on the residents’ doors before entering, and ensuring that care was conducted in the privacy of their own rooms. Each resident’s door had their name and picture of them on this, for easy identification. The accident records for the home were checked for the last 6 month period (10) and these showed us that there had been a significant reduction in the amount of falls, when compared with the previous 6 month period (35). This Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 16 was around a 60 reduction. The manager told us that this was because there were now more staff around to meet needs, better monitoring of the residents, and that the activities programme now provided stimulation and interest for the residents. This inspection confirmed that the residents, including those with dementia, were provided with regular and stimulating afternoon programmes, which many residents joined. (Please refer to the next section for details). The inspection of medication management was conducted by the Commission’s pharmacist inspector Mark Andrews following serious issues raised during the previous key inspection in October 2008. The Commission issued a statutory requirement notice on the 29th January 2009, in relation to the home’s management of medicines and has since conducted a further two visits and found an overall improvement in the way the home manages medicines for people living there. During this inspection, we found that medicines were being kept securely. Medicine trolleys were well organised and contained only medicines that were actively prescribed and administered. A cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations has still not been fitted in the medicine storage room for the special storage of controlled drugs, however, at a previous visit in April 2009, we agreed with the manager to extend the timescale for this as a cabinet that had been obtained was not sufficient in size and needed to be replaced. At the time of arrival for inspection, the registered nurse on duty confirmed that medicines scheduled for the morning of inspection, with the exception of one person’s who had been asleep, had by now all been given. When we looked at medication charts currently in use, we found only one record that had not been completed for a person’s paracetamol tablets scheduled for administration the morning of inspection. We also found some other recent omissions in records for the administration of medicines, however, there has been an overall improvement since previous inspections and the home is monitoring for such omissions. During the inspection we conducted an audit of medication available for administration against records for their receipt and administration at the home. Of a sample of medicines audited we identified several discrepancies including medicines prescribed with variable doses and where the actual dose administered was not recorded leaving records of medicine administration unclear. The home has put in place a system to enable all medicines to be accounted for and has recently started its own regular internal audits identifying some discrepancies; however, we noted that the audit records were inadequate and not dated. The manager informed us on discussion that a consultant to the home had provided a proper audit tool but that this had so far not been implemented. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 17 There was evidence that a recent and complex reducing schedule had been competently handled and recorded by staff and audits of warfarin prescribed for anti-coagulation were satisfactory. We found that anticoagulant blood testing had been undertaken and information about dose schedules following the tests was available. The schedules were clearly set out on medication charts representing further improvement. We found no evidence since the previous visit that medicines have been unavailable at the home to administer because they had not been obtained in time. The home now has people’s identifying photographs and other associated information available alongside medication charts to assist in safe medicine administration. We observed part of the lunch-time medicine round and saw procedures followed by the registered nurse were satisfactory. The nurse completed records of medicine administration for people following successful ingestion of medicines and confirmed to us that medicines are no longer left with residents to take unsupervised at later time. We found the nurse to be experienced and have a sound knowledge base on medicine management in care homes. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 18 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): 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 expect a choice of lifestyle opportunities that meets their specific needs including those with dementia. EVIDENCE: The care and support needs of the residents at the home are quite diverse as some of the residents require nursing support, and others require dementia care. Therefore the residents’ daily lifestyle needs will vary. Previous inspections had raised concerns around a lack of some appropriate lifestyle opportunities for the residents, particularly those with dementia. Positively the home has reviewed and changed the way they now deliver some of the social care and support for these residents. A significant change has been to better utilise the building space. The manager told us that nursing care is now mainly provided on the first floor, with dementia care on the ground floor. This enables specialist help to be concentrated where it is most needed. A once infrequently used ground floor lounge has now been successfully converted to an attractive area devoted for Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 19 the support needs of the people with dementia. During a random inspection of the home in March 2009, we made the following observations. ‘The manager told us that the second day room had now been reorganised specifically to meet the needs of people with dementia. On checking this we saw substantial improvements, including more space and light allowing for new tables and chairs