Inspection on 12/07/08 for Chollacott House Nursing Home

This inspection was carried out on 12th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Chollacott House Nursing Home 18/07/07

Chollacott House Nursing Home 14/02/07

Chollacott House Nursing Home 19/04/06

Chollacott House Nursing Home 31/01/06

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Chollacott House Nursing Home 61 Whitchurch Road Whitchurch Tavistock Devon PL19 9BD Lead Inspector Anita Sutcliffe Unannounced Inspection 02:06 12 and 21st July 2008 th 12/07/08 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 Chollacott House Nursing Home DS0000064645.V368246.R02.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. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chollacott House Nursing Home Address 61 Whitchurch Road Whitchurch Tavistock Devon PL19 9BD 01822 612811 01822 614076 chollacott@stone-haven.co.uk WWW.stone-haven.co.uk Stonehaven (Healthcare) Ltd 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) Mr Robert Edward Rotchell Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (30) of places Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Physical disability (Code PD) The maximum number of service users who can be accommodated is 30. 18th July 2007 Date of last inspection Brief Description of the Service: Chollacott House is a large Edwardian building near to the market town of Tavistock. The home is registered to provide nursing care to a maximum of 30 people who may have a physical disability. The accommodation is presented on two floors accessed via a passenger lift; there is level access throughout the building; there are 24 single rooms and 3 double rooms. There is a large dining and lounge conservatory area leading on to a further smaller lounge, all on ground floor level. Information about the home was found in the entrance hall. People can request a copy of the latest inspection report from the administration office. The current range of fees is from £425 to £950 a week. This relates to ‘private residential and nursing fees’. An additional fee is made for: Hairdressing, chiropody and any other health care professional visiting privately, a fee to accompany a person to hospital visits, trips away from the home, phone calls, stamps and stationery, newspapers, clothing, toilet requisites and items of luxury or of a personal nature. The home has been under the ownership of Stonehaven (Healthcare) Ltd since October 2005. Chollacott House Nursing Home DS0000064645.V368246.R02.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 that people who use this service experience adequate outcomes. Information about the home has been collected towards this inspection since July 2007. This key inspection included two unannounced visits to Chollacott. Surveys were sent to people who use the service, their families and staff. Only two surveys were returned. The registered provider sent us the annual quality assurance assessment (AQQA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us numerical information about the service. As part of the visit to the home we looked at all communal areas, the kitchen, laundry and several bedrooms. We looked in detail at the care and support that three people received, speaking with them and looking at their records. We spoke with the family of two of them. We also met many other people using the service and several visitors. We observed staff working, spoke with several of them and examined staffing records. The newly appointed deputy and the manager were informative and helpful. We were accompanied on the second visit by a Help the Aged representative working as an ‘Expert by Experience’. He spent three hours talking with people, also sharing lunch. His findings are found within this report. A Random Inspection was carried out in October 2007 following a complaint about the home. The Random Inspection report is not published but is available on request from the Commission. Reference to the findings of the Random Inspection is made within this report. People who use the service may be described within this report as residents, clients or service users. What the service does well: People who use the service, their family and other visitors spoke highly of the trained and care staff who are clearly liked and held in high regard. Comments included: “Carers are just wonderful”, “They are a good bunch” and “Would do anything for you”. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 6 We saw that staff were kind and friendly. People said they are happy with the care provided one saying it was excellent. All we observed, and records of care provided, suggests that people’s care and health needs are fully met. The communal rooms are clean, fresh, well furnished and have good views of the gardens. Many rooms are being upgraded, some with the addition of en suite bathroom. What has improved since the last inspection? What they could do better: Not all previous requirements have been met and some are only met in part. People tell us they are bored and need more stimulation and activities. They also say the standard, variety, choice and quantity of food needs to be improved. The menu is repetitive. Where there was a serious need for maintenance it was not done until part way through the inspection. The first floor ceiling was unsightly, unpleasant as it continually dropped debris and has been in need of repair for at least a year with buckets and commode pans catching leaking water and posing a trip hazard. This was fully dealt with for our second visit. In addition, both new people