Inspection on 17/01/08 for Chilton Meadows Residential & Nursing Home

This inspection was carried out on 17th January 2008.

CSCI found this care home to be providing an Excellent 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 Meadows Residential &... 22/01/07

Chilton Meadows Residential &... 05/01/06

Chilton Meadows Residential &... 27/09/05

Chilton Meadows Residential &... 15/12/04

Chilton Meadows Residential &... 30/06/04

Chilton Meadows Residential &... 01/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chilton Meadows Residential & Nursing Home Union Road Onehouse Stowmarket Suffolk IP14 1HL Lead Inspector Jill Clarke Unannounced Inspection 10:35 17 & 18 January 2008 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilton Meadows Residential & Nursing Home Address Union Road Onehouse Stowmarket Suffolk IP14 1HL 01449 770321 01449 614248 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) www.bupa.com BUPA Care Homes (CFHCare) Ltd Mrs Karen Patricia Earnshaw Care Home 120 Category(ies) of Dementia - over 65 years of age (65), Old age, registration, with number not falling within any other category (60), of places Physical disability (1) Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate one named person in the category of physical disability as detailed in the variation application dated 12 December 2006. 22nd January 2007 Date of last inspection Brief Description of the Service: Chilton Meadows is a purpose built care home, which offers residential, and nursing care, situated close (approximately a mile) to the town centre of Stowmarket. Stowmarket has a range of facilities, which include Post Office, banks, shops, cafés, cinema, rail and bus links. Chilton Meadows can accommodate up to 120 older people in four houses (Beech, Constable, Gainsborough, Munnings) each of which provides 30 bedrooms. Beech and Munnings Houses provides dementia and nursing care, for people who are mentally frail. All houses have a small kitchen, lounge/dining area, with a patio leading out to well maintained gardens. All bedrooms are of single occupancy, and are situated close to the communal toilets, and bathrooms. Although known as ‘houses’ the resident’s accommodation is built on the ground level, with wheelchair access throughout. The administration part of the complex is built on 2 floors, and houses the offices, hairdresser, laundry, main kitchen, reception area and training rooms. All areas that the residents would need to access are located on the ground floor. The home has it’s own mini bus, and on-site Activities Organisers. Whilst the entire home is the responsibility of the Matron, Mrs Karen Earnshaw, each house has its own Senior Sister who is responsible to Mrs Earnshaw, for the daily care of residents and supervision of staff. Current fees range from £502 to £802.50 for a privately funded nursing care bed. Costs vary according to the amount of nursing care required. For social care funded people, they will be informed by Social Services of the rate they will be asked to pay, taking into account their individual financial circumstances. All fees cover accommodation in a single furnished bedroom, personal care, nursing if applicable, food and processing of personal laundry. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.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 3 star. This means the people who use the service experience excellent quality outcomes. We (the Commission) undertook this inspection over 2 days (13 ½ hours). The first of the 2 days was unannounced. During the visits, we assessed the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA), and ‘Making judgements about the quality of service for people with dementia in care home’ (available to read on our web site www.csci.org.uk). We also looked at how the home were meeting the core National Minimum Standards relating to Older people, and gave a score (see scoring of outcomes section of this report) to show if they are being met. The report has been written using accumulated evidence gathered prior to, during, and contact made following the inspection. Commission for Social Care Inspection (CSCI) feedback surveys were sent to the home to distribute, prior to the inspection. This gave an opportunity for residents, relatives, visitors, and staff, to give feedback on how they thought the service was run. At the time of writing this report, 38 Resident, 3 relative and 10 staff surveys had been returned. Information gained from this surveys, has been included in this report. To enable us to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, we completed a Short Observational Framework for Inspection (SOFI) record sheet. Developed in conjunction with the University of Bradford, this enabled us over a period of 1¼ hours, to watch 5 residents sitting in Munnings Lounge/dining room. During this time we were able to look, and record how the residents spent their time, their mood/well being, and how well staff engaged (interacted) with the residents. Observations made, have been included in this report, within the relevant sections. We had aimed to undertake the SOFI for 2 hours, but had to stop when, after lunch residents were taken back to their bedroom to rest. However, it did give us a good insight into the lunchtime experience on that house. We also invited an ‘expert by experience’ (a person who because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in the home) to join us on the first day of the inspection. They arrived in time to join the residents on Constable House for lunch. After lunch they visited the other 3 houses, where they were able to speak to residents, relatives, staff and look at the environment. At the end of their visit, they gave feedback on their experience to the Homes Manager. At the time of writing this report, their