to compliment the lounge chairs already provided. There were new pictures of interest, fixtures and fittings. There were reminiscence objects and many points of interests throughout for people with dementia. For example, a series of tennis rackets were fixed to the wall, an old gramophone and records were on display, as were a board of door handles for the residents to experiment with’. This inspection showed us that since our random inspection in March 2009, the home had continued to improve their activities programme. Memorabilia boxes with different themes, for example ‘the war years’ had been introduced, and were displayed at various locations throughout the home. Considerable work and effort had been put into these boxes by staff to improve the quality of the home experience for the residents. The manager told us that staff use the memorabilia boxes as talking points with the residents, to create conservation relevant to them, and help them relate to the experiences they are able to recall. During the afternoon period, we joined some of the residents in the lounge, with their activities programme and we learned that activities are provided for the residents most afternoons of the week. The session was very relaxed and attended by 6 residents. A relative’s family who were visiting them, had been invited to join the session. The activities co-ordinator led the discussion and engaged all the residents in a very empowering way. People were talking about yesterdays ‘wine tasting session’, and other experiences and today were enjoying a ‘tasting’ session with fresh raspberries, marshmallows, and drinks. We spoke with the relatives who had joined in, and they told us that they often visited the home. They said ‘this is normal practice and happens everyday. It is impressive to see what they do. Things are arranged and done for a purpose’. The activities co-ordinator told us about the current activity programme. They told us that this included themed meals, for example a ‘Hungarian traditional meal’ or a ‘couples special evening’. Other events included tasting sessions where cake, wine, chocolate, cheese or fruit was themed in the sessions, and the residents offered different samples. The residents we spoke with told us they ‘really enjoyed these sessions’, and were something ‘to look forward to’. There were also Laurel and Hardy movies, or the local primary school choir had been invited to sing for the residents at the home. There had been an arts and craft session, games, bingo, and reminisce photo sessions. Positively, time was spent on a one to one basis with some of the residents in their own rooms. Some of the residents’ records we checked for those with dementia, showed us that the home had a ‘memory record’ which included detailed information and Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 20 photos around their place of birth, a professional profile, information about their family background and working life, their likes and dislikes, and any favourite pets. This was very helpful and informative information which would help the staff group better understand the resident as an individual. Feedback from the residents or relatives had the following views about the life at the home and the care received. ‘Our relative spends time in their room but the staff pop in all the time to see how they are. The staff always encourage them to join in the activities downstairs’. ‘People working here are very caring, and the residents get good care. There have been a lot of changes; many things are now done for the ones who suffer from dementia. There is a great deal of social interaction; many activities are done all the time. The homes now cater more and more for the social needs of the people here. The food is very good and the residents; nutrition is well taken care of’. ‘Our relative is well cared for, and always included in any of the home’s events’. ‘I was taken into the garden last week which I enjoyed. The record player is played over and over which I don’t enjoy’. ‘Our relative joined in the ‘fruit tasting and wine session’ recently. There are also themed meals usually on the last day of the month. They have had a Suffolk night with roast pheasant, an Italian meal, a mother’s day meal, Chinese food, and a birthday cake on their birthday. They really enjoy these events’. During the day residents were able to receive visitors including friends and families when they wished, and we met and saw relatives throughout the day. Relatives told us they were able to visit the home with out any restriction paced on them, and were made to feel welcome by the home. One relative told us, ‘We are invited to join in with the activities’, while another commented, ‘The home have supported our family’. During the lunchtime period we observed the meal being served to the residents in the lounge. Some of the residents remained in their own rooms and were assisted by individual staff members. The meal was unhurried and served hot to the residents directly from the kitchen. One resident said, ‘I have a good breakfast, and smaller lunch, which I prefer. They make a good job of the sandwiches in the evening. The lunch today is nice’. The meal was a choice of pork loin with plum or cheese and potato pie with bacon, and served with broccoli and carrots. Dessert was fruit salad. Drinks were served to the residents and/or their visitors at regular intervals throughout the day, and Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 21 during the activities session. The residents we spoke with in their bedrooms, had a jug of fluid available for their use. We checked a sample of the menu for the rest of the week which provided other meal options like shepherds pie or vegetable quiche, beef stew dumplings or mushroom stroganoff, chicken bacon melt or fish cake, fish and chips or poached salmon, roast lamb or tuna mayo salad. The current week’s menu was displayed in the hallway and provided with colour photos of some of the key choices. We also observed one vulnerable resident being assisted by a member of staff in their own room, and the meal was unhurried and timed to meet the resident’s needs. The meal had been pureed in constituent parts, and looked and smelt appetising. A recent kitchen check by the environmental health officer had found some shortfalls in the way in which kitchen staff had risk assessed their food handling procedures. The documentation had been updated and reviewed by the officer, and was now at the required standard. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 – 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 expect the home to have their complaints taken seriously and action taken to ensure that they are kept safe from harm. EVIDENCE: The information provided by the home told us, ‘We have robust complaints policies and procedures in place which are made readily available, and have been improved. We have appropriate policies and procedures on abuse, protection of vulnerable adults and discrimination’. The home provided us with a copy of their complaints procedure and this showed us how the home would deal with informal or formal complaints. The policy said that complaints to the home would be investigated and an outcome provided within 28 days. The home’s complaint book was checked and this showed us they had had received 3 complaints in the past 6 months. The complaints had been recorded, were appropriately investigated, and an outcome provided to the complainant. The three complaints were upheld and were around a cold meal, and 2 inadequately maintained rooms. As a result of these concerns, the owners had spoken with the cook about the meal, and redecorated the Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 23 resident’s rooms. Records indicated that the residents were satisfied with the outcome. There was company policy for the safeguarding and protection of vulnerable adults (POVA), with information and instructions on what staff must to do. The owner was aware of his responsibilities in reporting any allegations of abuse to the social care team for further investigation. There had been one safeguarding alert to the police within the last 6 months, around theft at the home from a resident. The matter had been fully investigated by the police, and the alert had been closed. The home fully refunded the residents losses. As a result of this alert, the home has reviewed its financial procedures, and residents are offered safekeeping of money. Two residents money was checked and the records matched with the cash held. A check of the home’s staff recruitment procedures showed that new employees are appropriately checked and cleared to work with vulnerable adults. (Please refer to standard 29). Discussion with the management and staff records checked confirmed that adult safeguarding training had been provided for all staff. This was to ensure they knew what to do in the event of any allegations of abuse by a resident. We asked some of the relatives if they knew how to raise any concerns with the home. One relative told us, ‘The new boss asked me to go to him, if I had any concerns. I can talk to him as he is very approachable’. Another relative said, ‘If we had any concerns, we know they will be resolved’. One relative who had a very poorly relative being cared for by the home said, ‘I have never had any concerns about our relative’s care or about them being fed properly, cared for, or being neglected. The staff at the home are great and very supportive’. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 a comfortable home where effort continues to be made to improve the environment. People with dementia can expect an environment that has been adapted to meet their specialist requirements. EVIDENCE: The previous key inspection identified that while the home provided care and support for 6 people with dementia, the environment had not been adapted to meet these specialised needs. The home has since reviewed this situation and changed the environment. During our random inspection in March 2009, we noted that the home has improved the environment. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 25 This included re-carpeting many worn out hallway areas, and a number of the residents’ rooms. Refurbishments of individual rooms were in evidence, including new fixtures, fittings and furniture. The front door now had a key pad to protect vulnerable residents, and relatives are made aware of the key code, to avoid delaying them on leaving. The second day room had now been reorganised specifically to meet the needs of people with dementia. This included substantial improvements, including more space and light allowing for new tables and chairs to compliment the lounge chairs already provided. There were new pictures of interest, fixtures and fittings. There were reminiscence objects and many points of interests throughout for people with dementia. For example, a series of tennis rackets were fixed to the wall, an old gramophone and records were on display, as were a board of door handles for the residents to experiment with. During the inspection today we toured the premises and grounds again, and saw that the home’s owners continue to substantially improve the fabric of the building and grounds. The reception area has been reorganised with a large staff notice board that introduces the staff group to the relatives and visitors. The main day room has had new pictures and memorabilia added of famous actors and movies from the past, which generates conservation points for the residents, and is now decorated, to the same standards, as the second day room area, as already described. Two of the radiators we saw in the main lounge did not have radiator covers in place, although they were behind some of the furniture, and were operating during the inspection. The hallways and stairwell have been repainted, and re-carpeted, and this has further improved the overall appearance of the building. At the last random inspection on the 6th March 2009 we raised concerns that both upstairs showers were unable to be used by staff as there were no working shower chairs. The home showed us that they have now purchased two new shower chairs for the benefit of the residents. No further concerns were raised