Inspection on 20/05/08 for Chilworth House

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Adequate service.

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

Chilworth House 01/02/10

Chilworth House 18/11/09

Chilworth House 20/01/09

Chilworth House 14/11/07

Chilworth House 15/11/06

Chilworth House 19/12/05

Chilworth House 04/08/05

Chilworth House 13/01/05

Chilworth House 02/08/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Chilworth House 7 Rectory Avenue High Wycombe Bucks HP13 6HN Lead Inspector Barbara Mulligan Unannounced Inspection 10:30 20th May 2008 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 Chilworth House DS0000022964.V363542.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. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilworth House Address 7 Rectory Avenue High Wycombe Bucks HP13 6HN 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) 01494 526867 01494 526140 simon@lloydscott-healthcare.co.uk Lloyd Scott Healthcare Limited Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2007 Brief Description of the Service: Chilworth House is a care home providing personal care and accommodation for 28 older people. It is privately owned. The home is situated in High Wycombe and is a short drive away from the amenities that a large town can offer. The home has been owned and operated by Lloyd Scott Healthcare since 1998 and has undergone many improvements since then. It is a well-maintained Edwardian building and the improvements are in keeping with the style of the building. There are 26 single bedrooms and two double rooms, which are comfortably furnished. The home has two lounges and a pleasant conservatory. There is a sheltered outside sitting area and well-kept garden. The fees for the home range from £360.00 for a shared room to £650.00 for a single room. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion. Information received by the Commission since the last inspection was also taken into account. No surveys were received by the time the report was written. The inspection officer was Barbara Mulligan. The registered manager is Sue Ann Cook. The inspection consisted of discussion with the registered manager and other staff, opportunities to meet with some people who use the service, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Twenty-nine of the National Minimum Standards for Older people were assessed during this visit. Six were assessed as almost met, standard six was assessed as not applicable and the remaining standards were fully met. As a result of the inspection the home has received seven requirements. The evidence seen and comments received indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. Feedback on the inspection findings and areas needing improvement was given to the manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the service does well: Healthcare support for people who use the service is good. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Meals are of a good standard and presented in an appealing way. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 6 There is a motivated and established staff team that consists of care/support staff who respond to service users in a respectful and appropriate manner. Communication between service users and visitors was observed to be positive and open. Improvements to the premises continue to be made to ensure a safe and homely living environment is maintained. What has improved since the last inspection? All potential residents now receive a needs assessment to ensure the home can meet their needs. All residents have a contract of the homes terms and conditions of stay in the home, the fees and method of payment of fees. All people using the service now have a care plan in place. The home has ensured that a local authorities review has taken place for one person about their suitability of placement in the home. Professional advice has been sought about the promotion of resident’s continence and this has been acted upon. The supply of continence aids has been reviewed for individual residents in order to ensure their needs are fully met. Training has been completed for the staff who are expected to carry out medicine administration. Procedures for recording, handling, safekeeping, safe administration and disposal of medicines received into the home has improved ensuring safe practices. Suitable arrangements have been made to ensure that the home is conducted in a manner, which promotes the residents rights to dignity and respect at all times. The home has employed a weekend chef. The home has purchased new waste bins in the kitchen to ensure the disposal of kitchen waste is carried out appropriately. All foods are stored in the fridge and are labelled and dated. The complaints procedure has been updated and includes the local Commission for Social Care Inspection details. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 7 All staff have now been trained in adult protection, including ancillary staff. . The heating in the conservatory has been repaired. The induction programme has been updated and staff are now expected to complete this within the first six weeks of employment. The staff have received up to date mandatory health and safety training. The acting manager has now registered with the Commission. Cleaning materials are now stored safely and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. 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. Chilworth House DS0000022964.V363542.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 Chilworth House DS0000022964.V363542.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 and 6. Quality in this outcome area is adequate. Prospective residents and their representatives do not have accurate information about the home in order that they can make an informed choice about moving to the home. All service users have a written, individual service contract ensuring that there is an understanding of the homes terms and conditions. Service users needs are assessed prior to admission ensuring that staff are prepared for admission and are given an opportunity to visit the home beforehand to ensure it meets their needs. This judgement has been made using available evidence including a visit to this service. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 10 EVIDENCE: During the previous inspection it was identified that the home’s Statement of Purpose and Service User Guide needed to be updated and copies made available to prospective individuals and people living in the home. A requirement was issued for improvement in this area. The inspector asked to look at these documents. The Statement of Purpose has been updated, but does not include the information detailed in Schedule 1 of the Care Homes Regulations. This was discussed with the registered manager who said that she will complete this and the inspector requests a copy of this document. The Service Users Guide was not available for inspection and the inspector requests that a copy is sent to the Commission for Social Care Inspection (CSCI) local office and will be a requirement of this report. At the previous inspection the Statement of Purpose contained a blank copy of the terms and conditions of a residents stay in the home. Two files looked at contained no information to evidence that the resident had been fully informed of their rights of residency and cost of services provided by the home. A requirement was issued for improvement. It is pleasing to see that this has been complied with. The inspector examined four care plans and there was a copy of the terms and conditions for each person in their file. These were dated and signed by the person using the service or their relative or representative. At the previous inspection it was identified that only one file out of two examined contained a documented pre admission needs assessment. The acting manager at the time of the previous visit acknowledged there was a significant shortfall and a requirement was made that all prospective residents must have a care needs assessment prior to admission. During this visit the inspector examined four files including those new to the service. Each file had a completed needs assessment and some of the areas that this covers includes health and hygiene, eyes, teeth, continence, mobility, broken skin, diet, like and dislikes and mobility. It is pleasing to see that this requirement has been has been complied with. All assessments seen were signed and dated by the person completing the assessment of need. The home does not admit service users for intermediate care. Chilworth House DS0000022964.V363542.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 and 10. Quality in this outcome area is adequate. The health, personal and social care needs of people who use the service are not adequately identified in the care plans, preventing the home from meeting all the needs of the individual. The medication policies and procedures are clear and staff have received medication training resulting in safe working practices. People who use the service feel that they are treated with respect and dignity and that their right to privacy is upheld ensuring personal care is delivered appropriately. This judgement has been made using available evidence including a visit to this service. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four care plans were examined during this inspection, including those newly admitted to the home. All four care plans examined cover just three main areas. These are mobility, personal hygiene and nutrition. Although these are well documented and provide staff with relevant guidance, the care plans need to be expanded upon to provide information about residents in a holistic way. For example, further areas that need to be assessed are spiritual needs, emotional needs and social needs. In one file looked at the multi disciplinary care notes written by the district nurse stated that the individual has pressure sores on both hips. However the care plan makes no mention of this and provides no guidelines for staff to follow. Where care plans record that an individual has a weekly bath, the care plans record, “has a weekly bath”. This is a vague statement and needs to be more detailed to provide staff with clear guidance to meet the needs of the individual. During the previous inspection it was identified that one resident required support by two staff using a portable hoist. This resident spent a lot of time in their room and was only supported downstairs for special events, as the hoist did not fit easily into the homes shaft lift. This issue was discussed with the acting manager at the previous inspection and a requirement was issued for the home to request a local authorities review for this person. This has been complied with and a copy of this was observed in the individuals file. This was carried out on the 10th December 2007. This review identifies that the individual is at risk of social isolation and recommends that the individual is encouraged to go downstairs on a daily basis and that a TV or radio is purchased. This information is not detailed in the care plan. Care plans must include all areas of need and must include up to date information about an individuals changing needs. A requirement has been issued for improvement in this area. At the previous inspection it was identified that one resident newly admitted to the home did not have a care plan. An immediate requirement was made that all residents must have a documented care plan, which is agreed by the resident or their representative and kept under review in order for the home to meet the needs and promote the welfare and wellbeing of residents. This requirement has been met and all people using the service at the time of the inspection had a plan of care in place. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 13 Care plans are being reviewed on a monthly basis. The care plan daily records are completed on a daily basis. However, on many occasions these contain only two or three lines and do give any detail about the individual. For example, what the person has done that day, what their mood was like, the activities they have taken part in and other relevant information. It is recommended that these notes be expanded upon to give a full account of how the individual has spent their day. Following the previous inspection a requirement was issued for the home to review the risk assessments to ensure that all the hazards in residents daily lives are clearly documented, measures are in place to ensure their safety and well being and reviews are undertaken at appropriate times. Risk assessment documentation was looked at in four care plans. In each file there is a moving ad handling assessment, a falls assessment, a Waterlow pressure area care assessment and a nutritional assessment. These are reviewed monthly. However they still need to be signed by the dated and signed by the author. No further risk assessment documentation was observed in