Inspection on 22/01/07 for Chilton Meadows Residential & Nursing Home

This inspection was carried out on 22nd January 2007.

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 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 &... 17/01/08

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, 2nd Inspector Tina Burns Key Unannounced Inspection 10:35 22 and 23rd January 2007 nd 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.V328175.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.V328175.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) Limited Mrs Karen Patricia Earnshaw Care Home 120 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (90), of places Physical disability (1) Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. In addition to the existing 30 places, the home can accommodate a further 8 individuals in the category of DE(E), as identified in correspondence from the registered person to the Commission dated 30 June and 3 October 2006. The home may accommodate one named person in the category of physical disability as detailed in the variation application dated 12 December 2006. 5th January 2006 2. Date of last inspection Brief Description of the Service: Chilton Meadows is a purpose built care home, 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, each of which provides 30 bedrooms. Two Houses - Constable and Munnings, provide nursing care for very dependent residents, many of whom use wheelchairs. Beech House provides dementia and nursing care, for people who are mentally frail. The fourth house, known as Gainsborough, provides care for frail older people, who may also have dementia, who do not require nursing care. 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 Manager/Senior Sister who is responsible to Mrs Earnshaw for the daily care of residents and supervision of staff. Current fees range form £284 to £470 for a residential care bed, and £442 to Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 5 £780 for a nursing care bed. Costs vary according to the amount of nursing care required. 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.V328175.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 2 days, by 2 inspectors (due to the size of the home), who focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in September. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (8), joint relative/visitor (13), and staff (18) feedback cards have been included in this report. During the inspection time was spent on all 4 houses, Beech, Munnings, Gainsborough and Constable, talking to residents, staff, looking at the environment, observing staff practice and reviewing records. Records seen included Medication, Care Plans, staff files, accounts, menus, Rotas and training plans. Residents, relatives, management and staff were helpful and cooperated fully throughout the inspection. Discussions at previous inspections, with people living at the home, and staff, identified that they preferred to be known as residents, rather than service users. This report respects their wishes. What the service does well: What has improved since the last inspection? Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 7 An audit Nurse undertakes regular checks of the home’s care plans and medication records. This ensures that across the home, records are maintained to a good level, and if any shortfalls are identified – dealt with. Monthly newsletter in the staff’s pay statement keeps them up to date on any organisational/work changes. The Chef/Manager or their deputy serves out the lunch on 1 of the houses, to enable them to get direct feedback from the residents on what they thought about the meal. The catering staff also visits the other 3 houses during lunchtime, to ensure everyone is happy with the quality of the food provided. The activities co-ordinators continue to develop, and increase the range of activities for residents to join in with. Welcome cards (made by residents) and toiletries are given to all new residents. The introduction of a ‘Hostess’ on each of the houses to serve meals, ay tables, enables staff to concentrate on the care issues during meal times. On-going investment into the home continues, which has included since the last inspection, upgrading the hot water system has been upgraded, and Beech House fitted with a new call bell system. 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.V328175.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.V328175.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. Standard 6 was not assessed, as the home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home, will be given information on the level of care provided, and can expect their needs to be fully assessed. This supports the prospective resident in identifying if the home is suitable, and ensures the home only admits residents whose care needs they can meet. EVIDENCE: Since the last inspection the home has increased their dementia care numbers to include 8 named residents, and to care for 1 named person with a physical disability under the age of 65. Whilst applying to make these changes the home was required to submit an updated Statement of Purpose, to support their application, which they did. Prior to the inspection feedback obtained from CSCI residents and relative surveys, confirmed that the Registered Manager (Matron) visited them in their own home, or care setting before they moved to Chilton Meadows. Resident’s Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 