about this issue. The home has also recently substantially redeveloped their rear garden space with new grassed areas and gardens, and which are wheelchair accessible by several access paths. There are points of interest by way of new potted flower plants, garden furniture, and a pond which the residents can enjoy. The pond was noted to be unprotected from a resident falling in although this had not been filled with much water at this stage. During the inspection we observed and spoke with cleaning, laundry and kitchen staff who continued to maintain the home to good standards. Domestic staff were seen cleaning throughout the home, and staff used protective aprons and gloves for infection control purposes. A number of the residents’ rooms were checked, and these were found to be adequately maintained, and were clean. There we no unpleasant odours and the home smelt fresh and clean. It was brought to our attention that the home had been without paper Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 26 handtowels for several days, due to the fact that the owners were in the process of changing from large to small dispensers, so the current stock had run out in some areas. The manager confirmed that new supplies had been reordered and were due in shortly, as a carry over measure. New smaller hand towel dispensers had been purchased and were to be installed in individual rooms over the next few weeks. When asked ‘is the home fresh and clean?’, 2 of 2 residents’ surveys said ‘always or usually’. One relative told us, ‘Our relative can always order what they want. There is a choice of meals’, and ‘When our relative visited they said the meals looked lovely, and were served with fresh vegetables’. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 could expect adequate staffing levels provided by staff who have received some basic training to meet their care and support needs. EVIDENCE: Resident numbers have fallen from 29 to 24, and so staff numbers had been adjusted to reflect this. While Chilton Croft is registered to provide care for up to 31 residents, two double rooms mainly only have one occupant, so rarely exceed 29 residents. However the home has plans to extend the building in the near future and increase it places by 6 people. As a result of the home’s poor rating, Social Care Services had suspended their accreditation resulting in no further admissions of residents placed by Social Care from January 2009. The rota showed us that the staff team includes the registered nurses, care staff, domestic and maintenance staff, the manager and the administrator. Care staff for the morning shift (8-2pm) usually includes 1 registered nurse (RN) and 5 carers, the late shift, (2 – 8pm) 1 RN and 4 care staff, and the night shift (8pm – 8am) 1 RN and 2 care staff. The staff rota was checked for the 3 week period 12th April to 2nd May 2009. This showed us that these staff numbers had been maintained through out this period. The staff we spoke with told us that staff numbers were adequate to meet the needs of the residents Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 28 although as stated, staff hours have been reduced as resident numbers have fallen. There has also been a reduction in the use of agency staff, and the home have employed new care staff, to ensure that care vacancies are filled, and correct staff numbers are maintained. Staffing levels were discussed with residents and relatives who told us the following. ‘Yes, there are no problems with the staffing skills and numbers’ or ‘Our friend is well looked after by care staff who are very caring and helpful’. During the inspection a number of staff we spoke with expressed concerns and anxiety about their jobs. Some staff told us that they felt ‘threatened with their jobs’ or ‘we are frightened to say things’. Other staff we spoke with were clear that positive improvements were being made. They said, ‘I feel the atmosphere is calmer than before’ or ‘in the last few months, there have been huge improvements’. All staff agreed that while this may be an unsettling time for them, the care for the residents was being fully maintained. Some personal issues raised by some staff members were employment matters, and were referred back to the manager for resolution. Since the last key inspection the home has employed a new administrator who has completely reorganised the office procedures (please see next section), so recruitment processes have also been reviewed. We noted that employees’ folders were maintained in a cabinet and that individual files had been organised in a logical sequence. We initially checked two staff files and these showed us the home operates adequate recruitment processes, to ensure that staff are checked and cleared to work with vulnerable adults. Staff records checked included Criminal Bureau Records (CRB) checks and Protection of Vulnerable Adults (POVA) checks, before they commence employment. Further, staff had completed an application form and provided a record of previous employment, to evidence they had the experience needed to do the job. Two references had been obtained from former employers, for each person, and these evidenced their suitability to work with vulnerable residents. One of 2 staff members’ records did not have any proof of their identity by way of a passport or birth certificate, but this was provided by the end of the inspection. Three of 4 further staff members’ records were checked for proof of their identity, and 3 records showed us that the home had provided this evidence. One staff member’s records did not provide this information. Therefore the home contacted the staff member to ensure that they provided this information immediately. One registered nurse’s records checked also included a record of their professional identification number (PIN), which showed they were registered with the nursing and midwifery council (NMC) of England, so were entitled to practice. It was positive to see the home continued to improve their staff training programme, but there is still more to do. The training records we checked showed us that all staff had received