Inspection on 10/10/06 for Churchill House Nursing and Residential Home

This inspection was carried out on 10th October 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Churchill House Nursing and... 20/09/07

Churchill House Nursing and... 07/02/06

Churchill House Nursing and... 19/07/05

Churchill House Nursing and... 20/01/05

Churchill House Nursing and... 07/07/04

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

CARE HOMES FOR OLDER PEOPLE Churchill House Nursing And Residential Home Bromfield Road Ludlow Shropshire SY8 1DW Lead Inspector Janet Oxley Key Unannounced Inspection 10th October 2006 9.30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Churchill House Nursing And Residential Home DS0000022242.V297100.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. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchill House Nursing And Residential Home Address Bromfield Road Ludlow Shropshire SY8 1DW 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) 01584 877500 01584 877500 Jubilee Care Ltd Mrs Susan Gillian Brown Mrs Rachael Caroline Ruscoe Care Home 55 Category(ies) of Dementia (13), Old age, not falling within any registration, with number other category (39), Physical disability (3) of places Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home must provide the following minimum staffing-: 8am-10pm Frail Elderly Unit 10-15 clients 16-20 clients 21-26 clients EMI Unit 5-8 clients 9-13 clients 1 RMN/1 EN(M)/1 RGN/1 EN(G); 1 HCA 1 RMN/1 EN(M)/1 RGN/1 EN(G); 2 HCA 1 RGN; 2 HCA 1 RGN; 3 HCA 1 RGN; 4 HCA A minimum input of 40 hours weekly to be supplied by an RMN. 10pm-8am Frail Elderly and EMI Unit 25-29 clients 30-35 clients 36-39 clients 1 RGN/RMN; 3 HCA 1 RGN/RMN; 3 HCA (with an RGN on all) 1 RGN/ 1 RMN/1 EN(M); 3 HCA At night if an RMN is on duty an RGN must be on call, with an RMN available for advice if an RGN is on duty. These are minimum levels, required for nursing clients only, everyday including weekends, and do not take account of extra staff needed when more heavily dependent and terminally ill persons are being nursed. These minimum levels are for patient care only. The home may accommodate a maximum of 55 service users. The home may accommodate a maximum of 3 persons with a Physical Disability, and 13 Older Persons with Dementia. The remainder being Elderly Persons, not falling into any other category. Both managers are to complete the Registered Managers Award by December 2005. 2. 3. 4. 5. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 5 Date of last inspection 7th February 2006 Brief Description of the Service: Churchill House is a care home with Nursing beds registered to provide care and accommodation for up to 55 elderly people. 13 beds provide care for the elderly mentally infirm and 3 beds for physically disabled people. Churchill House is owned by a limited company, Jubilee Care Ltd. The General Manager and Responsible Individual is Mrs Heather Stanford RGN, who has many years experience in management and the care of the elderly. The home is jointly managed on a day to day basis by Mrs Susan Brown, RGN, and Mrs Rachael Ruscoe, RGN. The home is situated on the fringe of Ludlow, in Shropshire, adjacent to the main A49 in a residential development. It was purpose built in 1995, the accommodation is on two floors (access via stairs or a shaft lift), and it is set in attractive gardens. The home makes their services known to prospective service users in: The Statement of Purpose, Service User Guide and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the entrance hall. Fees are reviewed annually and range from £435 - £675. The only additional charges to service users are for toiletries, hairdressing and newspapers. This is clearly laid out in the terms and conditions. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, looking at relevant records pertaining to key standards, chats with residents, 2 hairdressers, discussions with the staff on duty, discussion with the Responsible Individual and the Manager on duty, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports and observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? It has to be noted that at this home, management and staff continue to review and improve all aspects of the service to achieve best practice and maintain a good quality service. A number of areas of the home have been refurbished and redecorated, all administrative systems continue to be reviewed and updated when necessary and staff training is high on the agenda. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 7 The range of activities continue to be improved and a vehicle is available to take residents on a variety of outings. A Monitored Dosage System of medication is now in use and developments are under way to improve and amend the policies and procedures. 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. Churchill House Nursing And Residential Home DS0000022242.V297100.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 Churchill House Nursing And Residential Home DS0000022242.V297100.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures that are in place, and have been professionally followed, ensure that the home undertakes all necessary assessments for successful and satisfactory admissions to take place. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide, which include all the required information for prospective residents. Documentation examined indicated that individuals have a full and comprehensive assessment of their needs prior to admission, which is reviewed and amended as requirements change. Discussions with residents, the General Manager and one Registered Manager and staff on duty indicated that the home continues to meet the individual needs of the elderly people living at the home in a professional and sensitive manner. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal needs of service users are very well met with evidence of regular review and of good multi disciplinary working taking place on a regular basis EVIDENCE: Personal and healthcare support in this home is offered in such a way as to promote and protect service users’ dignity and privacy in their daily life and at the end of life. It was evident during the inspection from looking at records, inspecting the facilities and chatting to staff and residents that individual health, personal and social care needs were being met. The manner in which the care plans are maintained, continue to be developed and the professional way in which they promote the importance of the compatibility of the service user and their plan is good. Personal care monitoring is undertaken on a regular basis to ensure that staff are following Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 11 the care plans and that the residents are all getting a good quality of care. A sound key worker system is in place. Residents were being treated with respect and staff were working both professionally and sensitively in meeting individual needs. Those residents spoken to were complimentary regarding the quality of their lives at the home and visiting health professionals praise the management and care standards there. Those residents being nursed in bed looked extremely comfortable and well cared for Medication appears to be stored, recorded and administered satisfactorily and relevant staff have received the necessary training. The Home has recently changed to a Monitored Dosage System and is currently working on reviewing and amending the policy documents. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All Quality in this outcome area is very good. This judgement has been made using available evidence including a visit to this service. The routines of daily living at Churchill House are very flexible and each resident finds the lifestyle experienced in the home meets their individual needs. Many activities take place, there is an open visiting policy and the menu offers a choice of well balanced and wholesome meals. EVIDENCE: The residents are encouraged and enabled to personalise their bedrooms and use them as private places eg – one resident has a Lap Top, printer, Video, Slide Show, Fridge, TV etc, many things that she has bought on E-Bay and collections of treasured articles in her room and ensuite. A number of activities are arranged within the home and outside. These activities are publicised in the front hall, on various notice boards, a newsletter is available on a monthly basis and the activities residents participate in are recorded on individual files. A vehicle is available which enables residents, with carers, to have trips out. Individual needs, likes and dislikes are clearly shown in the care plans. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 13 Menus, the meal seen and tasted and discussions indicated that a good diet was on offer and that the catering arrangements were satisfactory. Staff were seen to support the more frail residents to eat their meal in a sensitive and professional manner and the dining areas are pleasant with attractively laid tables. Residents are certainly enabled to exercise choice and control over their own lives as far as they are able eg – one resident goes to church and luncheon clubs regularly and is learning Polish. There is a table in the hall with a good range of information for residents and visitors including aspects of advocacy and legal and financial matters. Visitors are always made welcome, are included in events and are given all the necessary information on aspects of the home and the welfare of the residents. Visitors spoken to have been complimentary regarding the care the residents receive at the home. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Concerns and complaints are dealt with promptly and professionally and robust procedures and practices are in place to ensure that individuals are protected from abuse. EVIDENCE: The home has a clear complaints procedure, which is given to residents and their relatives before they move into the home. No complaints have been received by the home or CSCI since the last inspection. Concerns, received by staff at the home, from or on behalf of residents, are dealt with in a professional manner without delay and are recorded. There is a strong key worker system in place and it was evident that management and staff respect, observe and listen to the residents. The home has all necessary documentation in relation to the protection of vulnerable adults and this subject is included in staff training. A number of staff have attended external training on abuse and this will be ongoing. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is generally good, providing service users with a warm, safe and homely place to live. Necessary improvements have been identified and are in hand. EVIDENCE: The location and layout of the home are suitable for elderly residents. Communal rooms are well equipped and are warm, homely and welcoming. Bedrooms are very personalised and suit individual needs and the gardens are attractive and there is a patio area with seating, easily accessible to residents and their visitors. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 16 At the time of the most recent Fire Officer and Environmental Health Officer’s inspections matters were reported to be satisfactory and advice given has been acted upon. It was evident that the managers and staff work hard to maintain this environment and further improvements, redecorating and refurbishment are in hand. A full time handyman is available. At the time of this inspection laundry facilities were very good, the standard of hygiene and cleanliness was good and following a recent good outcome from an Infection Control Audit recommendations have been complied with. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users appear to be supported by a well trained and committed staff group who are meeting the needs of each individual in a sensitive and professional manner. EVIDENCE: The rotas, ratios of staff on duty at the time of inspection and the number of domestic, laundry, kitchen, administrative and maintenance staff employed indicates that the home exceeds the laid down staff complement. Recruitment at the home is thorough and all elements required by Schedule 2 of the Care Home Regulations are maintained on file. The files of 2 newly recruited staff were seen to be satisfactory and staff members were very complimentary regarding the induction, support and supervision they had received. Staff turnover is fairly low and agency staff are rarely used. The arrangements for ongoing training and foundation training are good with staff completing this well within the first six months. The home continues to support staff to undertake their NVQ awards, more than 58 of care staff have achieved NVQ level 2, a good variety of other training has been undertaken and staff on duty indicated that they were very Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 18 sensitive to the service users needs and disabilities and that their attitudes and practice were monitored and supervised by the manager and senior staff. Recorded staff supervision, staff meetings and appraisals are undertaken in a professional manner and staff confirmed that this was so during discussions and all spoken to were complimentary regarding the management and care at the home. Training records are maintained for each staff member. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are clear lines of accountability within the homes management structure and the management approach creates an open and positive atmosphere from which the residents benefit. The home reviews all aspects of its performance through a programme of self review, questionnaires and consultations and meets the requirements of the Fire Officer and Environmental Health Officer, promoting the health, safety and welfare of the residents. EVIDENCE: The joint Registered Managers are State Registered Nurses and have completed the Registered Managers Award. They have had a number of years experience and carry out their responsibilities fully with sound leadership skills Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 20 promoting a professional ethos within the home. It is evident that they continue to update their own professional knowledge by attending a number of related courses to the resident group catered for. The managers involve themselves fully in the day-to-day running of the home and can relate to all matters pertaining to the National Minimum Standards. The manner in which the Manager on duty, her Line Manager and staff responded to this inspection indicated that a sound management approach is in place and that staff are committed to achieving best practice and to developing equal opportunities. Equality and diversity for the service users were seen to be promoted throughout the home, within the assessments, care plans and activities. Equality for staff is promoted through opportunities for training at all levels. Sound quality assurance systems are in place and there was evidence available to indicate the managers ensure, so far as is reasonably practical, the health, safety and welfare of service users and staff. All staff have attended a health and safety training and relevant mandatory training was reported to be up to date or booked for the near future. At the time of this inspection no potential hazards were identified and all records required are maintained in a professional manner. The accident records were satisfactory and it was reported that a first aider is on site at all times. Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 x x x 4 x 3 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Churchill House Nursing And Residential Home DS0000022242.V297100.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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