10 comments included the ‘Matron came to see me, brought some booklets, and told me about the home’ and ‘it was nice to see Matron when I was in hospital’. The manager confirmed that when they visited prospective clients to undertake a pre-assessment, they also gave information on BUPA homes, and more localised information on the house (Munnings, Beech, Gainsborough, Constable) that they would be moving into. A copy of the Homes Statement of Purpose, and recent CSCI report is available in the reception area for people to read. A copy of the ‘Resident information’ file was seen in the bedrooms visited. This gave a good level of information, which included meal times, Doctors visits, and the home’s ‘Philosophy of Care’. On the back of the bedroom doors was the name of the resident’s ‘Key-worker’ and if applicable ‘Named Nurse’. These are members of staff who oversee the resident’s care, and update their care records (care plans). Completed pre-assessments, undertaken by a qualified person, were seen on all the residents care plans whose care was tracked during the inspection. This covered the residents’ physical, mental and social health care needs. As 50 of the homes beds are contracted out to Social Services, many of the residents’ records seen, also contained a Social Care assessment. Residents confirmed that they had been invited to look around the home prior to admission, however, due to being in hospital, they were not able to look around them self, so relatives undertook their on their behalf. One resident said ‘ my daughter had visited and passed back information which helped me decide to move here’. Another resident already knew the home from visiting a relative. Time spent with the new residents, identified that they had no complaints about the level of care they were receiving, and praised the “friendly” staff. All 13 relatives completing the CSCI survey, said that they were satisfied with the overall care provided at the home. To make new residents feel welcomed, staff place a ‘welcome pack’ in their room, which contains toiletries and a card made by the residents. Although 2 of the residents spoken with were waiting to go home, they had not been admitted for intermediate care (which is more focused on supporting residents with their rehabilitation needs), instead they were receiving ‘respite care’ until, their care packages could be arranged to enable them to return home. Residents asked if they received the care and support they needed 5 said ‘always’ and 3 ‘usually’. Comments included ‘can feel a little rushed on occasions’ and ‘staff are very good. I am happy in my own tin-pot way’. Records held in the office, included copies of contracts, signed acceptance of Terms and Conditions, and letters sent by the home, confirming the residents admission. All the residents completing the CSCI survey said that they had been given a contract, therefore aware of the fees payable. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.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. People using the service can expect staff to monitor their care, based on their individual needs, and take appropriate action to support their changing physical and mental health. The principles of respect, dignity and privacy are put into practice. The home has safe systems in place to ensure medication is stored and administered correctly. EVIDENCE: Two residents care was tracked on each of the 4 houses. This involved, where possible talking to the residents to hear their views on the home, and reviewing their care records. Time was also spent with the staff to gain an insight into their knowledge of the resident’s needs, and how they met them. Currently the home uses 2 different types of care plans – nursing and nonnursing. The non- nursing care plans used on Gainsborough house gave more information on what the resident wanted, their daily routines, giving the reader the impression that the resident had been fully consulted, and their preferences written into their plan of care. Staff were given more detailed Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 12 information on what the residents could do for themselves, promoting independence. The care plans on the nursing houses, gave a good level of information on nursing needs for example monitoring pressure ulcers/wound care. However, there was not the same evidence that residents had been asked their preferences, more that they had been informed by staff on how they will meet their care needs. This was fed back to staff, who informed the inspector that this should be addressed when the new BUPA care plans, to be used at all their homes, are introduced. The new care plans will rely less on pre-written templates, and more on staff writing more ‘personalised’ information, within set guidelines on what should be included. The new care plans will be introduced once staff has received training in how to complete them. Although there was a difference on how the information was recorded in the care plans, there were positive elements in all care plans looked at; to evidence that resident’s physical, and mental health was being monitored. This included monitoring residents nutrition, condition of skin, and ensuring a safe environment through risk and manual handling assessments. Care plans are reviewed at least monthly, or earlier if the resident’s needs changed. Good practice was seen with random audits of care plans being undertaken. This is carried