admitted to the home had rooms with faults: one has a curtain which falls away from its runner and the other the window will not open, the radiator Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 7 cover is loose and the walk in wardrobe has no light bulb. It is also malodorous. For a second time we found a piece of medical equipment unclean and posing a risk to health and welfare and we saw stained, unpleasant commode pans. Staff recruitment does not protect vulnerable people from staff who might be unsuitable or unsafe to work with them. The necessary safety checks were not completed prior to them starting employment. An Immediate Requirement was issued that recruitment be made safe. Since September 2006 we have been requiring the home to keep cleaning chemicals safely so that people, who may be confused, will not be at risk if they come across them. This visit we saw those chemicals left in corridors and the door to the cleaning cupboard left both open and then with its key in the lock. We issued an Immediate Requirement that chemicals are stored and handled safely and will consider enforcement action if this occurs again. There are only enough staff to meet basic needs. This impacts on other aspects of the home life, like isolation, boredom and safety as staff have to do their tasks and move on. One person said: “We are left alone for such long periods of time”. Staff should be better informed about their rights should they wish to disclose concerns and know where the ‘whistle blowing’ policy is kept. The manager needs to review what might be considered a complaint as part of quality improvement at the home. Risks to people, both individual and general to the home, must be fully assessed. This will ensure that risks are understood and can therefore be removed or reduced towards improved safety. 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. Chollacott House Nursing Home DS0000064645.V368246.R02.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 Chollacott House Nursing Home DS0000064645.V368246.R02.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&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission procedure does not ensure that all necessary information is provided or sought which increases the possibility of misunderstanding and dissatisfaction. EVIDENCE: We looked at the current information provided to people who may be looking for a suitable nursing home. The information pack provided some very good information, for example, on staff and their qualifications, rooms and their sizes. However, as Chollacott is a nursing home the literature must include a breakdown of fees so it is clear what is paid for accommodation, what for nursing and what for personal care. In addition to the written information we also looked at the Stonehaven web site. Although containing some good information we also found some to be Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 10 very out of date. This gave a false impression of the activities available at the home. We looked in detail at the admission of two people recently admitted to Chollacott, speaking with them, their family and looking at their admission records. They had received the home’s literature and the registered manager had visited them to make an assessment of their needs. Information was also available from social and health care professionals who were involved in their care, but in all there was a lack of detail. Examples include: • ‘Wears glasses’, but not the cause or extent of the eye problem which the person themselves says is one of their main disabilities. • ‘Low mood/depression’, with no explanation of cause, history or previous treatments • ‘Walking at risk’, but no explanation as to why. Assessments also lack social and family history: dates of special family events, such as death of partner for example. We looked at several care files and found very little information about people’s end of life decisions and people are not being asked if they have made an advanced directive (living will) so staff have all necessary information. We found that, although it was confirmed by telephone that the home could meet the needs of a potential admission, it had not been confirmed in writing, which is part of the contractual arrangements between the provider and person coming to the home. The manager said he was unaware of this. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good personal and health care is delivered despite the current standard of care planning and staffing difficulties. People are treated with respect and kindness. EVIDENCE: We initially looked at three peoples’ care plans. These should inform staff what people need and want and how they are to provide assistance and care to meet those goals. We found they only contained very basic and mostly insufficient information. We asked care staff how much those care plans informs what they do. Comments include: “As a carer we don’t have any access to the care plans but in a days work we get information from the hand over on a day to day basis”. We then asked staff about the care needs of specific people and they were able to describe them. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 12 The deputy manager said she was fully aware that care planning needs improvement. She was able to show an example of a newly completed plan and explained they are currently improving all of them using a new format. The plan contained very good detail about the person as a whole; health and personal care needs, emotional and social needs. It would fully inform staff of the care and assistance that person needed. As yet people are not involved in planning their care. The deputy was quite clear that they are looking at ways to achieve this and also ensuring care staff use the plans more to inform them how care is to be delivered. People at the home hold the staff in high regard. When people were asked if they have confidence in the care provided all said yes and one added: “Without question”. Staff, asked what the home does best, said: “Carers work in the best interests of people” and “The level of care, although some staff are better than others”. The deputy manager said: “The care is of a high standard”. We asked the community nursing team if they had any concerns about care at the home and they do not. It was clear from records that the home ensures people have access to their doctor, eye, dental, foot care, and other specialist care as needed. We looked at how the home manages medicines and found this had improved. Medicines are kept more safely with the trolley always locked and the medicine keys handed between trained staff. The medicine records were clear and, as now more fully completed, they were improved. However, creams and lotions must be signed for when given (a tick is not sufficient) so there is a full record of their use. Where medicines are prescribed to be given ‘as required’ it must be clearly described as part of care planning under what circumstance staff can do this. Staff were observed working so as to respect people’s privacy and dignity, one example being ensuring a catheter bag is covered and so not in view to other people in the lounge. Family of one person said: “Individuals are respected and their dignity is maintained at all times”. People’s opinion of staff, and records seen, also indicate privacy and dignity are understood and upheld at the home. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lifestyle experience and quality of food in the home does not meet the expectations of many of the people who live there, but people’s rights to choice and control over their lives is, for the most part, respected. EVIDENCE: Records held about people who use the service continue with only limited information about their social and family histories, hobbies, interests and things of significance to them. We spoke with people and their families about activities, the home’s routines and community contact. With two exceptions people expressed dissatisfaction with what the home has to offer. Comments from family, who visit regularly, include: • “I’ve never ever seen anybody doing anything”. • “There’s nothing going on”. • “Would like mum to be more stimulated. Quite boring up there. Not enough to do. It’s so dull”. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 14 People who use the service said: • “I spend my time in the bedroom as staff do not seem to have enough time to put me in my wheelchair – would sometimes otherwise go to the lounge”. • “People spend the afternoon snoozing”. • “I have nobody to talk to and there is nothing going on”. • “Would like to live somewhere else where things are going on”. Staff asked about activities said: • “I don’t see anything happening. A relative said there was half an hour singing the other week”. • “Recent summer fete. We have nobody to coordinate activities – last year there was an entertainer”. • “Occasional music man and the aromatherapist visit every two weeks”. One family visitor said she had started a bingo session for people herself because they had nothing to do. A ‘Music laughter and Exercise Programme’ is advertised as started in early July but other than an occasional music session no one else could recall any activities at all. The service web site provides details of supposed activities at the home. This must be grossly out of date as staff when shown it did not recognise the names of people who, it reports, are providing most of the activities listed. The list includes ‘morning coffee’ and ‘tea and cakes’, which we do not consider to be activities unless arranged as a social event, which it is not. People benefit from the conservatory outlook over a well tended garden in which there is some seating. However, the sloping lawn does limit people’s use of the garden and was a particular concern to one family. People who visit are made welcome. One said: “I feel that at Chollacott there is a feeling of belonging to a family and that I haven’t left my father with strangers”. However, there are no outings undertaken by the home so community contact is dependent on family taking them out or family visitors. People confirmed, and it was clear from the hand over between staff, that choice is offered whenever possible. This choice is reduced by availability of staff. One person, at 9:45 am and wanting to get up could not until staff were available later. Staff did not finish getting people up until 12:30, which we were told is not unusual. However, if people choose to stay in bed or stay up late they do so. There is ‘bath routine’ but most people were satisfied with this although one complained about not having a bath only “top and tail”. We asked people their opinion of the food, the quality, choice of menu and if was there sufficient. Responses include: • “Food not all that good. I would like a better selection. There is no choice. Why no salads or curry?” • “Food all right” Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 15 • • “No choices unless it is something I don’t like and they will find me something else like corned beef”. “Enough food except I sometimes feel hungry in the evening”. People