Inspection on 05/01/06 for Chilton Meadows Residential & Nursing Home

This inspection was carried out on 5th January 2006.

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

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

Other inspections for this house

Chilton Meadows Residential &... 17/01/08

Chilton Meadows Residential &... 22/01/07

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/Gainsborough Hse Residential & Nursing Home Union Road Onehouse Stowmarket Suffolk IP14 1HL Lead Inspector Jill Clarke Second Inspector - Debbie Seddon Unannounced Inspection - 5th January 2006 09:30 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/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 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/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chilton Meadows/Gainsborough Hse Residential & Nursing Home Union Road Onehouse Stowmarket Suffolk IP14 1HL 01449 770321 01449 614248 Address 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 (30), Old age, registration, with number not falling within any other category (90) of places Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th September 2005 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 older people, who do not require nursing or dementia 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. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of 2 regulatory inspections, undertaken between 1 April 2005 and 31 March 2006. The inspection, due to the size of the home was undertaken by 2 inspectors, over 6 hours, on a Thursday in January. The aim of this inspection was to look at relevant standards, which had not been looked at during the first inspection (27 & 28 September 2005). Time was also spent to ensure that requirements and recommendations made following the last inspection, and a complaints visit (1 December 2005) had been addressed. During the inspection time was spent talking to 6 residents in private, to hear their views on what it was like living at Chilton Meadows. General feedback from residents and relatives were also obtained throughout the day. Time was spent with talking to staff in private throughout the inspection which included the Registered Manager, House Managers/Senior Nurse, Staff Nurses, Chef, Housekeeper Administrator and Care Assistants. The environmental tour took in communal rooms on 3 of the 4 units (Gainsborough, Constable and Beech Houses) and a sample of 4 bedrooms, sluice, 2 bathrooms to check the condition of the décor, furniture, cleanliness and hot water temperatures. Records inspected included care plans, medication records, menus and supervision/training records. 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: Feedback throughout the inspection on the level of care provided was good. Comments from residents included “very, very nice nothing to grumble about everyone very kind” “staff give me all the support I need”, “ staff are lovely, they are my friends, they are very good, do anything for you” and “staff pretty good – nice atmosphere here”. Relatives (2) asked about the standard of care replied that they were “very happy” with the “care” and that they felt the home had a “happy atmosphere”. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 6 Staff make visitors feel welcome, and are committed to using any feedback through resident/relative meetings, newsletters, and surveys undertaken to improve on, and monitor the service to ensure it meets the needs of people living at the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. People wishing to move into the home, can expect their needs to be fully assessed. This ensures that the home only admits residents within their registration category, whose care needs they can meet. Prospective residents are given a good level of information, to help them decide if the home offers the level of service they are looking for. EVIDENCE: Standard 5 were assessed as met, and standard 4 as nearly met during the inspection carried out on the 27 & 28 September 2005. Standard 6 was not assessed, as the home does not offer intermediate care. The home, to ensure standard 4 was fully met was asked (see report 27 & 28 September 2005) to reassess all their residents, to identify how many residents living at the home has dementia (see requirements section). Following correspondence (resident’s General Practitioner), and discussions with the manager during this inspection, it was identified how this should be carried out. To support the home, the timescale for this requirement has been extended. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 9 The Statement of Purpose, previous CSCI reports and information booklets on each of the houses (Munnings, Constable, Beech, Gainsbourgh) were available for visitors to read (or takeaway) in the main entrance. A copy of the ‘Resident information’ file was seen in the bedrooms. 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 residents ‘Named Nurse’ and ‘Key-worker’. These are members of staff who oversee the resident’s care, and update their care records (care plans). Time spent with 1 resident confirmed that they were fully aware of the costs, informing the inspector that they “will go up in April”. Contracts for 2 residents (1 private and 1 social care funded), were looked at which had been signed by all parties (resident or their advocate, the home, and if applicable local Authority) weekly costs, their contribution, and terms of residency. A sample of 3 care plans looked at, showed that the Manager had visited the prospective resident before they moved in, and carried out their own preassessment. They contained key information about the resident’s background; general health, physical and mental well-being and current care/nursing needs. Time was spent with a resident to discuss their admission to the home. They said that they had recently moved in from hospital, and at first, they had “found it difficult to cope with the change, but staff have been very supportive”. A member of staff was asked if they felt the information obtained through the pre-assessment reflected the resident’s needs?. They replied, “Yes – it was very accurate”. Care plans also contained, where applicable transfer letters from the hospital and social service assessments, which enabled the staff to gain a good level of knowledge about the person, who was being admitted care needs. Good practice was also seen where staff had visited and re-assessed a resident who had been in hospital, before their discharge back to the home. This was to ensure that the staff were still able to meet the person’s needs. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, and 9. People using the service can expect staff to monitor their care, and take appropriate action to support their changing physical, and mental health needs. Staff must ensure that medication is given out as prescribed. EVIDENCE: Although standards 7 & 8 were assessed as met during the last inspection, a further sample of 4 care plans were reviewed during this inspection. Care plans showed that the information obtained from the resident’s preadmission assessment, is used to form the basis of their individual care plan. A complaint was made direct to the CSCI (see complaints and protection), following a resident’s admission to hospital from Beech House. The hospital was concerned over the resident’s poor level of personal hygiene. This led to an unannounced visit by the CSCI (1/12/05) where shortfalls were identified in the level of information held in the resident’s care records (care plan), and the level of personal care they had been given. The home was asked to take immediate action to ensure the residents care needs were fully met and recorded in their care plan. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 11 The manager informed the inspectors, that in response to the issues raised in the complaint, an additional day has been built into the staff induction programme specifically on the importance of personal care. They have also introduced a ‘tick sheet’ that staff must tick after completing tasks assigned to them during their shift. As the resident had returned from hospital the inspectors were able to track their care. This involved looking at their care plan (to ensure it had been updated and reflected the level of support required) and spending time with the resident. Action had been taken by the home to update the information in the care plan, to ensure their personal hygiene needs were fully met, and reviewed. Although the resident was unable to fully communicate, the resident looked comfortable and cared for. A second residents care was tracked on Beech House showed that their care plan held a good level of information, which was regularly reviewed, to ensure that the information was current. Both care plans contained a ‘behavioural Assessment Scale of Later Life’ (BASOLL), which is used by the home to monitor residents mental health. Completed monthly, this supports staff in identifying any changes, and seek further medical guidance, when required. Care plans covered all aspects of the resident’s physical, mental and social care needs, and gave staff clear guidelines, on how the resident’s wanted to/wished to be cared for. This included nursing assessment (broken down to reflect the long and short-term goals), risk assessments (to monitor their nutrition, skin and personal safety). The care plans also evidenced visits by their general practitioner (GP) and any referrals to external Health professionals to support in identifying, treating and monitoring individual residents physical and mental health. Completed ‘body maps’ and photographs, gave information on any pressure sore/wounds being treated, which linked to the on-going Nursing assessment, which monitored the treatment and how the broken areas were responding. Consent had been obtained and signed for by a relative for the use of the photographs. Time was spent with 1 resident on Beech House to discuss the level of care received. The resident was familiar with the care plan and contents and showed the inspector their foot where the pressure sore was bandaged and told them “the pressure sore on my heel is getting better”. Evidence was seen that falls risk assessments were being completed and a falls diary being kept, these were being monitored and reviewed on a monthly basis. A relative (Beech House) when asked about the level of care, replied “I am very happy with the care my relative receives”. “The staff are very good and I Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 12 feel involved in my relatives care, there is always a happy atmosphere when I visit”. On Constable House a sample of 2 care plans were also looked at which also gave clear guidance to staff on how the residents wanted/needed to be looked after. Time was spent with a resident to hear their views on the level of care provided on Constable House. When asked if they were able to have regular baths, they said they had a “bath once a week”, when asked if they would like one more often? Replied “no”. Feedback on care was also obtained from residents living on Gainsborough house which included, “staff are lovely here, they are ever so nice” and “the home is very, very nice, there is nothing to grumble about every one is very kind” and “Staff give me all the support I need” and “Staff are lovely they are my friends, they are good and will do anything for me”. The home’s medication and it’s administration and storage was checked on 2 of the 4 houses (Beech and Constable). On both houses good practice was seen in the use of staff accountability sheets signed by the Nurses to confirm that the medication had been given out (or the appropriate code entered) as prescribed. The houses had safe systems in place for the recording of all medication received and out of the home. The temperature of the fridges, were checked regularly and staff had dated short life medications to ensure that they were disposed of, when required. Medication Administration Records (MAR) for both houses were checked, to ensure that staff had signed to confirm medication had been given (or appropriate code entered). MAR sheets on Constable house were fully completed, and a sample of 3 medications held, was checked against the MAR