Inspection on 20/09/07 for Churchill House Nursing and Residential Home

This inspection was carried out on 20th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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... 10/10/06

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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Maple Lodge

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Ravenhurst

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Inspirations

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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 Pat Scott Key Unannounced Inspection 20th September 2007 10:00 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.V342236.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.V342236.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 enquiries@churchillhouseludlow.co.uk 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.V342236.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.V342236.R01.S.doc Version 5.2 Page 5 Date of last inspection Brief Description of the Service: 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 £465 - £732. 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.V342236.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 in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance processes, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? The service had endeavoured to action any shortfalls identified through its quality assurance processes or by management reviews. These include areas such as: increased staff training and development, improved social activities, increased quality surveys, redecoration and refurbishment and meal provision. Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 7 The key aspect of this service is that any improvement is conducted through consultation and feedback with service users and their supporters. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Churchill House Nursing And Residential Home DS0000022242.V342236.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.V342236.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. EVIDENCE: The service maintains pre-admission and admission records. The assessments seen were personalised and addressed physical health, mental health, social care and spiritual needs of the individual. The manager keeps copies of the assessment summary and care plans of those carried out through care management arrangements. The service intends to improve further by seeking post-admission views of service users as to the quality of the admission process. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 7,8,9,10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Records seen showed that individual care is planned well and reviewed monthly or sooner if changes occur. Health screening takes place so that early Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 11 intervention can be established. Risk assessments are in place regarding manual handling, use of bed rails and any relating to individual behaviour. Key workers are allocated to service users to deal with every day personal requirements such as toiletries, clothing etc. It is the stated intention of the service to promote health awareness in service users, e.g. healthy eating through improved menus and choice, increasing exercise through an expanded activity programme. Service users are well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. Staff observed going about their work have a cheerful and professional attitude. Staff spoken with are very knowledgeable about clinical issues and how care is to be structured to address these. NVQ qualifications are at around 65 with other staff enrolled on the courses which will increase numbers to 78 . The service accepts responsibility for administering medication to service users. The service has suitable storage facilities for all types of medicines. Written records for receipt and disposal are maintained and the medication reviews regularly take place. The management has identified the need to develop a medication management audit tool to ensure that practice complies with procedures. The complaints and comments book detailed entries such as: “in excellent hands”, “kind and professional”, “dignity shown to my mother towards the end of her life”, “superb nursing care”. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15, Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: On entering the home there is an abundance of information available for all to see. Monthly newsletters are displayed together with information on independent advice/advocacy agencies. A varied daily activity programme is offered and co-ordinated by a dedicated member of staff. One to one time is identified for service users who for reasons of disability or frailty spend much of their time in bed. Examples of topics for leisure pursuits include: hairdressing, extend class, cookery class, parties, coffee morning, flower arranging and picnics during the summer. Activities attendance records are kept. There is a company minibus available for outings. Service users were seen to come and go as they liked and one had been into Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 13 town shopping. Another service user went out round the grounds on his motorised scooter. Menus show well balanced nutritious meals are provided. It is the intention of the service to encourage healthier eating by increasing catering staff contact with service users to improve the menus and provide even greater choice and variety. A service user spoken with confirmed that menus are planned with their input. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users surveys stated they know whom to approach if they have a problem. All expressed confidence that issues would be dealt with. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. The service reviews the complaint procedure 6 monthly to ensure it is still appropriate. It is the intention of the service to provide the procedure in audio format. Staff files seen showed that adult protection training has been provided. polices and procedures are in place that uphold equal opportunities, antidiscrimination practice, whistle blowing, gifts and wills etc. The complaint log details all concerns received whether written/verbal or ‘minor’ comments. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 19,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home has improved, through service user choice, so that they live in a safe, better-maintained and comfortable environment, which encourages independence. EVIDENCE: The dementia unit lounge and dining room has been redecorated and refurbished. Service user bedrooms are subject to on going decoration. The service has purchased new fixtures, fittings and furniture for communal and individual bedrooms. The nurse stations have been removed from the entrance and the first floor. These have been made into private seating areas for the use of service users and their relatives. This has given a less clinical feel to the home which service users state they welcome. There is a stated intention to Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 16 improve the premises further by providing a conservatory and to reduce shared rooms. Rooms entered are personalised according to service user’s wishes. All areas are clean and tidy with monthly rooms audits carried out. The laundry is well organised and infection control polices in place. Staff were seen to wash their hands after dealing with service user care. Gloves and aprons are used by staff when providing personal care. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 27,28,29,30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Staff in the home are being trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. EVIDENCE: The home has a good staff to service user ratio to care for service users with complex needs. Many have been in post for a number of years. Two new recruit files were examined. All checks required by Regulation were in place and well organised in the files. The management input is supernumerary to care staff numbers although the manager does directly supervise staff during their shift-work. Staffing rotas are in place and NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been exceeded. The service has plans to train catering and domestic staff to NVQ level. Staff meetings take place that are minuted so staff have forum to air their views. Training provision is high on the management agenda. Future training planned includes: foot care, infection control, food hygiene, anaphylaxis, pain management, care recording, multiple sclerosis and health and safety. The home has a link nurse for promotion of continence and infection control. The Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 18 management have identified the need for more dementia training for staff and are sourcing a suitable training body. Service users were very complimentary about staff and feel they are very well cared for. Churchill House Nursing And Residential Home DS0000022242.V342236.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. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems in place, service users are assured that the overall conduct of the home is being well managed. EVIDENCE: The provider, and general manager are competent to provide the service and demonstrate the ability to continually improve the service to provide value for money. The management is aware of the running costs of the home which they have effectively used to provide better outcomes for service users, e.g. the redecoration and refurbishment to improve the premises. There are two registered managers who job share. Both have clear lines of responsibility and both have the required qualifications in management and clinical practice. Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 20 Systems in place such as meetings for staff and service users, quality assurance processes, care audits and records show the service is adept at self assessing its practice and how this affects outcomes for the service users. Staff practice is very service user focussed and customer satisfaction is high on the agenda. This is evidenced by the commitment to conducting service user surveys, which have increased, and including service users ideas in management decisions. Service users stated that they trust the staff and feel safe in the home. The manager demonstrated a commitment to the equality and diversity of service users by addressing needs arising out of age and disability. Good record keeping systems are in place. All records seen are written in a way that shows the service listens to the people who use it. What people say is heard, acted upon and reviewed and elements of the annual quality self assessment were seen to be in place. E.g. consultation with service users, reviewed policies, revised quality systems etc. Churchill House Nursing And Residential Home DS0000022242.V342236.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 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.V342236.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.V342236.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: 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 Churchill House Nursing And Residential Home DS0000022242.V342236.R01.S.doc Version 5.2 Page 24 - 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. 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