core training around manual handing, fire prevention, health and safety, and safeguarding training. Dementia training Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 29 had been provided for around half of the staff group, and the effect of this training has been very positive so far for people with dementia. (Please refer to section on daily life). Around half of the care staff have received infection control and food handling training. The home had not provided training for care staff around continence care, end of life care training, catheter care, nutritional training, and mental capacity act training. Feedback from staff showed us that they were generally happy with the training they had received. Two of 2 employee surveys received told us that they are provided with training that was ‘relevant to their role, and that helps them understand and meet the needs of the residents. The AQAA told us their plans for the staff. ‘Through continuous monitoring and quality control, we should have even better trained staff. All staff members will be encouraged to take training and to do NVQs to promote their careers’. One nurse’s training records checked showed us they had received training appropriate to their professional learning needs, which included palliative care, skin and wound care training and enteric feed training. This was in addition to all other core training. The home told us that 47 of the care staff (8 of 17) had now achieved a national vocational care qualification (NVQ) level 2 or above, with the remaining care staff working towards this award. At the previous inspection this was 25 , although 6 staff had been working towards this award. This means that residents’ could expect staff who are better trained and qualified to meet their care and support needs. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 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 could expect the home to have basic quality assurance systems in place that ensures ongoing monitoring of the service provision. EVIDENCE: At our previous key inspection on the 14th October 2008, our judgment of the management outcomes for the home was that ‘people could not be assured that the home was managed in such a way, that the best interests of people who live there are consistently met, or that a suitably qualified manager was in charge’. The quality outcome was therefore accessed as ‘poor’. Due to our concerns around how the home was being managed, a random inspection was Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 31 undertaken in March 2009, to review the progress being made towards meeting this outcome area. During the inspection the follow observations were made. ‘During the inspection we saw evidence that Mr Diwan was taking the managers role very seriously, until a suitably qualified manager could be appointed. He told us about the changes that had made to date, to ensure the effective operation of the home. One change had been by the appointment of a new administrator, to assist him with the day-to-day running of the home, and to reorganise the office. The administrator’s responsibilities included overseeing the recruitment and employment processes, invoicing, assisting with the staff rota, modernising the computer records, and establishing a system for staff training. Further, they are responsible for staff and residents files, and for ensuring that record keeping, including quality monitoring, is maintained and up to date. It was very evident that the office area had been substantially reorganised, and that old files and records surplus to requirements, had been removed from the office. These were now in more appropriate storage facilities. The office looked well organised and managed, with files and records in logical sequence for ease of reference. Very positively, the administrator had organised a centralised file for quality monitoring purposes. These included sections for residents’ feedback questionnaires, regulation 26 provider visits, monthly residents’ and relatives’ newsletters, medicine system audits, night checks, and health and safety checks including hot water tap temperature checks. All sections checked were found up to date with several months of checks and records now available for inspection. These records were easy to audit, and provided good evidence of improved quality monitoring systems by the management team with evidence of improved communication with the residents and relatives’. Our inspection today focused on whether improvements to the management processes were being sustained by the management team. Mr Diwan, the owner, informed us that he still continued to be in day to day charge of the home, so providing leadership and direction for the staff group. All the residents and relatives we spoke with said that they were quite satisfied with the current management arrangements. People told us ‘If we have concerns these will be resolved’, or ‘The management are very involved with the home so there is good communication and feedback to us. We are informed of any changes to our relative’s condition’, or ‘Things have improved since Mr Diwan took over the home. People are well looked after and the staff provided good care’. The staff group were more divided on their views about the current management (please refer to last section) arrangements, some being very supportive of the management changes saying ‘things have really improved’, while others said ‘they feared for their jobs’, or ‘were afraid to say anything’. However all staff agreed that the residents were being well cared for. We were Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 32 somewhat concerned though, that some of the staff did not feel there was always an open and positive culture that encouraged them to contribute their views to the home. These points were put to the owner who said that he needed to consider these views and raise them with the staff group at the next staff meeting. The owner said he understood the importance of working with the staff group through a rapid period of change. At the previous inspection we raised concerns that a new manager had yet