written feedback was not Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 6 available, however, notes of their comments/observations taken during feedback back, have been included in this report. Prior to the inspection the home was required to complete their Annual Quality Assurance Assessment (AQAA). This enables staff to inform the CSCI on how well they are meeting the National Minimum Standards. The home was also asked to state what they felt they did well (and where able to provide evidence to back this up), and what areas they felt they could do better in. Information obtained from the AQAA, has also been included in this report. We spent time in all 4 houses, meeting and talking to residents, visitors and staff to hear their views on what it is like living at Chilton Meadows, and how well they think the home is managed. Records viewed included care plans, staff recruitment and training records, residents ‘information pack’ and medication records. Residents, staff and visitors we met during our inspection were very helpful, and gave us valuable feedback. As stated in our last key inspection report (January 2007) people living at the home, identified that they preferred to be known as residents’, rather than a person using a service, this report respects their wishes. What the service does well: What has improved since the last inspection? Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 7 The home has instigated the new ‘BUPA’ care plans, which are now used on all 4 houses, which assist the staff in developing a plan of care, to meet individual residents care needs. They now have systems in place to check that all menus provide the right level of nutrition, linked with individual residents health needs. The catering department has also introduced the ‘Nite Bite’ menu, which now means food is available to residents 24 hours a day. Staff have attended ‘palliative care’ training to ensure residents, terminally ill are cared for as they wish to be. 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. The summary of this inspection report can be made available in other formats on request. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care, therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed, are given information on the home, and invited to visit, which supports them in choosing if the home offers the environment and level of service they are looking for. EVIDENCE: The AQAA informs us that ‘all prospective residents undergo a pre-admission assessment to ensure the home can meet any identified need and the placement will be appropriate’. Due to the need to move people out of hospital quickly, we were informed that this could result in residents “being assessed 1 day – and in the next”. When the manager goes to assess they will give the prospective resident an ‘information pack’ on the home. The home also supplies an ‘Information file’ in all the residents bedrooms. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 10 The home informed us in their AQAA that they were going to update the information held in the files, to make it ‘more detailed’. When we arrived at the home the manager was in the process of doing this. We noticed that font size used on the information sheets varied, and asked if residents had problems reading the smaller print. The manager said that this is an area they are looking into, including what colour paper to use to support people with poor eyesight/dementia. We were also told through the AQAA that new residents receive ‘a copy of our latest CSCI report’. Care plans seen, held copies of completed assessments, undertaken before the residents moved in. The standard template used, covers people’s physical, nursing, social and mental health needs, with extra notes and observations written by the person undertaking the assessment at the time. Feedback (surveys), from residents and their friends/families confirmed that they had been given enough information on the home, to support them in making the decision if to move in. Comments made included ‘very good information’, ‘my family sorted it all out for me’, and ‘I had lots of information’. All the residents surveyed also confirmed that they have received a contract. We looked at a sample of 3 (funded and self funding) contracts/terms of conditions. They showed that prospective residents were being given all the relevant information on what it costs to live at the home, and how much they will need to pay. Since the last inspection the home has introduced facilities for residents to pay by Direct Debit. The 3 relatives/advocates completing our survey, all felt that the home was able to meet the needs of their relative/friend. This reflected our conversation with a resident when we asked if the home was able to meet their needs and provide the level of supported they wanted. They told us that they had settled in and they “liked the idea” that staff “come and wash you, see to you, and see your clothes are clean”. The expert by experience, told us that relatives had approached them during our visit, to say how happy they were with choosing this home for their next-of-kin. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide care based on residents individual needs, and take appropriate action to support residents changing physical, and mental health. There are systems in place to ensure residents receive their medication/ treatment, as prescribed by their Doctor. EVIDENCE: In our last key inspection report (January 2007), under ‘what the service could do better’, we said that care plans on the nursing houses could evidence more resident’s preferences and wishes, whilst focusing on maintaining life skills. We had found in their (then) residential House, Gainsborough good examples of care plans, which clearly stated what a resident could do for themselves, and information on how the resident would like to spend their day. However since our last inspection, Gainsborough house, which now offers nursing care, uses the same new care plan format (introduced since our last visit) as the rest of the houses. We looked at a sample of 4 care plans, for the people whose care we were ‘tracking’ during our inspection. Tracking involved looking at the care plan, meeting the resident and to discussing (were able) the level of care Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 12 they wanted/received, to see if it matched the guidance given to staff in the care plans. The new care plan format sets out each section of a person’s physical, mobility, mental and nursing care needs. Staff are asked to give a score to each section, which identifies if a person requires support in their area. For example with their personal care needs, where it is identified that a person requires help, what level of help is required is then written on a separate ‘personal plan’. On 1 resident’s care plan this included ‘needs assistance by 1 carer to dress self’. The information on the personal plans covered more nursing, then emotional wellbeing. Although there was information on resident’s preferences and wishes around food, and night routines. There was not the same level of information about how they liked to spend their days, and their preferences over their personal care. Where residents have dementia, more information could have been given from their perspective, on how it affects their daily lives, instead of just their area of need. This is especially relevant to residents who are at the earlier stages of dementia, and are able to do more for themselves. However, on saying this, we did find some good information that gave us more insight into a resident’s emotional needs, and preferences on some care plans, but it was not consistent. To give any examples might lead to the residents being identified. Staff surveyed confirmed that they are ‘always’ given up to date information about the needs of the people they support. Discussions with staff identified mixed knowledge about the resident’s life prior to moving into Chilton Meadows. The AQAA informed us that Beech House and Munnings House are assisting residents and relatives to put together “Life Histories”. In doing this it will support staff to have a more in-depth knowledge of the person they are looking after. Records showed there are good systems in place to monitor any variation in a resident’s skin, and appropriate action taken to reduce the risk of the skin breaking down (pressure ulcer). Staff are monitoring residents’ weight, and taking action where they are concerned over any undue weight loss. However, we did notice where staff had written comments about a resident taking very little diet; no action had been taken, to keep an accurate record of what they were taking. There was also no information, in the absence of diet how they were going keep the mouth moist and comfortable. The AQAA informed us that staff on 1 of the 4 houses ‘has undertaken the Gold Standards Framework’ training, and that they were looking to instigate the ‘end of life care’, for a resident following consultant with their Doctor. Care plans seen showed that residents had been asked their wishes around end of life care, comments form 1 resident included that they ‘would like family with them at the end of life’ if they ‘collapsed would like an ambulance called Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 13 and CPR given’. A thank you letter from a relative read ‘we would like to express our thanks for all the care ‘ they went on to say that staff had made the last few months of their next-of-kin life so much better’ and they’ were impressed with care and attention (resident) received. The AQAA tells us that staff have a good working relationship with their local Doctors, who we saw visiting during the inspection. We were also informed that a Psychogeriatric consultant visits weekly, Optician monthly and Chiropodist 6 weekly. Residents asked (surveys) if they received the medical support they needed, all but 3 (who said usually) replied ‘always’. They also told us that they ‘always’ (30) or ‘usually’ (8), received the care and support they needed. Their comments included ‘very good support from staff and everyone’, and ‘I always get the care and support I need from everybody’. A resident we spoke with, said that they had a “bath once a week – then get into lovely clean sheets”. We asked if they would like more baths, but they felt 1 was “enough”. They said that they could “wash and dress” themselves, and would “ring the bell” when they wanted help. They went on to say that “carers are very good and very helpful”. Another resident we asked about baths, said that they were “pretty regular”. The nursing staff complete a ‘daily life sheet’, which again covered more nursing/physical tasks undertaken, then the residents wellbeing, and how they would have spent their day. When we asked a carer (who would have more social interaction), if they wrote in the daily records, they said “no”. They said they would feedback the information to Nurses, who would then record it in the care plan. Residents surveyed, told us that staff listen, and acted on what they said. When we asked a resident the same question, they said sometimes staff would “say can’t do just now, but will come back to you and they do”. However, they said sometimes when they wanted the toilet, and where staff “might not come back for 10 –15 minutes” they found this “very difficult”. They also gave us information on the “toileting times”, when they knew everyone was being taken to the toilet. Another resident confirmed that staff ensured their privacy and dignity was maintained when they were having help with their