CARE HOMES FOR OLDER PEOPLE
Chorlton Place Nursing Home 290 Wilbraham Road Chorlton Manchester M16 8LT Lead Inspector
Geraldine Blow Unannounced 18 August 2005 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 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. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Chorlton Place Nursing Home Address 290 Wilbraham Road Chorlton Manchester M16 8LT 0161 882 0102 0161 882 0870 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Responsible Individual - Mr Philip Scott Veronica Amadi CRH Care home N Care home with nursing 48 48 Category(ies) of OP Old age registration, with number of places Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: The maximum number of service users requiring nursing care shall be 45. The maximum number of service users requiring personal care only shall be 3. Registration is subject to compliance with the minimum nursing staffing levels indicated in the Notice previously served in accordance with Section 25 (3) of the Registered Homes Act 1984 issued on 3 June 2001. The service should,at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Date of last inspection 03 November 2005 Brief Description of the Service: Chorlton Place Nursing Home provides accommodation for 48 older people. The home is registered to accommodate 45 older people assessed as requiring nursing care and 3 older people assessed as requiring personal care only. The premises are owned by Nursing Home Properties (NHP) Plc and are leased to Southern Cross Healthcare Limited. Mr Philip Scott is the Responsible Individual on behalf of Southern Cross Healthcare Limited. The home is located in the Chorlton area of Manchester close to main public transport routes, local shops, public houses and other social and recreational areas and amenities. Parking facilities are available to the front and rear of the property. The home is a three storey ‘purpose-built building’ set in its own well maintained grounds. Bedroom accommodation for residents is provided on the first 2 floors and the third floor is used as office space, which includes the company’s divisional offices. The home offered accommodation in 48 single, en-suite bedrooms. Each floor has 2 lounges, a dining room and 2 small seating areas. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of 6 hours on Thursday 18th August 2005. During the course of the inspection time was spent talking to the manager, staff and residents to find out their views of the home. Time was spent examining records, documents, residents and staff files. A tour of the building was also conducted. Since the last inspection, in November 2004, the home has received 1 complaint and CSCI has received one compliant. At the time of inspection both complaints were under investigation. In addition the home had received 1 allegation of abuse that was currently under investigation. The requirements from the previous inspection had been addressed and there was evidence that the home was continuing to work hard to develop the service. During this inspection only a selection of the key National Minimum Standards were assessed therefore in order to gain the full picture of how the home meets the needs of residents this report should be read with the previous and any future reports. What the service does well:
The home has a large, secure, well-maintained garden to the rear of the property, which residents can enjoy in the warmer weather. On the day of inspection there was a gazebo next to the patio to provide a shaded area for residents to sit. The home assessed prospective residents care needs before their admission to the home to ensure their needs can be met. The complaint policy was on display in the main reception area and was included in the Service User Guide, which all residents had a copy of. Several residents spoken to said they have never needed to make a complaint. One resident said “ I have never made a proper complaint but Veronica, the manager, has sorted out some minor problems for me. If I had a proper complaint I would go straight to Veronica”. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 6 The standard of cleanliness throughout the home was high. One resident said, “the home is always clean and tidy”. Another resident said, “this is a nice, pleasant place and I have a lovely comfortable bed”. All of the bedrooms had a suitable privacy lock fitted and all rooms had a lockable storage space. The bedrooms were nicely decorated and several had been highly personalised. The home appeared to treat the residents with respect and dignity. The manager said that residents get choice with regard to their daily lives e.g. unless it is detrimental to their care the residents can go to bed and get up when they choose. The residents spoken to confirmed this. One resident said “ the staff are all nice and do a good job here “, another resident said “staff do not hesitate when asked to do something for you they just do it”. The home has a daily menu on display in the main reception area and each dining room has a menu sheet available. The menu offers a choice at each mealtime. One resident spoken to said “the food is nice and there is always plenty of it”, “another resident said the food is Ok and you can have a choice of 2 meals”. What has improved since the last inspection? What they could do better:
The manager must make sure that staff have signed for everything that is given to residents on the medication sheets so that a full audit trail is available.
Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 7 The manager said that light snacks and drinks were available on request throughout the day and night. However the residents spoken to appeared unaware of this. One resident said “you can only have a drink and something to eat at the set times”. He told the inspector that there was plenty of food and that he had no need to ask for more food but if he did he thought the staff would say no. Another resident said “you would not get a drink outside of the set times although I have never asked for one”. The manager should ensure that residents are made aware of their right to request snacks and drinks in addition to the set times. The manager must reply in writing to the prospective resident following the pre admission assessment that the home is able/not able to meet their assessed needs. It is recommended that the home have information regarding advocacy services available. 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. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, & 5 Information was available for prospective residents to make a choice about where to live. The home undertakes an assessment of prospective residents care needs prior to their admission. Their relatives/friends are able to visit the home before making a decision to stay. EVIDENCE: The Statement of Purpose contained the information required to assist potential residents to make an informed choice in respect of moving into the home. The Service User Guide had been given to all residents and the Statement of Purpose was freely available within the home. The requirement made at the previous inspection that the Service User Guide must contain a standard form of contract and appropriate reference to the latest inspection report had been met. A copy of the Statement of Purpose and the Service User Guide was made available for inspection. Evidence was seen that prospective residents had a pre-admission assessment to ensure that the home could meet all of their assessed needs. The assessment included the involvement of the prospective resident, his/her
Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 10 representatives and any relevant professionals. For residents who are referred through Care Management arrangements the home obtains a summary of the Care Management Assessment prior to admission. Following the pre-admission assessment the manager must confirm in writing to the prospective resident that the home is able/not able to meet their assessed needs. On admission the residents have a further assessment period during which time the home formulates its own care plan. Prospective residents and or their representatives are encouraged to view the home and speak to staff. Residents have a trial period at the home of 4/6 weeks prior to a decision being made about admission. After the 4/6 week period a review meeting was held with the resident, the family / representative, the care manager, the home manager and the named nurse. The home had an emergency admission policy, however the manager said that on the whole the home discouraged emergency admissions. Where an emergency admission is necessary, the home would inform the resident and / or their representative of the home’s rules and routines etc within 48 hours of the admission and to meet all of the admission criteria within five working days. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 & 10 Overall the health and personal care needs of the residents were being met at the home. However a risk assessment must be implemented for the use of the equipment necessary to support residents. The system for recording all prescribed medicines needed some improvement to provide an accurate audit trail of medication. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 12 EVIDENCE: A limited number of care plans were inspected. Each resident had a comprehensive and detailed individual plan of care, which had been generated from a needs assessment and the homes own care planning process. The home operated on a named nurse and key worker system. Each individual file was found to contain an up to date photograph of the resident for easy identification. The plans of care set out the action that needed to be taken by staff to ensure that all aspects of health, personal and social care needs of the residents were met. The residents plan included appropriate risk assessments, however the use of the ‘Bucket Chair’ must be risk assessed and consent for its use be obtained. The plans of care were reviewed at monthly intervals and were updated to reflect the changing needs of the service users. Evidence was seen that the requirement from the last inspection with regard to retaining evidence of resident/representative involvement in the development/review of the care plans had been met. All residents were registered with local General Practitioners and had access to visiting healthcare professionals e.g., chiropody, dentistry and ophthalmology. A record of these was maintained. The incident of pressure sores their treatment and outcome was recorded. Body maps were present in the care files and appeared to be appropriately used to plot the site and extent of wounds or pressure sores. There was evidence that the tissue viability nurse had visited the home to provide advice regarding the most appropriate treatment. Equipment necessary for the promotion of tissue viability and the prevention or treatment of pressure sores was viewed during the inspection. The plan of care documented which pressure-relieving mattress was in use for individual residents. A recognised assessment tool was used in monitoring the service user’s psychological needs. Nutritional screening was routinely conducted on admission to the home and the home liaised appropriately with dieticians whilst monitoring the residents’ weight at appropriate intervals. However, it was noted that the recording on food charts was inconstant. For example, one recording stated “cooked breakfast eaten”. The recording of food must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 13 The home had a comprehensive corporate medication policy in addition to appropriate medication procedures. The policy was available to all staff members within the home. There was a treatment room, which was kept locked when not in use. Both drug trolleys were stored in the treatment room secured to the wall. The home a blister pack system and each tablet/capsule was sealed into a separate compartment for easy identification. The locked drug fridge was situated within the treatment room and daily temperature recordings were seen. On examination of the Medicine Administration Record (MAR) sheets it was noted that some prescribed medication e.g. creams and bath oil had not been signed for. All prescribed medication must be signed for by the person administrating them to facilitate audits and to ensure that the records are clear and accurate. In line with new legislation, from the 1st Aril 2005, the home employed the services of an independent company to dispose of pharmaceutical waste. The medication file contained residents’ photographs, which acted as an aid to identification at the time of medication administration. In addition the file contained a list of staff signatures. From observations made during the inspection and discussions with members of staff and residents it was obvious that the nurses and care staff treated the residents with respect and dignity. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Activities were available to residents. It appeared that residents were able to maintain contact with family/friends and were able exercise choice and control over their daily lives. Meals appeared to be nutritious and well balanced. EVIDENCE: Since the last inspection the activity co-ordinator had left the home. However, a newly appointed co-ordinator is due to take up post in September 2005. Her role will be co-ordinate and facilitate the residents’ involvement in a variety of divisional, occupational and leisure activities. Records have been maintained of residents’ involvement in the planning of activities and each resident has an activity sheet within their care pan. An extensive social history is completed on admission. Photograph evidence was on display of recent activities and some cross-stitch work of one resident was on display. The home operated an open visiting policy and residents spoken to confirmed this. The home had a corporate policy relevant to the maintenance of social and community contact; the Service User Guide contained a section pertinent to this. The residents were able to receive visitors in private or in one of the communal spaces. The residents were able to choose which visitors they received. Visiting was only restricted upon the expressed wishes of the service user or their advocate, if one was appointed to act on their behalf; any restriction was formally recorded and communicated to all persons concerned.
Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 15 From observations of the inspectors and residents spoken to it appeared that residents were able to exercise choice and control with regard to their day-today lives. Evidence was seen that the home encouraged residents to bring personal possessions with them, at the time of their admission to the home, in an effort to help the resident “settle into the home.” The home maintained a record of such items. The menu inspected had been developed on a 4-week rota system. The care staff fill in a menu request form in the evening for the next day. The home provided an attractive dinning room on each floor and most residents were encouraged to have their meals there. However, residents were able to use other areas of the home on request. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home had a complaints procedure on display and all residents had been given a copy. The home’s policies and procedures served to protect the residents from abuse. EVIDENCE: The home had the complaint procedure on display in the main reception area and it was included within the Service User Guide. The home maintained a complaint file, which contained details of the complaint, the actions taken and the outcomes. The home had corporate policies relevant to vulnerable adult protection including whistle blowing; the home subscribed to the Manchester MultiAgency Protection of Vulnerable Adult policy, procedures and protocols. The homes’ own policies were in line with the multi-agency policy and the Department of Health (DOH) guidance, “No Secrets.” Staff had received training on the actions to be taken in the event of an allegation of abuse in 2004. The manager was in the process of organising training for new members of staff and a refresher course for existing staff. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 24 & 26 The homes environment was generally clean, comfortable and equipped to meet the needs of the residents. EVIDENCE: The location and layout of the home was suitable for its stated purpose. On the day of inspection the home was clean, tidy and free from offensive odours. The home provided 5 communal bathrooms and one assisted shower to meet the needs of the residents. These were clearly marked, with the exception of the shower room and were within close proximity of the communal sitting and dining areas. There was a sluice of each floor and these were kept locked when not in use. The home had corporate policies relating to infection and the laundry was sited on the second floor of the home, which did not offer any resident accommodation. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 & 29 The numbers and skill mix of staff appeared to be sufficient to meet the needs of the residents. The homes recruitment policies and procedures promoted the safety and wellbeing of the residents. EVIDENCE: At the time of the inspection the home accommodated 46 residents i.e. 42 residents assessed as requiring nursing care and 4 residents assessed as requiring personal care only. The numbers and skill mix of the staff, at the time of inspection appeared to be sufficient to meet the needs of the number of residents accommodated. Five of the home’s care assistant staff held the NVQ level II in direct care and a further 13 care assistant staff members were said by the home manager to be undertaking the NVQ level II programme. The sample of staff files inspected contained all the information and documents listed in Schedule 2 of the Care Home Regulations 2001. The home operated a three-months probationary period for all appointments. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 The home is well managed by a qualified and competent manager. EVIDENCE: The manager is a Registered General Nurse (RGN) with over 12 years experience as a trained nurse. She had spent over 4 of those years within the independent healthcare sector working with older people. The manager commenced the Registered Manager’s Award in June 2004. She had the responsibility of managing Chorlton Place and no other care home. The manager and staff appeared to be familiar with the conditions associated with old age. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x 3 x x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x x Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? 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 3 Regulation 14 Requirement The Responsible Individual must ensure that the home confirmes in writng to the prospective resident following the preadmission assessment that the home is able/not able to meet their assessed needs. The use of restraints such as the Bucket Chair must be risk assessed and consent be obtained for its use. The record of food provided to a resident must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition. All prescribed medication must be signed for by the person administrating them. Timescale for action 17/11/05 2. 7 13 22/9/05 3. 8 17 Schedule 4 22/9/05 4. 9 13 22/9/05 5. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 22 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. 3. Refer to Standard 7 14 15 Good Practice Recommendations It is recommonded that the daily report sheet contain more detail to accurately reflect the care provided over a 24 hour period. It is recommonded that the home has information regarding advocay services on display within the home. It is recommonded that residents are made aware of their right to request snacks /drinks at any time. Chorlton Place Nursing Home F55 F05 s21637 chorlton place v244737 180805 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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