the four files examined. The registered manager said that she was still in the process of reviewing the current risk assessments and was due to complete this shortly when she had sought advice from the homes consultant. Chiropody Services visit the home on a six weekly basis. Additional support is accessed through the local GP surgeries, where people who use the service can access physiotherapists, occupational therapists and speech therapists. The home receives district nurse support and they are available for advice regarding pressure area care and can assist in the provision of pressure relieving equipment. Visits to the home from healthcare professionals take place in the service users bedrooms. Staff provide support to individuals needing to attend outpatient and other appointments. There is evidence in files of optical screening and the registered manager said that dental screening is carried out on a needs only basis. The nutritional needs of service users are identified and their weight is monitored on a regular basis. Referrals to the dietician are made via the individuals GP. Following the previous inspection it was identified that that three incontinence pads are available to each resident over a twenty-four hour period, which Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 14 would include one pad being used during the night. A requirement was issued that professional advice be sought about the promotion of continence and acted upon and the current supply of aids reviewed for individual residents in order to ensure their needs are fully met. It is pleasing to see that this has been complied with. The inspector examined medication records and it is pleasing to note there were no omissions observed. There is a medication policy in place and this covers all areas detailed in standard 9. Following the previous inspection a requirement was issued for robust arrangements to be made for staff training, recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The inspector examined the medication cupboard in the home, which was stored in one of the offices in the home. The cupboard was orderly, clean and was well stocked. The home has a monitored dosage system (MDS), which is supplied by the local Pharmacist. The home encourages people to self medicate and they are supported to maintain their independence and choice. There are guidelines regarding residents self-administering creams and inhalers to ensure that people were safely taking their medication. It is recognised that the home supports resident’s rights not to take their medication and the registered manager reassured the inspector that ongoing refusal to take medicines would be alerted to health care professionals. At the time of the visit the home was using Temazepam tablets for one person. This was being treated as a controlled medicine and was stored within a lockable metal cupboard with the medicine cabinet. The controlled drugs register was being completed and signed by two staff on all occasions. The registered manager advised that five staff were trained to administer medicines. These include the registered manager, two senior carers and two carers who work permanently on the night shift. Training records for these individuals show that they have completed recent medication training. The inspector has assessed this standard as met and the previous requirement has been complied with. During the previous inspection a requirement was issued for suitable arrangements to be made to ensure that the home is conducted in a manner, which promotes the residents rights to dignity and respect at all times. During the previous inspection it was identified that on two occasions resident’s rights to dignity and respect were not recognised. These were when staff were observed to support one resident in a shared bedroom with their meal at lunchtime and suppertime, with the other resident sitting next to a used Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 15 commode without a lid. There were further incidents of other residents sitting in their rooms at meal times with commodes without lids on. This was not observed to happen during this visit. The registered manager said that she has made this a topic for staff training and staff meetings. One concern raised by a resident of the home was regarding the call bells. The inspector was told they the call bells go off late at night, several times during the night and very early in the morning. This prevents residents from having a peaceful night sleep. In addition to this the inspector was informed that staff working at night put laundry away and enter bedrooms on several occasions to do this. Again preventing a peaceful nights sleep. This needs to be addressed by the registered manager. During this visit staff were observed to address residents in a professional and caring manner and residents were addressed by their first or full name and where appropriate. Staff were observed to preserve and maintain residents dignity and privacy by knocking on their room doors prior to entry and supporting resident’s discreetly to the bathroom. Feedback received from people who use the service was positive about the way they are treated. They all said they were treated with courtesy and staff respect their privacy when providing personal care. “The staff are excellent. I have nothing bad to say about any of them.” “The staff are very friendly and very professional.” “Staff know how to do their job properly and they do it well.” “I am very well looked after. I couldn’t wish for anywhere better to live. Staff are very kind and will go to extra trouble to help me.” “I would give the staff five stars.” Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 16 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 adequate. The daily routines of the home promote individual choice and freedom of movement, however individuals are not presented with adequate opportunities for social and recreational inclusion, which could leave them at risk of becoming socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service, however residents need to be made aware of the alternative selection of meal to allow them to make a preferred choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector spent time talking with people who use the service and comments about activities provided by the home were mixed. Several residents told the inspector “the people who need a lot of help don’t get much stimulation.” “I find it difficult to go downstairs and don’t see many people, sometimes for several hours. It is often a long lonely day.” Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 17 “I like to stay in my room and don’t like to go downstairs very often. That’s how I like it..” “We like to play cards a lot and arrange to do this ourselves most afternoons.” One relative said “my mum is dependant on staff for most of her care and needs extra help. There are very few activities provided for her or others in the same situation. Some days she doesn’t talk to many people and gets very lonely. I would like to see some activities available for those people who are less independent.” A small group of people using the service told the inspector about an entertainer to the home who performed a show two weeks previous. They said this had been very funny and was enjoyed by all. The inspector was informed that entertainers visit the home every month. Care plans show some routines of daily living and include bathing, rising and retiring times. However there is no information or plans of care in place regarding meeting the social or recreational needs of residents. There is limited information in the initial needs assessment about past interests. The inspector observed several residents providing their own entertainment. For example, some people were reading the paper, a small group of people were playing cards and another individual was reading a book. There was no staff involvement in any of these activities. Care staff undertake some activities for service users. However the inspector was told, “they are often called away to help another member of staff provide care and activities usually take second place. It’s not ideal but what else can they do.” One person spoken to said “ I tend to stay in my room most of the time as getting downstairs is difficult.” She said her hearing aid doesn’t work very well and her TV isn’t working very well. She said she feels very isolated. The home is failing to meet the social and recreational interests of people who use the service. This is particularly relevant to people who are more dependant on staff for their care needs. A requirement has been issued for improvement in this area. Residents spoken to said that family and friends can visit when they wish. One individual said, “My sister pops in when ever she likes. There are no strict rules on visiting which I like.” The home promotes peoples spiritual and religious beliefs by providing a church service within the home an a fortnightly basis. . Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 18 Service users are offered three meals a day and the menu is rotated on a four weekly cycle. The inspector had the opportunity to join residents for a lunchtime meal in the conservatory area. This was relaxed, unrushed and well organised. Meals were attractively presented and tasty. The inspector asked the residents with whom she had joined for lunch what they were able to have as an alternative, if they didn’t like what was being served on that day. One person said there was no alternative. Another said that they are asked what they want for dinner the previous day. If they don’t like what’s on the menu, the chef knows what they like and will cook them something else. No one knew what he or she would have as an alternative. There is not a written menu available which offers a choice of meals and this is recommended. The inspector was told that service users can take their meals in their rooms if they wish. The home offers drinks and snacks throughout the day in accordance with needs of the service users. The nutritional needs of service users are assessed and there is good detailed evidence of regular monitoring in all care plans seen. During the previous inspection it was identified that the staff member undertaking the evening meal preparation was the senior care staff who was in charge of the shift. It was felt that she could not oversee the shift and supervise junior staff whilst being in the kitchen undertaking meal preparation. A requirement was issued for improvement in this area. The registered manager said that they have now employed a weekend chef who will cover when the full time chef is on leave. During the previous inspection it was observed during a tour of the kitchen that the waste bin not have a lid and opened sauces/relishes bottles and blocks of cheese stored in the fridge had not been labelled in compliance with food safety and hygiene standards. A requirement was issued for improvement in this area. During this visit the inspector visited the kitchen and found it to be clean, and orderly. All foods stored in the fridge were labelled and dated. The waste bin has a suitable lid and most staff have since completed Basic Food Hygiene training to raise awareness of food safety and hygiene standards. However, the inspector could not find a certificate of Basic Food Hygiene training for the weekend chef. This is essential for staff preparing meals. The registered manager said that he had completed this and the inspector requests a copy be sent to the Commission. This will be a requirement of the report. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. The home has its own complaints policy and procedure to ensure service users can voice concerns about their care. Policies and procedures to protect service users from abuse are in place, however these to need to be reviewed to reflect the local authorities multi agency procedures for safeguarding adults, to ensure staff are working from the same information, ensuring residents are not at risk of abuse and harm and their rights to be safe are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the previous inspection a requirement was issued for the homes complaint procedure to be updated and to include the local Commission for Social Care Inspection details. It is pleasing to see that this has been completed. The policy details timescales for response and is on display in the entrance hall. A requirement was issued following the previous inspection for the home to complete a complaints log which details a clear chronology of events; for example dates of correspondence and outcomes regarding complaints received by the home and an update of outstanding complaints must be sent to the CSCI local area office. The complaints log shows two complaints have been Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 20 received since the previous inspection. These are well recorded and responded to within timescales. The Commission has received one anonymous complaint about