records, and found to be correct. On Beech House, sachets of nutritional supplements were checked against the records held for 1 resident. The amount left was found to be short by 54 sachets. Further conversation with the Nurse identified that staff may have used sachets out of the box for other residents, who were prescribed the same supplement. This raised concerns that the supplement had been prescribed for a individual resident, and should not be used for others. It also made it more difficult for staff to monitor to ensure that the supplements had been given out. For 1 resident who was prescribed a varied dose of 1 to 2 Paracetamol, staff had not always entered how many tablets had been given. Out of the 3 residents medication checked against the MAR records. One was found to be incorrect, with 1 extra tablet left than should have been. This raised concerns that a member of staff had signed to say medication had been given when it was still in the box. The home was asked to take immediate action to ensure that residents received their medication as prescribed. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15. Staff are committed to providing a choice of nutritionally balanced meals, which meets resident’s individual likes and dislikes. EVIDENCE: Standard 12, 13, and 14, was assessed as met during the 27 & 28 September 2005 inspection and the following judgement made ‘People using the service can expect to be treated with respect by staff and supported to take part in a range of activities. Visiting is flexible, and visitors are made to feel welcome’. No concerns were raised during this inspection to require the standards to be re-assessed. Breakfast menus on Constable showed that residents were offered that morning, fruit juice, assorted cereals or porridge, poached egg, tomatoes, toast and preserves. A resident praised the breakfast choices, saying that sometimes they also had “kippers” which they enjoyed. The home has a 5-week rotating menu. Lunch menu on the day of the inspection, offered Soup as a starter, followed by Salad of their choice, Braised Pork Chop or Pasta Bolognaise. The main courses was served with Mashed potatoes, Broad Beans and Cauliflower. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 14 During lunchtime, the inspectors each choose a different house, to observe the lunchtime routines. The first inspector observed Beech House. The 7 staff on duty helped the 30 residents, with 3 staff sitting and assisting a resident each, which left 4 staff to serve and assist the other residents. Jugs of orange squash were seen on each table. A list was seen displayed on the wall near the kitchen and serving area, of residents requiring special diets. Sixteen residents were shown as requiring a pureed meal and 3 were highlighted as diabetic. Puréed meals were served in plates with dividers, which separated the individual food items, keeping the colour, tastes and textures apart. The meals were nicely presented and looked appetising. For desert, residents were offered fruit and jelly. A separate fruit and jelly had been made for diabetic residents. An alternative of bread and butter pudding was on the menu however; this was not seen during the lunchtime meal in Beech House. One resident spoken with informed the inspector “ food was very nice”. The resident refused their lunch, which was plated up for the resident to have later - if they wished. A note of this was recorded in their care plan. On Constable House, there was a relaxed atmosphere, as staff sat and assisted residents who required help, which was undertaken in an unhurried sensitive manner, engaging residents in conversations. Staff assisting residents waited until the resident had finished what they were eating, before offering more. Residents were asked by staff what they wanted for dessert, from a tray – or shown the menu, to help them choose. The co-ordinated furnishings, helped promote a homely atmosphere. Staff said the kitchen “ was good”. They confirmed snacks (sandwich, toast, cakes, cereals, Yogurts) and drinks were always available for residents 24 hours a day, from the house kitchen. Time was spent with a resident, and their relative, to hear their views on the quality and choice of food available. They said that the standard did “does vary”, but “the meat on the whole was good” and that for “supper, they nearly always had a salad which was good”. Further discussion identified that they felt vegetables were sometimes undercooked (“carrots not cooked enough”). They would also like to see more variety given (desserts and cakes) for diabetics. The difference in the texture of the vegetables was noted when the inspector tried to cut some left over carrots and broad beans. Some of the carrots were quite firm – where other pieces were softer. The resident said that there only ever appeared to be a choice of 2 (chocolate or fruit – although the “fruit ones were tasty”) diabetic cakes on offer and that puddings “were boring” with “mostly milk puddings on offer”. A member of staff confirmed that the choice of home made diabetic cakes, was normally the 2 stated by the resident. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 15 The resident asked if they were given enough refreshments during the day replied “yes – we always get plenty”. They went on to say “I like my breakfast in bed – one of the little treats I give myself”. With their permission their comments were fed back to the Chef who took the feedback positively, and said they would look into the situation with the vegetables and increasing the variety of diabetic puddings/cakes. They confirmed that they aim to use all fresh vegetables, which are cooked in a steamer. Time spent with the Chef also identified how committed the staff are at obtaining feedback, and working to meet individual residents likes/dislikes and nutritional requirements. This included the new BUPA ‘Food Cube’ which gave recipes, nutrition, specialist diets and ideals to support older people who have a poor appetite. Time was also spent talking with residents as a group and also privately (3) on Gainsborough House. Residents spoken with generally found