personal care. Feedback from the expert by experience showed that when residents “needed to go to the toilet” that it was “done discreetly” and residents were assisted with their lunch in a “sensitive, respectful way” which ensured their “dignity”. Comments on the resident’s preferred gender of carer, to assist them with their personal care, had been included on 1 of the care plans we read. The home has systems in place for the ordering, safe storage, disposal, and dispensing of medication. We observed medication being given out on 1 of the houses, by a trained nurse. This was undertaken in an unhurried manner, 1 resident at a time, and did not interrupt with the resident’s lunch. When Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 14 medication had been given, staff initialled the resident’s Medication Administration Record (MAR) chart (this gives a list of residents medication, including how much is to be taken and at what time). A sample of MAR charts looked at on 1 of the houses, found that nurses were initialling the chart correctly, to confirm that they had given the resident their medication. Where the medication had not been given, then nursing staff had written the reason why. A record was being kept of the fridge and room temperature where drugs were stored, to ensure medication did not deteriorate from getting too warm. Controlled drugs were kept securely in a separate lockable cupboard. A sample check of 3 medications, including a controlled drug, against the home’s record, was correct, showing that they had been given out as prescribed. We asked a resident if the home had ever run out of their medication, they replied “never” and that the staff were “marvellous” in ensuring that they received their tablets. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can take part in a range of activities, and can enjoy a varied choice of tasty, nutritious, home cooked meals and snacks, 24 hours a day. EVIDENCE: The home employs 5 part-time activity co-ordinators to specifically engage with residents, and promote spontaneous, and planned activities. The autumn/winter addition of the Chilton Chatterbox (an in-house newsletter for residents, visitors and staff) showed photographs of residents and staff (including the Manager dressed as part of the ‘motley crew’, complete with beard) during the ‘Pirate invasion’. This was part of their ‘pretend cruise’ activity. Photographs displayed in the home included the route the ‘cruise took’, and at each ‘stop off’ point, staff decorated the tables to match the theme, and residents were treated to a menu of that country. Other events mentioned in the newsletter included the ‘Chilton Capers’, which included ‘a mixture of sporting activities for both residents and staff’. The residents of Gainsborough House won the shield. A BBQ was held in August, a Harvest festival in October and Firework party in November. There was also a good write up on what would be happening at the home in the lead up to Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 16 Christmas. The activity organisers had also included a feature covering the work they do, and asked for ‘any staff, family or visitors that have ideas for a different activity to please tell the activity organiser and we will try to include this in our programme’. They went on to mention that the activity organisers ‘get together twice a week to plan the following week’s programme, which is put into each resident’s room on a Friday’. A group of activity co-ordinators were seen doing this during our visit. Residents surveyed, were asked if there were activities arranged by the home that they could take part in, 23 replied ‘always’, and 11 ‘usually’. Comments included ‘the outings I enjoy’, ‘started me knitting again after 30 years’, ‘do when able to’, ‘bingo, outings, quizzes’, ‘even my (relative) joins in activities’ when they are here’. Residents we spoke to confirmed that they were always made to feel welcome – whenever they visited. Where 2 people had not ticked their answers, they informed us that they liked the trips out, and ‘I do most activities, I look forward to having my hair done and bingo’. When we visited 1 house, a group of 4 residents were playing cards. We asked 3 other residents if there was enough to fill their day, 1 told us it was a “bit boring – just have to put up with it – not the life I had”. They said they “don’t play cards”, however they did take part in the “exercises that had just started”. When we spoke to a resident in their bedroom, they told us that they “like to listen to people walking along the corridor”, they said staff “would soon switch the TV on if I want it”, but were happy to “read my paper and drop off”. A resident on another house said they enjoyed the sing-a-longs, and religious services, saying “where there is a service I go - once a month on a Wednesday and second Sunday (Baptist service) in the month”. The Chilton Chatterbox informed residents that if they wanted to see the visiting Chaplain privately, that this could be arranged through the activity organisers. The expert by experience felt it was very good (and reassuring) that residents are able to bring their pets in with them, which the manager confirmed that they try to accommodate. In the newsletter, the manager comments on the ‘growing number of animals’, which includes cats, aviaries, fish, chipmunks, cockatiel, and a visiting ‘pat dog’. The home has now registered with the ‘Cinnamon Trust’, who supports them by giving advice on how to look after all the animals. When we spent time on Munnings undertaking SOFI, we noticed that for many residents sat in their wheelchairs/armchairs there was nothing to occupy their time. There were no objects in front of residents to stimulate their senses (for example different textured materials). As it was leading up to, and over the lunch period, we observed what happened after lunch, in case it was because tables/trays had been cleared for lunch. However, we noticed it was the same after lunch. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 17 Lunchtime routines were observed on 2 of the houses, (general nursing and dementia care). The expert by experience joined the residents on Constable for Lunch, and enjoyed a “tasty, well presented” meal. They felt the lunch service was not rushed, so residents could sit and enjoy the meal. On the dementia care house, several residents required assistance with their meals, which meant that not all people requiring assistance could be given it at the same time. However, staff managed the situation well, to ensure no resident were left waiting for long. Some staff interacted more with the resident they were assisting than others, asking if it “was nice” and bringing the resident into any conversations they were having with other staff. Whilst assisting 1 resident with their meal, the member of staff was called away to answer the telephone, however, no one took over from the member of staff, leaving the food getting cool. A relative came to assist another resident with their lunch, and was made to feel welcome by staff. When 1 member of staff assisted a resident with their meal, good interaction was seen when the member of staff saying “here you are (residents name) Cheesecake – Chocolate and Lime, which would you like”. Where another member of staff was not sure what the pureed meal was, they had to ask other staff. When we spoke about this to the Chef, they said that the pureed meals are all labelled, but if the cling film has been removed before it is given to staff, this is where the confusion can happen. We saw 1 resident holding their head, quietly showing signs of distress, a member of staff spotted this within 10 minutes, and they came over and spoke to the resident (their care plan reflected the reasons why they did this). The resident was very responsive; each time staff came up and spoke to them, showing signs of wellbeing, which disappeared when staff walked off (as staff needed to assist other people). However, staff between helping other people, would come back and talk to the resident. Although no one was watching the television, it was left on during the lunch, which added another noise to the sound of ‘dishing up’. The atmosphere was quite busy as staff walked around the tables, offering assistance, and serving meals, and 1 resident calling out at times. However, the interaction with staff was good, they instigated conversations, and joked with residents. The AQAA informs us that as part of their plans ‘plans for improvement in the next 12 months’, is to ‘introduce “Service Standard Training for Food Presentation” within the whole home’. This will include looking at promoting, and making it a positive dining experience for residents. Residents asked (surveys) if they liked the meals at the home 16 replied ‘always’ (‘I like my food here’), 20 ‘usually’ (‘good’) and 2 ‘sometimes’ (‘not always the lunches’). We asked residents what would happen if they did not like any of the choices on the menu, they said that they just had to ask and they will “give you something else”. Another resident said when they did not Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 18 like the choice they would “order a salad, nice, lovely fresh lettuce and ham”. When asked if they were given enough drinks they replied “oh yes – all fruit drinks” and that they could “ask for tea, coffee anything” at any time. They also mentioned that they were offered alcoholic drinks with some of their meals. When we asked a resident what they had ordered for lunch, they said they had ordered “2 days ago” and had “forgotten”. They told us they enjoyed the Sunday roasts, and “had a very nice lunch the other day – lovely sauce – with rice”. Another resident felt that food “varies – some I like – could be improved” further discussion identified that they felt the vegetables were not cooked enough for their liking, and sometimes they found the “meat sometimes a bit tough”. Displayed in the houses was the ‘Nite bite menu’, to ensure ‘food is available 24 hours’. The AQAA also informed us that the home has introduced the ‘BUPA Menu Master’, which helps to ensure the menus ‘meets the nutritional needs of the residents’. Time spent talking with the Chef, demonstrated their commitment to meeting all 120 residents needs, by going out on the houses to observe the meal service and gain feedback from the residents. In undertaking this, they had been able to gain a good insight into individual residents likes and dislikes, including providing ‘finger foods’, to support a resident to be able to feed themselves independently. To ensure the finger foods “doesn’t get dull and boring” they had a system in place to offer a range of foods each week. We asked a resident if they still felt in control, and could say what they wanted to do, for example what time they wanted to get up. They said staff were “very good” and would “say come on wake up – time you got up”. We asked what would happen if they did not want to get up, they replied, “will let you stay in bed”. Further discussion showed that they enjoyed the morning routine, and they were got up at a time, which was suitable to them. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a robust complaints procedure in place, and staff are trained to safeguard the interests of people they care for. Residents and their advocates, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: The home’s complaints procedure is displayed throughout the home, a copy of which is also contained in the Home’s Statement of Purpose and Resident information pack. Feedback we received from our resident and relative surveys, confirmed that people were aware of the home’s complaint procedure, and felt comfortable to raise any concerns direct with staff. Staff surveyed confirmed that they were aware of what action they should take, when a resident, or their advocate, raised any concerns about the home. The AQAA informed us that the home had received no complaints during the last 12 months. However, at the time of the inspection, the manager said that they were just investigating a complaint, which was about fees, further discussion identified that it did not fall within our remit. The day following our inspection, an advocate raised concerns with us that staff may be turning off a resident’s call bell during the night. With their Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 20 permission, we contacted the homes manager, who quickly took action to investigate the concerns raised. The manager visited the houses at night, to check that none of the call bells had been turned off. They also checked the automatic printout of resident’s call bells, looking for any irregularities, which could indicate that they had been turned off. The manager then wrote to the complainant, informing them of what they had done, and that they had found no evidence that call bells had been switched off. The manager also reminded staff that all residents must have access to a call bell at all times. The home aims to acknowledge ‘complaints within 3 days’ and answer them within 5. Whilst sitting in on the new carers induction training, we heard the trainer instigate conversations of what is seen as abuse. They also discussed different situations, which could occur in a home, which is classed as abuse (for example putting a call bell out of reach). They also shared with staff a copy of SOFI ‘wellbeing and ill feeling’ list, so they could see how different situations could affect a resident’s health and welfare. Staff offices around the home displayed posters for forthcoming training in Elder Abuse, as part of staffs ongoing refresher training. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a comfortable, clean, safe, well maintained environment, which meets their mobility needs. Gardens offer places of interest to sit and enjoy. EVIDENCE: The Chilton Newsletter (Autumn/winter 2007) gave residents an insight into the work of the ‘members of the maintenance department, which includes more than just ‘hanging up pictures and un-blocking toilets’. This included ‘daily checks of the 75 fire extinguishers’ around the home, and ‘weekly fire alarm tests’ to ensure that they are in good working order. The maintenance people also informed readers of the ‘routine’ tasks they undertake which includes redecorating bedrooms, and checking equipment reported as broken or not working correctly. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 22 Since the last inspection the AQAA informs us that that Munnings House (which has become the second dementia care unit), has been ‘decorated and refurbished, and 25 residents bedrooms have been redecorated’. We found the décor and lighting in Munnings Lounge/Dinner was not as light and bright (which is more suitable for people with dementia) as the other houses lounges we visited. Although the dementia houses (Munnings and Beech) had coloured pictures on the walls and have adapted some signage, there was a lack of sensory stimuli. For example the pictures were smooth, or fitted in a frame, which gave a point of interest with its bright colours, but did not provide stimuli for the touch and smell senses. The lounge is split into 2 areas by a wall divider, however when we were sitting in the dining room, the sounds of the television and radio could be heard coming from both areas. The manager said that they are currently collecting items, to turn the old sensory room into a reminiscence room. We found on both days (unannounced and announced) the home to be clean, and free from unpleasant odours. Residents surveyed were asked if they felt the home was kept fresh and clean, 33 replied ‘always’ and the remainder said ‘usually’. Comments included ‘always smells nice’ and that the home is kept ‘very clean’. People visited in their bedrooms also told us that their room was kept “lovely and clean”. The expert by experience spent time looking at bedrooms on all 4 houses, and was pleased to find all the rooms clean, fresh and had been personalised by the resident. A resident also praised the laundry system in place saying that you “don’t have to stand at the sink to wash clothing - just send to the laundry and they will see to all that” and they come back “lovely and clean”. A visitor pointed out that there was no call bell in the lounge for the residents to use, and said ‘if you want to go to the toilet they have to shout out” We fed this back to the manager who said they would look into the situation, as the call bell box in the resident’s bedrooms, can be removed and taken into the lounge with the resident, so they are all able to summon help with out the need to call out. Residents we visited in their bedrooms, who were able to use a call bell - had them close to hand. Although we did not spend time during this visit in the gardens, as we mentioned in our last report ‘the gardens are well maintained, are wheelchair user friendly, and have many points of interests including water features, flowerbeds and aviary. . Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and have staff in sufficient numbers to meet residents changing physical needs. EVIDENCE: Residents surveyed, in response to being asked if staff were available when they needed them, 26 replied ‘always’ and 12 ‘usually’, with 2 people commenting ‘that staff do the best they can’. When we asked a resident the same question during the visit they said “if you want anything” you just ring the call bell. They went on to say that at busy times staff “might say can’t do just now – but will come back to you and they do”. We also asked the resident if the house they lived on was ever short staffed. They replied, “ I think somebody did not turn up this week – cold or something – but always someone from another house will give you a hand”. This reflected what the manager had told us, about moving staff around to support other houses, especially when they were not at full occupancy, where they were unable to cover a shift. A visitor commented that when they visited, it “worried” them at times, as there was “often no carers around”. Further discussion identified that this was because staff were helping residents in other parts of the house. Further discussion identified that they felt a member of staff should be visible in the lounge area at all times, due to the frailty of some of the residents. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 24 A resident also commented on the ‘toileting’ routines, and felt that they should employ a member of staff “just to take them to the toilet”. They went on to explain, “after breakfast” if you want to go to “the toilet then” that you “can’t go”, as staff are busy. The Statement of Purpose gives the staffing levels (providing personal care) as: 8.00 am – 2.00 pm - 2 Registered General Nurses and 4 care assistants 2.00 pm – 8.00 pm - 1 Registered General Nurse and 4 care assistants 8.00 pm – 8.00 am - 1 Registered General Nurse and 2 care assistants The manager made us aware that 1 of the houses was a carer short, when we arrived. However, the house concerned only had 18 instead of 30 residents living there at the time, therefore reducing the care staff by 1, did not affect the level of care and support they received. On 3 of the houses, residents are also supported by part time ‘hostess’ who serve, and assist them with their food and drinks. As mentioned early to support residents with their social needs, (see Daily Life and Social Activities section of this report) part time Activity Organisers cover all the houses. We also spoke to members of the part time housekeeping staff, who felt that they were given sufficient hours to be able to keep the home clean. Staff surveyed were asked if they felt there was enough staff on duty to meet the individual needs of the people using the service, 6 replied ‘always’, 3 ‘usually’ and 1 ‘sometimes’. Where the member of staff had replied ‘sometimes’ they gave no further information, as to why they thought this. During the inspection, when call bells went off – staff answered them quickly. All the staff surveyed confirmed that references and CRB checks had been undertaken/obtained before they started work at the home. We looked at 2 staff’s recruitment paperwork, which held references and paperwork to validate their identity. However, for both applicants we found they had not supplied the management with a full employment history. Without the information the management would be unable to identify if the applicants had previously worked with vulnerable people, and their reason for leaving. No problems had been identified during the last inspection, however the manager said that they had been away, and not overseen the recruitment paperwork. As the people concerned were on their induction, the manager confirmed that they would contact them and ask for the missing information. Staff felt their induction training covered what they needed to know to get them started in their role. The AQAA informed us that they have ‘a 4 day induction programme for new care staff, which combined with a week supernummary on the house ensures they are fully supported as new members of staff’. During the inspection we sat in on an induction training session, Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 25 being carried out in the training room, by the homes dedicated training coordinator, described by 1 member of staff as being ‘really good’. We saw good interaction between the trainer and new staff, which enabled them to feel comfortable and confident to clarify any points, to ensure they understood what was being said. Staff told us (surveys) that they felt the training they receive is relevant to their role, and keeps them updated with new ways of working. They also felt that they are given the right support, and have the experience and knowledge to meet the individual diversity and cultural needs of the people they care for. Comments included, the home provides ‘informative and comprehensive training for staff’ and ‘training is brilliant’. Information given in the AQAA informed us that they have ‘53 of Care assistants with NVQ 2’. However, there was some inconsistancy in the break down of the numbers, as in 1 section they gave their total number of care staff as ‘80’, but in the break down, informed us that they had 49 care staff (24 of whom had achieved an NVQ level 2 or above). The inconsistency in the information was not picked up until after the inspection, therefore we will contact the home to clarify the situation. Staff surveyed told us that they ‘regularly’ or ‘often’ received support from their line manager to gain feedback on their working practice. The Expert by Experience said that all the feedback they had received from residents and relatives had “all been complimentary about the staff”. The only point raised was that sometimes, people had difficulty in understanding staff where English is not their first language. The manager confirmed that overseas staff are supported in developing their language skills (if required) through specialist language courses. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be well run by an experienced manager, which is based on openness and respect, working in the best interests of the residents. Staff are committed to ensuring a safe living environment for residents. EVIDENCE: The home is run by the Registered Manager Karen Earnshaw, a qualified nurse, who holds the Registered Manager Award. Mrs Earnshaw is an experienced manager who attends regular training courses to keep their skills and knowledge updated. Staff surveyed were positive on the management of the home. Their comments included ‘matron always listens if you have a problem and tries to help resolve it’ and ‘working at Chilton meadows and for Karen Earnshaw is a privilege and you especially should be aware of that’. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 27 When staff were asked if the systems they had in place for passing information about residents, between staff (including the manager) worked well, all but 1 (who replied ‘sometimes’) of the staff surveyed replied ‘always’. Comments included ‘effective communication with residents and relatives’ and ‘everyone is friendly and work hard at giving residents what they want’. Staff told us ‘everyone is helpful and supportive – I really like working here, best home I have worked in’. The home has good systems in place for the recording and retrieving of information, therefore any extra information we asked for was quickly found. A dedicated person regularly audits medication records and care plans. Staff confirmed that they are made aware of any shortfalls found, and asked to take appropriate action to address them, to ensure records have been completed fully, and contain all the required information. One of the systems the home has for keeping in contact and passing on news with residents and relatives is through their publication of their newsletter ‘Chilton Chatterbox’. We looked at the Autumn/Winter and Christmas copies. The front gives a message ‘from matron’, and the autumn/winter edition showed photographs of residents and staff. There is a good ethos amongst the staff and management in ‘constantly reviewing all aspects of the home and bring about changes to improve the service we give residents’. This was summoned up by a member of staff, who wrote in their survey ‘no one is perfect but monitoring and an open minded attitude we can all improve within our home and aid the home to move forward’. Systems the home has in place for monitoring the service included the manager twice a day ‘walks the floor’ to ‘ensure that residents and staff have the opportunity to discuss any issues’. The AQAA also told us that they had introduced ‘resident for the day’, which enables each resident to be asked over a month their views on different aspects of the service, such as food and activities. However, at the inspection the manager said after feedback from residents, they felt that once a month was too much, and it had been changed to once every 3 months. The Chilton Chatterbox newsletter informed residents of the change, saying that residents felt ‘it was a little pointless when they were happy with the services provided’ to be asked on a monthly basis. When we spoke to a resident they confirmed that staff “do come round and ask about things”. All the systems currently in place for gaining feedback on the service rely on people being able to communicate their opinions, and say what it is like living at the home. However, there are no systems in place for staff to be able to gain feedback from people with dementia, where they are unable to give verbal feedback, or complete the home’s surveys. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 28 The Chilton Chatterbox also informs people of safety checks that are undertaken routinely on a daily (Fire equipment), weekly (fire alarm systems), monthly (monitoring the hot water temperature of all the hot water outlets, to reduce any risk of people being scolded. They also routinely check the bed rails, hoists and slings to ensure they are not damaged and are safe to use. Whilst sitting in on the staff induction training, they were just completing a questionnaire in the safe use of fitting bedsides, to ensure they are only used in the right circumstances, and are fitted properly to the bed. There was good evidence that the home promotes safe working practices to ensure the safety of residents and staff. This included supplying staff with a monthly analysis of incidents/accidents, which showed the type of incident and when it occurred. This supports staff in identifying any reasons why incidences occurred more at certain times of the day, and take action to reduce the risk of it happening. Training records seen, and discussion with staff evidence that staff receive appropriate health and safety training on a regular basis, to ensure their knowledge is kept updated. This included food hygiene, first aid, fire protection and infection control. The AQAA gave information on the Policies and Procedures they have in place to ensure the welfare of people living and working in the home. The contents of which were being reviewed regularly, to ensure they met current regulatory and legal guidance, and best practice. Administration staff informed us that they held “no valuables” held for safekeeping at the moment. However, they were holding monies on behalf of residents, in an interest, itemised bank account. We looked at 1 resident’s account, which gave a break down of monies taken out and deposited, backed up by receipts. Residents (or if applicable their advocate) can ask for a printout of their account at any time. Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 29 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 3 3 Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 30 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chilton Meadows Residential & Nursing Home DS0000024359.V358231.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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