out by an experience Nurse, who writes a report of their findings, including anything they find wrong. The Senior Sister/Manager of that house then addresses theses shortfalls. All the care plans held a photograph of the resident, and their consent for the photograph to be taken. Residents surveyed, were asked if they received the medical support they needed, all had answered ‘always’. Comments included ‘I see her when I need to’, and that the ‘Doctor visits every week’. Care plans held completed ‘Spiritual’ needs assessments, which asked the resident ‘what is important to you as a person’, 1 resident had replied ‘living’. They were also asked about their religious beliefs, what was important to them as a person and if they had ‘any concerns or worries about dying e.g. pain’. Staff were asked to record if residents ‘expressed any thought / anxieties / special wishes during conversation’. Residents (or if applicable their representative) were asked their wishes concerning funeral arrangements, and the information recorded in their care plan. On the second day of the inspection, a resident had passed away. Staff spoke sensitively of the situation, and the support given to the resident and their family. One resident spoke of a friend they had made since moving into the home, who had sadly passed away. They felt it had helped them as part of their grieving in being able to attend the funeral. Macmillan Foundation training in palliative care is currently being organised for all grades of staff. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 13 Throughout the time spent on the different houses, staff were observed to treat residents with respect, and to ensure doors were closed whilst personal care was being undertaken. Discussions with a resident and their relative, confirmed that this was normal practice. Care plans gave staff guidance on actions taken to ensure resident’s privacy and dignity is maintained, including how the resident preferred to be addressed. Staff followed good practice when residents were sitting in chairs, by bending down to ensure that they had eye level, before asking any questions. To ensure staff were following safe systems of storing and dispensing medication, the records, and staff practice on 2 of the 4 houses were looked at. Records on both of the houses were of a good standard. A sample check of 4 resident’s medication held against the Medication Administration Records (MAR) were checked and correct. Medication received into the home was being recorded on the MAR charts, staff were signing to confirm medication was being given. Safe systems were in place to return/destroy any medication not taken/required by the resident. Staff were observed to follow safe practice when giving out a controlled drug (pain killer) to a resident, and completing required records. A sample check of resident’s controlled medication held on both houses was correct against the home’s own records. Medication was held securely, and transported around the home in a lockable specialist storage trolley. When observing a Nurse giving out medication on the second house, good practice was seen with them giving residents a drink with their medication, to assist them in swallowing the tablets. Medication was given out after lunch, so it did not disturb the residents eating their meal. The procedures used by the Nurse were relaxed and methodical, which ensured residents were not made to feel rushed. The Nurse locked the medication trolley whenever they walked away, however, there was still a rack containing blister packs of medication left on the top. Although there was other staff working in the lounge at the time, and no residents were seen to approach the trolley, staff should review this practice to remove any potential risk. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 14 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 expect to be able to choose their life style, social activity and keep in contact with family and friends. Residents are offered a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Feedback from staff and residents, records seen and observations made during the inspection, evidenced that overall the home is committed to providing appropriate individual and group activities. Five part-time activity co-ordinators were employed specifically to engage with residents and promote spontaneous and planned activities. The home’s social club also meet every three months to plan activities, fund raising events and excursions. At the time of inspection staff were observed in Munnings house chatting with residents, playing draughts with 1, and helping several others complete a crossword in the daily newspaper. During the afternoon, residents took part in a ‘bake and taste’, making Cheese Scones and Buns, which they later enjoyed with a cup of tea. A resident on Gainsborough commented, “yesterday we had a quiz - makes all the difference – we also do bread making now”. Another house was host to the ‘gentlemen’s club’ that meets on a fortnightly basis. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 15 One resident wrote on their CSCI comment card, ‘I enjoy crafts, quizzes and outside entertainments, singing and music afternoons. I also go and watch the Chipmunks daily’. Since the last inspection, the Chipmunk enclosure has been completed, and from comments made had become a favourite with residents. The communal areas in all units were equipped with televisions, music systems and pay phones. A new booklet produced by BUPA and entitled ‘An Introduction to Activities’ has been issued to all staff employed at the home. This has been undertaken to develop people’s awareness of the importance of activities, and promote interaction and engagement between residents and staff at all levels. Comments were generally positive but indicated that some residents, especially those in Beech house, were given less opportunities than others. The home runs a resident’s knitting club, who raised funds for a cancer charity when they produced ‘a mile of knitting’. The notice board displayed newspaper cuttings and a letter from the local MP, acknowledging their achievement. The notice boards, and houses were full of photographs displaying residents and staff taking part in different activities. Bedrooms visited, evidence that residents are sent copies of the monthly activity programme. Residents spoken with and observations made during the inspection confirmed that the home welcomes visitors, and encourages residents to maintain relationships with their friends and families. This reflected the findings in the CSCI relative surveys, who all felt that they were welcomed at the home at any time. Feedback from staff and residents and observations made during meal times evidenced that overall the standard of food was good. Menus were healthy, balanced and nutritious and the meals seen during the inspection looked and smelled appetising. Residents were able to choose from a selection of two main meals with alternative options available should they prefer something different. Mealtimes were generally relaxed, unhurried and sociable. Good practice was seen with menus on the tables, and tables laid nicely with clothes, flowers, napkins, placemats, cutlery and condiments. Each unit varied slightly in how residents chose their meals, from being asked their choices 2-days in advance, to what was seen as good practice on the dementia unit, where residents were shown the 2 choices, and asked to choose. On the house where residents were asked to choose 2 days in advance, 2 said that usually forgot what they had ordered when it came to the mealtime. Tables in one unit had already been laid for lunch - at 10.30am, even though several residents were seated at the tables for the morning. Assistance during the meals was good. Staff were helpful, polite and patient. Those residents requiring 1 to 1 help were assisted appropriately and respectfully. Staff on all the units was seen to ask residents if they were Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 16 enjoying their meal, and when assisting 1 to 1, discussing what was on the plate. Beech House had a higher level of residents requiring assistance. Good practice was seen with residents requiring individual help in the dining room, being given their meal at the same time, therefore not having to watch someone eat before them. However, the residents sitting at the table could have benefited from having a member of staff sitting with, to reassure a resident who called out, and offer assistance/aids such as plate guards to residents who were pushing food off their plate. The 4-week rotating menus offer a range of choice. Lunch menu on the first day of the inspection was: Soup or salad of choice ****** Steak & Kidney pie or poached Fish and Parsley sauce Peas, carrots and new potatoes ****** Spotted Dick & Custard or Tapioca The menus (displayed on the tables) also informs residents that fresh fruit is available at every meal. The evening meal also consists of 3 courses, which includes choices such as Spaghetti on Toast, Cheese and Ham Omelettes and Salad. Residents completing the CSCI surveys were asked if they liked the meals in the home/, 5 had replied ‘always’ and 3 ‘usually’. One resident had written that the meals were ‘pretty good, I get a good choice which is good as I am a vegetarian’. This reflected comments made during the inspection, with residents also saying that they are offered drinks throughout the day, and night if wanted. Residents visited in their bedrooms had jugs of cold drinks, as well as being offered hot drinks at regular intervals. The Chef Manager has completed ‘Menu manager’ training to ensure that all meals are nutritionally balanced. As part of the homes on-going quality monitoring, the Chef Manager or their Deputy, serve the main meals to the residents on Gainsborough House, which enables them to receive comments on the food, direct from the residents. They also visit the other 3 houses at lunchtime to gain further feedback from residents. Residents spoken with during the inspection, said they were able to “make their own decisions” for example when they wanted to get up or go to bed. When they wanted time on their own – staff respected this, and left them to call staff if they needed them. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 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. People living at the home, 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 Homes Statement of Purpose and Residents information pack. The procedure includes appropriate times scales for responding to complaints and information on who to complain too. The wording used, ‘If you wish to refer a complaint to the CSCI’ needs to be updated/amended to reflect that the CSCI is not a complaints agency. However, if the person making a complaint is not satisfied in the way the home had dealt with it, they can contact the CSCI to seek further advice. Feedback from CSCI resident and relative surveys, confirmed that people were aware of the home’s complaint procedure, and felt comfortable to raise any concerns with senior staff. One resident wrote ‘I have never needed to make a complaint – I haven’t been unhappy – I like it here’. Discussion with the manager and feedback from residents suggested that issues were normally resolved promptly and before reaching the complaints stage. Complaints records examined indicated that two complaints had been received since the last inspection in January 2006. Records were complete and included Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 18 evidence that the complaints had been appropriately investigated and responded to. There was also a record of compliments received by the home that indicated that 55 compliments had been received in the last 12 months. During the inspection guidelines for staff regarding the reporting of concerns and suspicions of abuse were seen in the office on each of the houses. The guidelines included contact numbers and reflected the local authority inter agency procedures for the protection of vulnerable adults. In addition guidelines displayed also included the homes procedures for ‘whistle blowing’. The manager confirmed that there had been no reports of concerns or allegations since the last inspection. Discussion with the training co-ordinator and training records examined, evidenced that the home provides appropriate staff training in relation to recognising signs of abuse and reporting concerns. Staff spoken with were confident that they knew the reporting procedures and would respond appropriately to any concerns. Care plans looked at held completed restraint forms for the use of wheelchair lap belts and bedsides, to ensure the residents safety. These had been signed by either the resident themselves, or their advocate, and regularly reviewed. One care plan viewed for a new resident who had only been at the home for a week, held a restraint form, for staff to hold the resident’s hands if they became verbally and physically abusive whilst staff were undertaking their personal care. Although a risk assessment had been undertaken – there was no record of when staff had needed to use physical intervention, and any monitoring to identify why the resident’s behaviour changed. The restraint form showed that 3 members of senior staff from the home had been involved in the decision. The inspector was informed that they had also been given verbal permission to use physical intervention from the resident’s social worker. The home was asked to arrange a full multidisciplinary review, to include Health & Social care professionals, and keep more detailed records of when the intervention was used. The social care assessment gave limited information on the resident’s previous behavioural patterns, and what investigations had been undertaken. Contact with the home following the inspection showed that staff were taking action to address the points raised. The homes procedures for safe guarding residents finances were explored during the inspection. The homes administrator advised that generally resident’s relatives assisted residents with their financial matters. All bedrooms seen had lockable facilities for the safe keeping of resident’s money and valuables. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a comfortable, environment to live in, which suits their needs. Although some areas are showing wear and tear, this will be addressed as part of the home’s on-going maintenance and refurbishment programme. EVIDENCE: On arriving unannounced for the first day of the inspection, the inspectors undertook a tour of all 4 houses, taking in all the communal rooms and sample of bedrooms on each house. The houses were found to be clean and fresh, although 1 of the houses had an unpleasant odour, further discussion with staff identified the cause, and what action they were taking to eliminate the odour, and support the residents concerned. Feedback from residents surveyed confirmed that the home was ‘always’ clean and fresh, with 1 resident commenting that the cleanliness of the home was in their opinion ‘jolly good’. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 20 Each house had their own character, and varied in the standard of décor, soft furnishings and layout of the communal rooms. Some of the corridors paintwork on the houses were showing signs of wear and tear. The manager confirmed that this would be addressed as part of the home’s on-going maintenance programme. In 1 empty bedroom (Gainsborough house), fresh towels had been put out for the new occupant, 1 of which was frayed and had a hole. Although the Housekeeping supervisor should pick this up, during their final check of rooms prior to a new admission moving in, systems should be in place to replace worn towels, before they leave the laundry. The dining rooms had a range of tables, which were suitable for both wheelchair, and non-wheelchair users. The gardens are well maintained, are wheelchair user friendly, and have many points of interests including water features, flowerbeds and aviary. Residents confirmed their enjoyment of the outside facilities including the recent addition of a Chipmunk enclosure. Residents bedrooms looked at were personalised with family photographs, pictures, ornaments and some had their own televisions. On Beech House, residents sign a permission form to enable staff to lock their bedroom door when they are not in their room. The home