this service. Following the previous inspection it was identified that the homes policy statement regarding reporting abuse was noted to be in conflict with the local authorities multi agency procedures. For example, staff are advised to report sexual abuse to social services but report all other abuse to the proprietor or ‘care manager’ (manager of the home). An immediate requirement was issued for the home to review their policy and procedures regarding safeguarding vulnerable adults, to reflect compliance with the local authorities multi agency policies and procedures in order to safeguard people in their care. The registered manager said that this is still being reviewed and this will remain a requirement of the report. The home has a copy of the local authorities multi agency procedures for safeguarding adults dated 2004. One safeguarding referral has been received by the home and has been dealt appropriately. At the previous inspection a it was identified that a requirement had been made at the November 2006 key inspection for all staff to be trained in adult protection. This requirement had not been met at the random inspection in May 2007 or the previous key inspection. Staff training records were examined and show that all staff, including ancillary staff, have now received training in the Protection of Vulnerable Adults. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is good. The standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Chilworth House is a care home providing personal care and accommodation for 28 older people. The home is situated in High Wycombe and is a short drive away from the amenities that a large town can offer. The home has two lounges and a pleasant conservatory. These are well maintained and nicely decorated, bright and cheerful. There are personal touches around the home such as flowers, pictures, books and mirrors. Following the previous inspection it was identified that the heating in the conservatory was not working and a requirement was issued for this to be repaired. It is pleasing to see that this has been complied with. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 22 There is a sheltered outside sitting area and well-kept garden. There are 26 single bedrooms and two double rooms. The inspector was invited to look at several personal bedrooms. Several were noted to have an unpleasant odour and this needs to be addressed. There are accessible toilets available for residents, throughout the home and close to each lounge. All bedrooms seen are individualised and some contain their own items of furniture, personal possessions, leisure items including televisions, radios, and books. Some residents told the inspector that they had telephones in their rooms, which they enjoyed having in order to keep in contact with friends and family and one person had an aquarium in their room. The inspector observed that hand washing facilities were available and also disinfectant hand rub was located throughout the home in order to promote safe practice in regard to infection control. Training records show that all care staff have received infection control training. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. People who use the service benefit from a staff team who are adequately trained and sufficient in numbers to support the residents with personal care. The home has a recruitment procedure that needs to be strengthened to ensure the safety and protection of residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staff rota demonstrates that there are adequate numbers of staff on duty at all times to ensure the personal and healthcare needs of residents are met. However, concerns have been raised about the home not being to meet the social and recreational needs of people who use the service. The current staffing numbers do not allow for activities to be carried out on a regular basis and this needs to be addressed. The home would benefit from an activities coordinator who will not be used as a carer when the staff team is short of staff. A requirement has been made under standard 12 of the Care Homes Regulations for the home to ensure they meet the social and recreational needs of people who use the service. During the previous inspection it was identified that several staff were working excessive hours, for example 64-66 hours per week and worked 13-14 hour shifts. A requirement was issued for the staffing numbers be reconsidered and Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 24 the duty rota revised to include more effective deployment of staff in order to ensure that residents needs are met at all times. The registered manager has not increased staffing levels in the home but has changed the times of some shifts so that there is always more staff on duty at peak times. There are no staff working in the home who are aged under 18 years of age and there are no members of staff under the age of 21yrs left in charge of the home. The registered manager explained that the home employs a multi-cultural workforce and equality and diversity issues are addressed both by people living in the home and staff. The home continues to support staff on NVQ training and at the time of this inspection six staff had obtained NVQ level 2 training or above and a further four staff were working towards NVQ training. The inspector examined six staff files including those new to the service. These were varied in their contents. For example, one file contained only one written reference, another file showed that the Criminal Bureau Records check application form had been returned due to errors but there was no evidence of a returned copy. One file looked at did not have the interview questions sheet completed and in another file the medical questionnaire was not completed. In some files there was evidence of training and development certificates and in others there were none available. Only two files had evidence of an induction. A requirement has been made for improvement in this area. During the previous inspection it was identified that there was a lack of induction training and little evidence of mandatory training. A requirement was issued for all persons employed by the registered person to work in the care home to receive training appropriate to the work they perform, including a structured induction to ensure that the homes staff are suitably trained and competent in their duties. The registered manager said that the home has introduced the Common Induction Standards Workbook and at the time of the visit five staff were completing this. The inspector was told that all staff will be expected to complete this, including staff who have been with the organisation for a long while. Six staff training files were examined and these show that all mandatory training has been completed. The home has employed the services of two consultants who are providing staff with necessary training and providing the registered manager with support and advice as needed. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 25 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, 33, 35 and 38. Quality in this outcome area is adequate. The home has been without a registered manager for over twelve months, however, there is now a registered manager in place who has a good understanding of the areas in which the home need to improve to be able to satisfactorily meet service users needs. The home has a quality assurance system but this needs to be strengthened and delivered more consistently to ensure the home is being proactive in identifying issues that may effect the well being of services users. There are systems within the home that are used to ensure that service users health, safety and welfare are protected and promoted. This judgement has been made using available evidence including a visit to this service. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 26 EVIDENCE: At the previous inspection the management arrangements for the home were unclear. A requirement was issued for the proprietor to inform the CSCI, in writing, of the ongoing management arrangements of the home in order to ensure the effective management of the home and the safety and wellbeing of residents. The previous acting manager has now registered with the Commission. She has commenced the Registered Managers Award. Further training undertaken by the registered manager includes first aid, basic food hygiene, supervision training, care planning and review training and risk assessment training. The home has employed the service of two consultants who provide training for staff and are available to provide advice and support to the registered manager. Progress has been made since the previous inspection and needs to continue. The inspector asked the registered manager about the homes Quality Assurance systems in place. She said that a “systems quarterly quality assurance checklist has been devised. This covers such areas as care planning, medication records, risk assessments, accidents and reviews. However this has not yet been implemented. There is a Quality Assurance Policy in draft form that is yet to be introduced. The registered manager said that no service satisfaction questionnaires have been sent to people who use the service but said this will be completed in the near future. The quality assurance systems in the home needs to be strengthened and a requirement is issued for improvement in this area. The inspector did not sample any of the homes financial accounting processes and was advised by the registered manager that the home does not safekeep residents money. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually. All staff have completed recent fire safety training. Evidence of mandatory health and safety training demonstrates that staff are up to date with this training. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 27 Service reports are in place for the maintenance of hoists and the lift. There are service certificates for PAT testing February 2008. However the registered manager was unable to find service certificates for electrical installation and gas appliances. The registered manager said that she thought they were with the proprietor and the inspector requests that a copy of these are sent to the Commission. Following the previous inspection a requirement was issued for cleaning materials to stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. It is pleasing to see that this has been complied with. All materials are now kept on the upper floor in a lockable cupboard. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation Schedule 1 and Regulation 4 and 5. Requirement The registered person must ensure that the Statement of Purpose and Service Users Guide are updated and provide copies to the Commission for Social Care Inspection. (Previous timescales of 31/12/07, 31/03/07 & 31/05/07 not met.) The registered person is required to ensure that all aspects of the health, personal and social care needs of people who use the service are documented in the care plans. The registered person is required to ensure the social and recreational needs of people using the service are met and these are recorded in the care plans. The registered person is required to provide a copy of the Basic Food Hygiene certificate for the weekend chef. If this is not available, the registered manager must provide the Commission with details of when the weekend chef will complete DS0000022964.V363542.R01.S.doc Timescale for action 31/07/08 2. OP7 15 (10) 30/07/08 3. OP12 16 (2) (m) (n) 30/07/08 4. OP15 18 (1) (a) (c) 30/07/08 Chilworth House Version 5.2 Page 30 5. OP18 13. (6) 6. OP29 19 Schedule 2&4 this training and what arrangements are in place until he has completed it. The home must review their 30/06/08 policy and procedures regarding safeguarding vulnerable adults to reflect compliance with the local authorities multi agency policies and procedures in order to safeguard people in their care. (Previous timescale of 14/11/08 not met) The proprietor must ensure that 30/06/08 copies of the information required by Regulation 19, Schedules 2 and 4 of the Care Homes Regulations 2001 (as amended 2006) are in every staff member’s file. (Previous timescales of 31/03/07 & 31/05/07 & 30/12/07 not met) The registered person is required to ensure that an effective quality assurance and quality monitoring system is in place, based on seeking the views of service users. 30/08/08 7 OP33 24 (1) 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 OP15 OP7 Good Practice Recommendations It is recommended that there is a menu offering a choice of meals in written or other formats to suit the capacities of all people who use the service. It is recommended that the care plan daily notes contain more detail about how an individual has spent their day. Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Chilworth House DS0000022964.V363542.R01.S.doc Version 5.2 Page 32 - 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. 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