seemed to be unaware they could request a snack in the evening and one person’s request for more food at lunch time was met from a meal, which, it was said by staff, was intended for staff. The meal on the day of the first visit was a plated lunch (no option of choice at the time of the meal) consisting of two medium sized sausages with onion gravy mashed potatoes and broccoli followed by rice pudding. There was a tasteless orange coloured drink available. Several people found that they were unable to cope with the firmness of the broccoli and left it. We looked at the current four week menus. They were very lacking in variety. For example, for one week there is liver and bacon casserole Tuesday, roast pork Wednesday and sausage and mash Thursday; probably a pig based meal three consecutive days. The only fish mentioned is battered or fish fingers every Friday or sardines on toast alternate weeks. Some people chose to eat in the lounge, some the conservatory or at the dining table. Carers assisted some people to eat. This was done discreetly. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are safe but the standard of complaints and protection could be further improved. EVIDENCE: The service has a complaints procedure clearly written and openly displayed within the home and found within the literature. The manager reports that there have been no complaints this year, but one person who uses the service, and the family of another person at the home, said they have expressed their dissatisfaction/complained to staff. One said: “I told the manager several times about the rubble outside my room but nothing has been done about it”. Another: “I’ve mentioned the problem more than twice”. Asked if they are listened to people said: “yes”, “not always” and “yes, and action usually taken”. The Commission received two complaints about the home. One was passed to the provider to investigate and one led to an unannounced inspection visit, related to cleanliness of equipment, and was upheld. We spoke to four staff on their knowledge of how to protect vulnerable people from abuse. Two were recruited in April and so relatively new to the home. Two of the four knew that they were protected in law if they chose to disclose Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 17 concerns outside the home (known as whistle blowing) but two did not. Two knew where the whistle blowing policy was kept and two did not. Asked about training on abuse staff said: “It comes under NVQ. Nothing from the home itself” and “We had a series of courses”. Another said they had training in 2007. People were asked if they felt safe at Chollacott and all said yes one adding: “without question”. There is literature available at the home on advocacy which provides a form of independent help for people should they require it. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People live in a home where hygiene, safety and acceptable standards of the living environment are not always fully maintained. EVIDENCE: We looked around the home, visiting several bedrooms and all communal areas, the laundry and kitchen. We also spoke to people, their family and staff about the home environment. There has been an extensive refurbishment of parts of the home. The sitting rooms appeared clean and fresh, homely and well maintained. People benefit from a large digital television and there are pleasant views, from the conservatory, of the well-tended garden. However, some areas of the home were in a poor state. Of particular note is the first floor corridor Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 19 ceiling, which had buckets under it at the previous inspection one year ago. At the first of these visits we found four buckets under it, presumably to collect water, and the domestic cleaning staff cleared the area of debris more than once during the visit. It was both unsightly, unpleasant and posed a trip hazard to both people and staff. At the second visit the problem had been dealt with. We also found the curtain falling away from its hanger in an occupied, newly completed bedroom. The window in another ground floor bedroom will not open, the light in the walk-in wardrobe does not work and the radiator cover was coming away. We were told the room was like this from when first offered for occupation. One staff said when asked what had improved at the home: “The place looks less shabby” and indeed there is much fresh paint and effort to freshen and brighten parts of the home. Many rooms are being upgraded, some with the addition of en suite bathroom. The newly registered manager has made improvements including new flooring and cooling fans in the conservatory/dining areas. Staff confirmed that they have the equipment necessary to provide care in a safe way. We saw hoists, specialist mattresses to prevent pressure sores, and a chair for the seating weighing of people. However, there is no hand-rail along the main area of bed rooms. This reduces the independence of people who might have restricted mobility. We looked at cleanliness and hygiene in the home. Staff confirmed that they have the necessary protective clothing to prevent cross contamination and the home uses a non-touch (red bag) system so that staff do not have to handle soiled laundry. However, it would be of benefit if other laundry could be separated (bedding from personal clothing) as the laundry room is small and distance from clean and dirty reduces the likelihood of cross contamination. A complaint made October 2007, which was about cleanliness, including that of equipment, led