the food too spicy and preferred more traditional style of food. Examples of residents comments were “The food varies, there is too much foreign food, I prefer traditional food, I can not stomach spices”, I am used to home cooking” and “I do not like the lunches, they are to continental, I am used to home cooking, I like plain food, I will normally choose to have a jacket potato and cheese for lunch instead” however, they do provide nice puddings” and “The teas and breakfasts provided are nice, we can choose from a selection of soups, sandwiches, cheese and biscuits, beans on toast, yogurts and puddings”. Following the inspection (27/1/06) this was fed back to the Chef, who confirmed that foreign (Indian, Italian), dishes for example Mild Lamb Curry, and Bolognaise, were served no more than twice a week. They also went on to say that that when a ‘foreign’ dish was on the menu, there was always a second traditional dish such as Steak & Kidney Pie or breaded fish. The Chef said that a new member of the catering staff had been using extra seasonings and spices (which is what they used in their previous employment) however, once this had been identified, the situation had been addressed. Further discussion identified that they were cooking for 120 people whose ages can range from 65 to 100 years of age. The younger residents were more use to eating foreign dishes (and asked for them), where the older residents preferred a more traditional style. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: Standard 18 was assessed as met during the last routine inspection carried out over 2 days, 27 & 28 September 2005. Standard 16 was also assessed as met during the last inspection, which showed that the home had procedures in place to ensure that complaints were listened to, and investigated. An unannounced inspection was undertaken on the 1 December 2005, following a complaint made direct to the CSCI. The complainant raised the following concerns: • Concerns over monitoring a resident’s personal care – upheld • Concerns over nursing care – monitoring a resident’s pressure areas – unresolved • Concerns over communication between the home and hospital – upheld A copy of the complaint report (Comp.337) is available through CSCI Suffolk Area Office. This inspection confirmed that the home had acted positively to address the identified shortfalls (see Health & Personal Care section). Discussions with residents during the inspection, confirmed that they were happy to raise any concerns with staff or the Manager. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 and 26. Staff are committed to providing a clean, homely environment for residents to live in. EVIDENCE: Standards 19, 20, 24 and 25 were assessed as met during the 27th & 28 September 2005 inspection. Standard 26 was assessed as nearly met, following concerns raised over commodes in a sluice room (Beech House) which had not been properly cleaned. During this inspection the sluice room was found to be clean and tidy, fresh smelling with no unpleasant odours. Commode pots were clean. Procedures were in place directing staff how to deal with soiled linen and resident’s laundry. Red dissolvable bags were provided for linen, soiled by bodily fluids (urine, blood vomit, faeces) which would then be put through a sluice cycle in the washing machines separately. As part of the homes infection control procedures, disposable gloves aprons, liquid soap and disposable hand towels were seen throughout the home. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 18 The home was pleasantly decorated with bright colours providing a bright and cheerful atmosphere. Evidence was seen that the home was in the process of having automatic fire closures to the doors in the home so that residents could have their doors open during the night. Concerns were raised during the last inspection (27 & 28 September 2005), over the temperature of the hot water not always being maintained. On Beech House, the hot water supplied to 1 resident’s hand basin was found to be cold. The Home admitted that they had problems with the water system, which they were looking into. During this visit the manager confirmed that BUPA have authorised the expenditure for Chilton Meadows to have a new heating system installed. This should address all the problems. The water temperatures were checked in 3 bathrooms. The temperatures ranged between 32°C and 38°C, these temperatures were seen to be on the cooler side, and should to ensure the comfort of residents (unless otherwise stated in their care plan) be maintained between 41 to 43°C. A member of nursing staff was asked if they had sufficient mobility equipment to meet residents transfer needs, replied they “had a lot on here – hoists and slings”. On Beech House, there was a list of residents names, and the type of specialist mattress/bed provided to prevent any skin problems (pressure ulcers). Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None See below EVIDENCE: Standards 27, 28, 29 and 30 were assessed as met during the 27th & 28 September 2005 inspection with standard 30 given a commendable rating. Which resulted in the following judgement being made ‘People using this service can expect staff to be well trained, and have the skills and knowledge to undertake their job’. There were no concerns raised during this inspection, to lead the inspectors to re-assess these standards. A resident asked if they ever felt staff rushed their care, they replied “no – not too bad at all”., and went on to say that “staff are very good”. Asked if they felt the unit had enough staff, replied “sometimes short”. They went on to say that sometimes (not always) they were “sat up ready for breakfast at 8.30”, but had to wait an hour before receiving it as there was only 1 person helping with breakfast. Discussions with 1 member of staff (Beech House) confirmed that they felt there were adequate staffing levels for the number of residents. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 36, 37 and 38. Staff feel supported by the management, and are committed to providing a good level of care within a safe environment. EVIDENCE: One member of staff informed the inspector that they had not had supervision for 6 months; their file seen confirmed their last recorded supervision was in September 2005. The files of other staff seen showed that out of 16 staff, 4 staff had had supervision in November 2005, 2 staff had a supervision session in October, (although these records had not been fully completed or signed and dated). 5 staff had supervision in September 2005. 2 staff had supervision in May 2005 and 1 member of staff’s last recorded supervision was February 2005. 2 staff had no record of supervision taking place. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 21 The senior on duty and the manager informed the inspector that the member of staff responsible for the training in the home had recently attended a supervision-training course. Information about supervision had been circulated to the different houses of Chilton Meadows on new ideas to make the supervision process more beneficial and meaningful for staff. As a result a new supervision (staff support) sessions are to be implemented using a new supervision template. A copy of the supervision agreement and template were shown to the inspector. Discussions with staff during the complaints investigation (1/12/05) and during this inspection identified that staff are not always reading the residents care plans. A member of staff on Beech House was asked if they were aware of the changes of the resident’s concern care plan following the complaint investigation. The carer went on to say that it was the nursing staff who write and record in the care plans, and that they had received verbal information about the changes with regards to the resident’s personal hygiene and pressure care. However, the member of staff was not aware that the resident’s needs had changed involving the frequency of having their hair washed. They were also not aware of a behavioural plan in place regarding one resident who sometimes displayed aggressive behaviour when using the hoist, although they aware that resident often become verbally abusive. The home is run by the registered Manager, Karen Earnshaw, a qualified Nurse, who holds the Registered Manager Award. Mrs Earnshaw worked cooperatively throughout the inspection process, taking any feedback positively. A member of staff asked about the abilities of the Manager, replied that they found Mrs Earnshaw “very supportive and understanding”, they went on to say that you went to the Manager with “any problems – and it will be dealt with straight away”. Another member of staff asked if they felt supported by the Management? Replied “yes – especially by Karen”, who they felt was “approachable” and ensured “confidentiality”. The system in place for safe keeping residents money and valuables was looked at. Any monies paid in by residents for safekeeping were held in a central, interest paying, bank account. Residents are able to withdraw money at any time, and records seen, showed that they received interest. Residents can also request a print out of their ‘statement’ at any time. A statement seen showed interest had been added and a list of any withdrawals or deposits made. The home does not promote keeping residents valuables. If valuables, such as a ring are given in for safe keeping, the home writes to their next of kin (or representative) requesting them to collect the item. Records viewed showed that the home had a safe system of recording and storing the valuable items until they are collected. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 22 During the last inspection concerns were raised that fire doors were being ‘wedged’ open, which put residents and staff at risk. This inspection evidence that the home had action the requirements made. Fire doors were not held open, unless by ‘self closures’, which would enable the doors to close automatically when, the fire alarms went off. Since the last inspection the home has been working with residents, who wish to keep their doors open, to have automatic closers fitted. Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 23 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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X 3 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 2 2 3 Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14, 16 Requirement The home must re-assess all their residents to identify who has a diagnosis of dementia on Gainsborough, Constable and Munnings Houses. Timescale for action 01/05/06 2. OP9OP37 13 (2) Once completed, the home must submit an application to increase their registered numbers for people with dementia. Repeat requirement (27 & 28/9/05) which has been extended to take into account the work that needs to be undertaken. Staff must ensure medication is 05/01/06 given out as prescribed, and as entered (directed) on the MAR sheet. The home must ensure that where food supplements have been prescribed, staff use the residents own food supplement to enable them to monitor that the supplement has been given. 10/01/06 3 OP9 13 (2) Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 25 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 Refer to Standard OP15 Good Practice Recommendations The home must continue to work with residents to address the comments made by residents in this report (food too spicy, vegetables under cooked, more variety of diabetic desserts and cakes). When staff have assisted residents to get ready for breakfast, they should monitor the situation to ensure that the resident is not left waiting too long before they are served breakfast. The home should aim to ensure all care staff receive regular, formal supervision at least 6 times a year. Staff are not always reading residents care plans, instead relying on verbal information, which could lead to mistakes. The home as part of staff’s induction and ongoing development/supervision, encourage staff to read care plans them self. 2 OP27 3 4 OP36 OP36 Chilton Meadows/Gainsborough Hse Residential & Nursing Home DS0000024359.V275677.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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