should monitor the situation, to see if this is required, or just at times when a resident may become mistaken and go in, or remove articles from another resident’s bedroom. Time spent with residents showed that they had been provided with specialist beds/mattresses/seat cushions to ensure their comfort. On the second day of inspection the company’s surveyor was undertaking a planned review of the homes fire risk assessment. The home had also had an inspection by the local authority fire service in November 2006. Records seen and discussion with the manager evidenced that the home had appropriate systems in place to protect staff and residents from fire. The home has an on-going maintenance programme. The Manager supplied a list of work undertaken since the last inspection which included up-grading the hot water system, refurbishment of 10 bedrooms on Beech house which included new carpets, curtains, bed linen, redecoration, chair and commode. All staff completing the CSCI surveys confirmed that they had sufficient manual handling aids to support them in their work. This was also evidenced by the information supplied by the home, which included the purchase of 3 electric hoists, and 7 pressure relieving mattresses in the last year. Time spent in the homes ‘in-house’ laundry, showed that it was well organised, and had methods in place to reduce the risk of lost laundry, which included their own labelling machine. The laundry has recently had a system put in that eliminates the need for hot water, reduces the volume of chemicals used and washing is disinfected every wash cycle. Staff approved of the new system, saying the washing “smells fresh – as if it has just come off a line”. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of Residents. EVIDENCE: Feedback from staff and residents, records examined and observations during the inspection confirmed that the home employs appropriate numbers of staff with a wide range of experience and skills. This includes nurses, care assistants, maintenance workers, laundry and house keeping staff, chefs/cooks and kitchen staff, activity co-ordinators, administrators, and a training coordinator. Recruitment records examined, discussion with the manager and feedback from staff and residents also confirmed that the home has thorough and robust recruitment procedures in place. Three staff recruitment records examined evidenced that all information required is obtained by the home and included written references, Criminal Record Bureau Disclosure checks, declarations of health, application forms and evidence of face-to-face interviews and identification checks. Residents spoken with were very complimentary about the attitude and quality of the staff. Comments included “They’ve picked winners” and “very nice people doing their best”. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 22 The CSCI survey asked residents if staff are available when they needed them. 3 had replied ‘always’, 4 ‘usually’ and 1’sometimes’. There comments included ‘I ring the bell and they come to see me’, ‘occasionally I need to wait in the mornings after breakfast for the toilet. The staff are always busy then’ and ‘when I ring for the toilet it can seem to be a long time before they come’. This was fed back to staff, who show the inspector the call bell monitoring system, which invoices producing a printout which records the time a call bell is rung, and the time it is answered. Senior staff regularly review the printouts, and if a resident raises concerns that they have been left waiting – the printout will be checked, and if required appropriate action taken. Evidence also indicated that although the home employs many overseas workers the company did not rely on agencies for their recruitment and undertook face-to-face interviews themselves. Consequently the outcome was generally very positive and with the exception of feedback from 1 relative who felt that there was a communication issue with some staff that did not have English as their first language, staff and residents indicated that on the whole language difficulties were minimal and communication was good. Discussion with the manager and training co-ordinator, staff spoken with and records seen confirmed that staff working at the home are appropriately trained and qualified. Qualifications included nursing and a range of National Vocational Qualifications (NVQ’s). NVQ training undertaken during the last twelve months included Level 2, 3 and 4 in care, Level 2 in activities; level 2 in house keeping and level 2 in managing teams. Care workers induction programmes has been developed in line with “skills for care” handbooks. The range of in-house and external training undertaken since the last inspection was vast. This included mandatory and refresher training in areas such as moving and handling, first aid, prevention of fire, food hygiene and protection of vulnerable adults in addition to a wide range of specialist, health and safety and complementary training for staff at all levels. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People can expect a well managed home, 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 ensures that her knowledge is kept up to date through supervision, training and development. Feedback from staff and residents regarding the running of the home was very positive. Staff and residents confirmed that they found the manager and senior staff helpful and approachable. There were also clear lines of accountability throughout the home, each unit having a senior manager and assistant manager. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 24 Observations during the inspection and discussion with the manager and staff in a range of roles indicated that the management of the home creates a positive and inclusive atmosphere. The company encourages staff at all levels to integrate with the residents and this was evident in a conversation with one of the residents who talked fondly about laundry assistants, maintenance and house keeping staff. Overall there was a good sense of team spirit and commitment from the whole workforce. Staff spoken with, newsletters and certificates seen evidenced that the company encourages good practice, innovative ideas, and hard work through acknowledgement and awards. Quality assurance systems were in place and included internal audits, regular visual ‘checks’ of the grounds and premises and customer satisfaction survey’s. The manager also spoke about a new initiative that they were thinking about introducing where they would identify a different resident each day and seek their views about matters such as laundry services, meals and activities. The manager also advised that they usually “walked the floor” twice a day to ensure that residents and staff had the opportunity to talk with her. Overall the systems in place were positive but the home had not developed their quality assurance processes to include an annual report and development plan. The home has safe systems in place to hold money in safe keeping for residents, by placing into an account. This gives residents easy access to cash without having to hold large sums of money in their rooms. Electronic records seen evidenced that the money is held in an appropriate bank account, and all interest is applied to each resident’s balance monthly. Resident’s expenditure, receipts and accounts are reconciled on a monthly basis by the administrator, and checked by the manager. The administrator believed that the account was also audited periodically. Discussion with the manager, training co-ordinator and staff, evidenced that although the home aims to ensure that nursing and care staff receive individual supervision 6 times a year this is not consistently achieved. However other activities such as staff handovers, team meetings and informal supervision indicated that overall staff are appropriately supervised. Feedback from staff CSCI surveys and during the inspection, confirmed that they felt supported by their colleagues and managers. There was good evidence that the home promotes safe working practices to ensure the safety of residents and staff. Discussion with the manager and records examined confirmed that incidents/accidents are appropriately reported and analysed monthly. This enabled the manager to monitor accidents and ensure that appropriate action had been taken. Training records and staff spoken with also evidenced that staff receive appropriate health and safety training on a regular basis. Safety procedures Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 25 and notices were clearly displayed around the home and appropriate policies, procedures and records were in place. The manager confirmed that health and safety meetings took place every 3 months with the homes health and safety representatives. During the inspection a BUPA estates officer was undertaking a detailed Fire Risk Assessment, and each house had contact details for out of hours emergency maintenance cover. Records seen confirmed that health and safety policies and procedures were regularly reviewed and updated and internal audits were carried out. Discussion with the training co-ordinator, staff feedback and records seen evidenced that the home provided appropriate health and safety training including food hygiene, first aid, fire protection and infection control. A list of staff qualified to give first aid was displayed in the offices on each of the houses. Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 26 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 N/A 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 3 X 3 Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 27 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 OP18 Regulation 13 (7) Requirement The home must arrange for a full multidisciplinary review for the resident requiring physical intervention. Full records must be kept of when and why it was used, and action taken by staff to stop the need of using physical intervention to ensure the safety of the resident. Timescale for action 23/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP16 Good Practice Recommendations The home should have systems in place to monitor that all residents are given an equal opportunity for social engagement, either 1 to 1 or within group activities. The home should review their complaints policy, to ensure that the reader is aware that the CSCI is not a complaints agency, however if they are unhappy how the home has investigated their complaint, they can contact the CSCI to seek further advice. DS0000024359.V328175.R01.S.doc Version 5.2 Page 28 Chilton Meadows Residential & Nursing Home 3. OP36 The home should aim to ensure all care staff receive regular, formal supervision at least 6 times a year. Repeat recommendation 5/1/06 Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chilton Meadows Residential & Nursing Home DS0000024359.V328175.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!