to an unannounced visit. The complaint was upheld. On this occasion we found the previously stained equipment clean, but other medical equipment was found on a bedroom floor, dusty, some staining and in touchable contact with a cleaning brush. This is an unacceptable level of cleanliness where the consequence could be detrimental to the person’s health. We checked the cleanliness of the kitchen. It was adequate. We checked the cleanliness of the laundry. It was dusty. However, bedrooms were clean and all were odour free except for one which was very unpleasant. People confirmed that the home is always warm enough for them. We looked at the cleanliness of several commode basins. One in a bedroom was stained and some in the sluice room were stained, but might have been used to collect water and debris from the ceiling. However, a dirty commode lid was seen in the sluice on both visits. For the most part hand soap and Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 20 paper towels were available for staff use but a sluice bin did not have a collection bag for the waste from hand washing. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people benefit from a kind, caring and competent staff they are not protected by safe recruitment practice and there are insufficient staff to fully meet their needs. EVIDENCE: People who use the service, their family and visitors were very complimentary about the staff at Chollacott. Comments include: • “Carers are just wonderful”. • “They are a good bunch” • “Would do anything for you” People have confidence in and affection for the staff. We observed staff engaging with people with caring, good nature and respect. A common theme throughout the inspection was low numbers of staff. This was mentioned by people who use the service: • “Staff do not seem to have enough time to put me in the wheelchair”. • “We are left alone for such long periods of time”. • “This is my biggest complaint”. Their family said: Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 22 • • Staff • • • “Short staffed I know. People are asking visitors to take them to the toilet”. “We do try not to be to demanding, but they who shout loudest and cause problems get!”. said: “Staff don’t have enough time with residents. Basic needs are being met but that’s all”. “We have to cope up. If they’re short staffed you’re always in a hurry”. “We’re asked to do extended shifts just before it’s time to go home. We’re all tired”. We met one person unable to get up when they wanted. Staff did not finish getting people up until 12:30. We were told this is not unusual. People asked us to help them to the toilet and during a 35-minute period in the morning no staff members were seen to enter the lounge/conservatory areas. To the annoyance of other residents one person called out “Nurse” every 30 seconds for 15 minutes without response. People said that whilst the call bell response time was good at night the same could not be said for the daytime. The information provided about the home does not mention staffing numbers at all. We talked to staff about their training and looked at training records. Two newly recruited care staff said they were given an induction training pack, which the supervisor ‘ticks off’ as sections of learning are completed. Staff said they are given enough training to do the work they do which included the control of infection, behaviours that challenge, first aid and safe handling of chemicals. People who use the service and their family had no concerns about staff ability. We also saw future training events advertised. We looked at whether the recruitment practice at the home protects people from staff who may be unsafe or unsuitable to work with vulnerable adults. Of the two records examined neither had the necessary two written references in place before staff started employment, neither had a criminal record check before they started employment and, where one had previously worked with vulnerable adults, there was no record of the reason they left that employment. We issued an immediate requirement for the standard of recruitment to be improved. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management are committed to providing a quality service but health and safety are not sufficiently prioritised and there is still much to do towards improvement. EVIDENCE: There has been no consistent management at Chollacott since the previous key inspection. The current manager, Mr Robert Rotchell, is a qualified Registered Mental Nurse and Registered General Nurse. He is also been a Community Psychiatric Nurse. He has demonstrated to the Commission that he is qualified Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 24 to run this care home and that he understands his responsibilities. People who use the service when asked about the management said: • “He seems pretty good but there is always room for improvement”. Family said: • “Bob is absolutely brilliant. He has a passion for his job”. Staff said: • “I think the new management are doing well”. • “More friendly to staff. You can ask anything”. Mr. Rotchell spoke with clarity about his role as manager and described his further planned improvements. He confirmed that he has arranged for his training in management to commence in the autumn. We discussed the recent admission to the home of a person whose condition is now contrary to the home’s registration and statement of purpose. Whilst he explained the circumstance surrounding this, it remains that people must not be admitted where specialist care, including in this case that of