to be appointed and that, as the responsible individual, Mr Diwan had not then formally notified the Commission, of his appointment as the RI. Mr Diwan told us that the search for the new manager continues but that a suitable manager had not yet been found. At the random inspection in March 2009, we were provided with evidence that the post continues to be advertised. Currently Mr Diwan continues to act as the manager, to ensure that the day to day management of the home is undertaken. However, Mr Diwan said he was aware that he did not have the clinical skills to advise nursing staff on health related issues. For example, around the management and control of medicines. Therefore more nurses have been employed to ensure that each shift is lead by appropriately qualified healthcare staff. The nurses are responsible to oversee and manage all health related issues, and to discuss any concerns with the acting manager. Mr Diwan is currently considering appointing a clinical lead nurse, to ensure that one of the nurses is in overall charge of clinical direction. Although we have had previous concerns around the management of medicines, (Please refer to the personal healthcare section) the pharmacy inspector has confirmed that medicine practices have in the main now been improved and resolved. We were concerned though, around the length of time it has taken the home to resolve medicine audits and practices. Mr Diwan advised us that he thought he had informed the Commission that he was the Responsible Individual (RI) for the home. However, we explained that he must complete the appropriate nomination form himself and provide this to our registration department. Shortly after the inspection, we were advised that Mr Diwan has completed this process, and a new certificate of registration has been issued, which states he is the RI. The previous key inspection had raised concerns around the way in which the home managed its quality assurance systems and procedures. When we visited in March 2009 we observed the following. ‘The manager also showed us that the home had new systems in place to receive feedback from the residents and relatives around the quality of the service provision. Quality assurance feedback questionnaires had been sent to the residents in December 2008, and we checked 8 of approximately 20 questionnaires received by the home. These provided evidence that residents’ Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 33 views and opinions are being considered and that improvements were being made. The home has made considerable effort to improve communication with the residents, relatives and staff. Since the last inspection the home has commenced monthly newsletters to all residents and relatives, to ensure that they are aware of the latest changes and issues at the home. Two newsletters we checked were very frank and open with the residents about the improvements that were needed, including the CQC requirements for improvements to medicine care. The home also outlined how they proposed to make more improvements, for example, by staff retraining’. During our inspection today, we rechecked all quality assurance records including the annual service reviews, regulation 26 provider report checks, night visits by the provider, hot water tap temperatures, food hygiene and fire records. These records provided us with evidence that the home was continuing to regularly monitor health and safety issues around the home. There was also evidence that key working had now commenced, where a staff member is nominated to assist individual residents. This included ensuring that events like their birthday is remembered or medical appointments are booked and not missed. During our tour of the premises we noted that a small chain had been attached to one of the ground floor fire doors marked as ‘fire exit’, and would be an obstruction, in the case of a fire emergency. When we raised this with the manager, this was immediately removed. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 34 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 x x 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 X X 2 Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1) Requirement The statement of purpose must 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. Controlled drugs must be stored in a cabinet compliant with the Misuse of Drugs (Safe Custody) Regulations. This is a repeat requirement but extended for one month. Essential staff training must be provided for all staff. This is to ensure that the staff group have the skills and training to meet the needs of the residents. Timescale for action 12/08/09 2. OP9 13 (2) 30/05/09 3. OP29 18(1) 12/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 36 No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should reflect more detail around the residents’ emotional and social care needs. This is to ensure that their choices and preferences are recorded, so that staff can meet these needs. Care plans should provide more detailed information around their end of life care needs. This is to ensure that the home can meet the residents’ end of life care needs. The home should put into place a further robust auditing system undertaking regular checks to account for medicines and take prompt action when discrepancies are identified. The home should undertake a risk assessment of any radiators without protectors, to ensure that they do not pose any risk of scalding to the residents. This is to ensure the residents’ safety. An appropriately qualified, skilled, and experienced manager should be recruited and appointed without delay. This is to ensure that the home and residents benefit from a suitably managed service. The home should ensure that the garden pond is risk assessed to ensure that it poses no risks to vulnerable residents. This is to ensure that the outdoor garden area is a safe for the residents. 2. OP7 3. OP9 4. OP25 5. OP31 5. OP38 Chilton Croft Nursing Home DS0000024358.V375555.R01.S.doc Version 5.2 Page 37 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. 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