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Inspection on 12/10/05 for Chilton House Nursing Home

Also see our care home review for Chilton House Nursing Home for more information

This inspection was carried out on 12th October 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The admission processes and the opportunity of a trial visit gives potential residents information to help them to decide whether they wish to move to the home. There is a good multi-professional approach to meeting resident`s healthcare needs and comprehensive care plans are maintained. The medication management systems are good. The home also has the facility to offer shortterm rehabilitation for those who have recently been in hospital or have suffered an illness. The standard of food is high and residents said that they enjoyed their meals. There are complaints and protection of vulnerable adult policies in place. Staff training is good and gives carers the skills that they need to care for residents.

What has improved since the last inspection?

The home now has the facility to care for residents on a short- term basis who require rehabilitation following illness or surgery. Window restrictors have been fitted to the upstairs bedrooms to protect residents from accidental falls.

What the care home could do better:

The recruitment policy and procedures must be changed to ensure that no member of staff, who has contact with residents, starts work until the POVA first check has been received and is supervised until a full Criminal Records Bureau check is received. The training records should be reviewed and consideration be given to integrating the two approaches to record keeping that are currently in place. The home should hold an up-to date copy of the Buckinghamshire multiagency strategy for the protection of vulnerable adults.

CARE HOMES FOR OLDER PEOPLE Chilton House Nursing Home Chilton Aylesbury Bucks HP18 9LR Lead Inspector Christine Sidwell Unannounced 12 October 2005 09:00am 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chilton House Nursing Home Address Chilton, Aylesbury, Bucks, HP18 9LR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01844 265200 Chilton House Limited Laura Bale Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Maximum of 45 residents 2 This includes a maximum of 10 nursing care Date of last inspection 09 March 2005 Brief Description of the Service: Chilton House is a grade two listed Manor House set in the rural village of Chilton. The Home is registered to provide care for 45 older people of whom up to ten may require nursing care. The Home also provides respite care and intermediate care for older people who are recovering from illness. The Home provides individual accommodation on three floors with lounge and dining areas on the ground floor. There are extensive and well maintained grounds with large patio areas. There is an experienced management team. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the unannounced inspection, which took place on the 12th October 2005. Care plans, medication records, recruitment files and other records were examined. Care practices were observed. The manager, deputy manager and some of the staff who were on duty at the time were spoken to. The views of four service users were sought. What the service does well: What has improved since the last inspection? The home now has the facility to care for residents on a short- term basis who require rehabilitation following illness or surgery. Window restrictors have been fitted to the upstairs bedrooms to protect residents from accidental falls. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 6 The home’s admission processes work well, giving potential residents and staff the confidence that their needs can be met. The multi-professional approach to care helps both the permanent residents and those admitted for rehabilitation to maximise their abilities. EVIDENCE: There was evidence in the care plans that new residents move to the home following a comprehensive assessment of their needs. The documentation used to record this is in line with the care planning documentation and care needs identified on the assessment were seen to have been transferred to the care plans. Potential residents have the opportunity to stay in the home for a trial visit before deciding whether they wish to move to the home. All service users have a multi-professional assessment on arrival at the home. There is an experienced nursing team in place supported by the Community Nursing teams. There was evidence in the care plans that residents have access to secondary healthcare, chiropody and optical services. The home has now been registered to care for residents requiring short-term rehabilitation following surgery or an illness. There are separate rehabilitation facilities and the Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 9 residents have access to medical, nursing and physiotherapy services. There are no residents from an ethnic or minority background at the present. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 The care plans give staff the information that they need to care fully for residents. Resident’s healthcare needs are met with good evidence of multiprofessional working. The medication management systems work well ensuring that residents receive their medication in a timely and safe way. EVIDENCE: The home uses the Standex system of care planning documentation. This was completed comprehensively. All care entries were signed and dated. Care given at night was recorded. Risk assessments were in place. There were daily entries and care plans had been reviewed on a monthly basis. There are no residents on a care management programme at present. There was evidence in the individual care plans and residents confirmed that they had seen their general practitioner and had had the opportunity to see a physiotherapist privately. All residents were well groomed and clearly had access to hairdressing facilities. There was also evidence that the community nurses, chiropodist and optician visit regularly. The physiotherapists assess those residents who have falls and one resident has been referred to the local specialist falls clinic. The care plans showed that residents have a nutritional assessment and are weighed regularly. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 11 There are medication policies and procedures in place. The home uses a prepacked system and resident’s medication is kept in their rooms in a lockable container. Records are kept of all medication entering and leaving the home. The medication administration records were completed correctly. Controlled drugs are stored correctly and their administration is recorded. All carers who administer medication have medication training. Two residents manage their own medication and this was stored safely and risk assessments were in place. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The standard of food and its presentation is high meeting and meets resident’s social and nutritional needs. EVIDENCE: The food at Chilton house is of a high standard. There is a varied menu plan and resident’s confirmed that they had a choice and that they enjoyed the meals. There is a menu plan, which was varied. The menus contained adequate fruit and vegetable dishes. Snacks and drinks are available at all times. The chef said that she was able to cater for specific therapeutic diets. The dining room is attractive and residents were enjoying an unhurried and relaxed meal. They confirmed that they could choose whom they sat with. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The protection of vulnerable adults and complaints policies should give residents and their families confidence that their concerns will be addressed. EVIDENCE: There are complaints, protection of vulnerable adults and whistle-blowing policies in place. There was evidence in the staff training records that staff have received training in the protection of vulnerable adults. There have been no complaints or allegations of abuse. The home should acquire a copy of the latest Buckinghamshire Multi-agency Protection of Vulnerable Adults strategy. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not assessed at this inspection but have been met or almost met at previous inspections. EVIDENCE: Although these standards were not assessed at this inspection it was noted that, in line with a requirement made at the last inspection, window restrictors have been fitted to upstairs windows. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28, 29 and 30 The staff recruitment process does not fully protect residents from the employment of unsuitable staff. The training offered to staff gives them the skills that they need to care for residents, although the training records should be updated. EVIDENCE: There is an active National Vocational Qualification programme in place and nine of the thirteen carers hold this qualification at Level 2or 3, meeting the standard that 50 of care staff hold National Vocational Qualifications. The induction programme is TOPPS accredited and there was some evidence that staff have mandatory training with annual updates. The recruitment files of three recently recruited members of staff were examined. They all contained application forms, curriculum vitae and interview notes. Two references had been sought and verification of nursing registration had been sought. They contained photographic verification of the staff member’s identity and their current work permits. Two of the staff members had however commenced working before the POVA first check or the full Criminal Records Bureau check had been undertaken. The manager said that these staff had started working under supervision. This must be addressed and no staff member should commence work until the POVA first check has been obtained and must be supervised at all times until the Criminal records Bureau check is received. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none These standards were not assessed at this inspection but were met at previous inspections. EVIDENCE: Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 18 yes Are there any outstanding requirements from the last inspection? 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 29 Regulation 19 Requirement The manager must ensure that no staff member commences work until a POVA first check is obtained and that staff members are supervised until the full Criminal Records Bureau check is received Timescale for action 31.12.05 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 18 30 Good Practice Recommendations The manager should obtain a copy of the latest Buckinghamshire County Council multi-agency stategy for the protection of vulnerable adults The training records should be reviewed and consistent documentation be agreed to reduce duplication. Chilton House Nursing Home 20051012_Chilton House_UI_Stage 4_S19194_V244251_CS_ces.doc Version 1.40 Page 19 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close, Aylesbury, Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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