dementia, are not in place. There has also been the recent recruitment of a deputy manager. She showed a good understanding of person centred care planning, people’s liberty, upholding their rights and the balance between making choices and risk. She said about the provider: “The owners listen. You have support and back up”. It was clear that she and the manager are working closely and cooperatively together toward improvement. We looked at the measures in place to ensure a quality service and good outcomes for people who use the service. We discussed with the manager the dissatisfaction/complaints that had not been investigated. (See the standard on complaints). However, we found the manager very keen to know people’s opinion and very approachable, saying in his monthly ‘Stop Press’ newsletter: “As ever, an problem pop in and see me”. There have also been recent meetings for people’s family and staff. However, of three staff asked if they receive a formal supervision of their work one said: “No”, one said: “Never had one”, and one said: “Yes, this year”. Staff should receive regular, formalised supervision of their work to ensure any issues can be addressed, training needs identified and the philosophy of care in the home is understood – all aspects that relate to the quality of service provided. The provider undertakes the required monthly unannounced visits to the home to monitor quality and the home have kept the Commission informed of any event which has affected the well being of people. The registered manager told us of the people able to look after their own finances and said that, where the home keeps money on their behalf, there are proper records kept and measures taken to do this safely. We looked at health and safety in the home, taking into account the environment, staff practice and records. We found cable and buckets obstructing the first floor corridor, posing a trip hazard to anybody walking in Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 25 the area. We found, several times despite mentioning it, cleaning chemicals left unsupervised and the storage cupboard for cleaning products unlocked. The safe storage of hazardous chemicals has been a previous requirement and the provider had confirmed that measures had been taken which would prevent a repeat of this hazard. An immediate requirement was issued so that people, who may be confused, are not put at risk by this practice. We found inadequate, sometimes no, assessment of risk, or measures in place to reduce risk. These include: • Where a confused person has wandered away from the home. • Where a person had five falls in a one month period. • The safe handling of cleaning chemicals in the home. We also found unsafe recruitment practice, people unable to get staff attention when they needed help and insufficiently clean medical equipment, which was sitting on the floor with a cleaning brush, next to a person’s bed. However, trained and care staff receive the necessary health and safety training and there were no issues relating to the standards of personal or health care delivered. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 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 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 1 Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 27 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 4, 5 Requirement Timescale for action 31/08/08 2. OP3 14 (1) (d) 3. OP12 16 (2) (m) 4. OP15 16 (2) (i) The Statement of Purpose and Service User Guide must contain all the required information so that people are fully informed about the service provided. That information must also be current and in a suitable format for people at the home. The manager must confirm in 08/08/08 writing to the service user that, having assessed their needs, the care home is suitable and able to meet them. This protects both the person using the service and the home. People must be consulted about 31/08/08 their interests and arrangements made to enable them to engage in local, social and community activities as they wish. This helps people lead a fulfilled life within their capabilities. People must be offered a 30/09/08 genuine choice of nutritious food, in sufficient quantity, and to their taste and preference. This will help ensure food is enjoyed and health promoted. Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 28 5. OP26 23(2)(d) 6. OP27 18 (1) 7. OP29 19 8. OP38 13(4) Medical equipment must be kept clean and hygienic. This will reduce the likelihood of infection and cross contamination. Carried forward from 31/10/07. There should be sufficient staff available that: People do not have to ask visitors to take them to the toilet; people are not left unsupervised in the lounge for long periods and people can do as they prefer, not fit in with staff arrangements instead. People must not start employment at the home until two suitable written references are received and the list of people unsuitable to work with vulnerable adults is checked. This protects people. An Immediate Requirement was issued. All substances that could be hazardous to health (cleaning materials) must be stored securely when not in use so that people, who may be confused, will not be at risk from contact with them. This risk must also be assessed. Carried forward from 01/09/06, 01/04/07 and 12/10/07 An Immediate Requirement was issued. 21/07/08 31/08/08 21/07/08 21/07/08 Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Chollacott House Nursing Home DS0000064645.V368246.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!