Care Home: Chalfont

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What the care home does well Prospective residents have their needs assessed and given full information about the home, before being offered a placement. Generally people`s health and social care needs are met through the homes care planning systems. Residents are treated with respect and dignity. Generally medication is well managed and administered safely by trained members of staff. The home has a well-publicised complaints procedure. Chalfont provides a homely and well maintained environment for its residents. Staffing levels meet the needs of residents. The staff have been provided with good levels of training. The home is well managed and run in the interests of the residents. What has improved since the last inspection? Risk assessments had now been completed to inform staff on how to minimise the risk of harm when providing personal care to residents. There is now evidence that residents or their representatives are involved in developing personal care plans. All the staff and both registered providers have now undertaken training in adult protection and first aid, meeting requirements made at the last inspection. All radiators within the home are now covered thus making the environment safer for residents. The home now carries out a quality assurance survey involving residents relatives and health and social care professionals. What the care home could do better: Where a decision has been made for bed rails to be used in order to protect residents from the risks of falling from their bed, their agreement should be sought from a member of the health care team as well as the resident or their representative. Where residents require that fluid intake to be monitored we recommend that their care plan indicate what is a satisfactory level of fluids. Where hand entries have to be made to the medication administration records, a second member of staff should check and sign that the entries have been made correctly. Wardrobes should be risk assessed as to their likelihood of being toppled, and where such risk is identified the wardrobe should be bracketed to the wall. Key inspection report Care homes for older people Name: Address: Chalfont 6 Southern Road Southbourne Bournemouth Dorset BH6 3SR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Martin Bayne     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Chalfont 6 Southern Road Southbourne Bournemouth Dorset BH6 3SR 01202420957 SAMEASTEL: Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Terence Charles Aston,Mr Michael Robert Adams care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: One named service user (as known to CSCI) under the age of 65 may be accommodated. Date of last inspection Brief description of the care home Chalfont is a detached property situated in a quiet residential area of Southbourne. It is situated between the seafront and a shopping centre and other local amenities that include a post office, cafes, restaurants, a library and places of worship. Public transport is available within easy walking distance and provides access to other areas of Bournemouth. The home is registered to provide care to up to 11 older people. The accommodation is arranged on two floors and there are 9 bedrooms available, 8 are single and there is 1 double. There is a chair lift to assist with access to the first floor. There is a separate lounge and dining room. There is an enclosed garden to the rear of the property with Care Homes for Older People Page 4 of 27 Over 65 11 0 0 7 1 0 2 0 0 8 Brief description of the care home seating. The front of the home has a forecourt, which is used for parking up to 3 cars. There are pets in the home belonging to residents and the registered providers. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out a key inspection of Chalfont Residential Home between 9:15am and 2:30pm. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against key National Minimum Standards for older persons, and to follow up on the six requirements made at the last key inspection of the home in October 2008. We were assisted throughout the inspection by both Mr Aston and Mr Adams, the Registered Providers. At the time of our inspection there were seven people living at the home. Throughout the inspection we used a sample of two peoples care plans and related documentation to track the required records that must be maintained on behalf of people living at the home. We looked at how medication was administered, arrangements for peoples daily living, the food provided, how staff are recruited, trained and managed, as well as looking at the overall management of the home. We Care Homes for Older People Page 6 of 27 carried out a tour of the premises and spoke with three of the residents and to one relative who was visiting the home that day. Additional information that helped form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document AQAA completed by the home. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Where a decision has been made for bed rails to be used in order to protect residents from the risks of falling from their bed, their agreement should be sought from a member of the health care team as well as the resident or their representative. Where residents require that fluid intake to be monitored we recommend that their care plan indicate what is a satisfactory level of fluids. Where hand entries have to be made to the medication administration records, a second member of staff should check and sign that the entries have been made correctly. Care Homes for Older People Page 8 of 27 Wardrobes should be risk assessed as to their likelihood of being toppled, and where such risk is identified the wardrobe should be bracketed to the wall. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their needs assessed prior to being offered a placement at the home. This procedure makes sure that the home can meet the needs of people it admits for residential care. Evidence: We were told that since the last key inspection there have been three admissions to the home. One admission was for a short period of respite care and the other two admissions had taken place over the preceding week to this inspection. We found that one of the providers and the senior carer had carried out and recorded a preadmission assessment of these peoples needs before they were offered a placement at the home. We saw that the completed pre-admission assessment forms covered all of the topics detailed within the National Minimum Standards. Following the decision to offer a placement at the home, a letter had been sent to the person informing that their needs could be met at the home. Care Homes for Older People Page 11 of 27 Evidence: We were told that the home has an information pack that is sent out to prospective residents informing them of the services and facilities provided at the home. Prospective residents are informed that the owners have four dogs. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally we found that residents health care needs were being met through the homes care planning systems and that residents were treated with respect and dignity with their medication being administered safely. Evidence: At the last key inspection two requirements were made concerning care planning. One requirement was for risk assessments to be carried out concerning specific care tasks such as, management of peoples skin care and catheter care. The other requirement was for residents or their representatives to be involved in development of care plans. We looked at the care plans for one resident who had high care needs and for one of the newly admitted residents. We saw that there was a photograph of the person concerned at the front of their care plan together with key information and contacts. Care plans were person centred and provided sufficient information for a new member of staff to be able to meet that persons care needs. We also saw that the care plans had been signed by either the resident or their representative. Where residents have been accommodated through care management arrangements we saw that the home had obtained a copy of the assessment and care plan. Supporting the care plans were Care Homes for Older People Page 13 of 27 Evidence: detailed risk assessments that provided information on how to minimise the risk of harm in meeting peoples care needs. The person we tracked through the inspection with high care needs was being cared for in bed. This person had been cared for in bed for two years with their skin integrity being maintained. On account of their failing health, bed rails had been fitted to make sure that they did not fall from the bed. We saw that a risk assessment had been completed as required. We recommend that the providers should request that a health care team member also sign the risk assessment, as bed rails can be seen as a means of restraint. We saw that a nutritional assessment had been carried out with this resident and that their care plan directed that fluid charts be maintained to make sure that they received adequate hydration. We saw that fluid charts were being completed but we recommend that the care plan inform of a baseline of a satisfactory fluid intake level with an action plan in the event of the person not achieving this level of hydration. Within the care plans we saw that other health-care needs relating to dentistry, eye care and chiropody were being met. Overall we found that residents health care needs were being met. During the inspection we spoke with one relative and one resident who was able to give a good account of what it was like to live at the home. Both told us that they had high regard for the registered providers and confirmed that privacy and dignity of residents were maintained at all times. We looked at how medication was administered within the home. Since the last key inspection the homes policies and procedures and general arrangements for managing medication in the home have been reviewed with the pharmacist from the local PCT. The home now has a controlled drugs cabinet that meets new regulatory requirements. We looked within the medication cabinets and saw that medications were being stored correctly. We also saw that the home had a small fridge for storing of medications requiring refrigeration. A maximum and minimum thermometer had been purchased and the fridge temperatures were being maintained. We saw that where medications had a use by date, the date on which they had been opened was being recorded. We looked at the medication administration records for all of the residents. We saw good practice of a photograph of the person concerned at the front of their records together with information regarding any allergies from which they suffer. There was also a sheet that provided samples of the signatures of those staff trained to administer medication. We saw that the medication administration records had been completed with there being no gaps within the records. We recommend however, that where hand entries have to be made to the medication administration records, a second member of staff checks and signs that the entries have been made Care Homes for Older People Page 14 of 27 Evidence: correctly. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their social, leisure and recreational needs being met and by being provided with a good standard of food. Evidence: The majority of the residents are now very frail with many of them preferring to spend time within their bedrooms rather the communal areas. We were told that there were no formal communal activities arranged on behalf of residents as they do not wish for these to be provided. One person who has lived at the home for 15 years has been cared for in bed for the last two years. We saw that mood lighting and a radio had been provided to make a comfortable and stimulating environment for this person. Another resident we spoke with told us that they were quite happy with their television and by being able to engage and chat with staff. Another very frail resident is provided with a comfort toy that they like having in their presence. One resident who is more able said that they were happy with the level of stimulation as they enjoyed looking after the homes dogs who spend much of the day in their room. Visitors are welcome at any time but it is requested that mealtimes are respected. The relative we spoke with told us that they thought the home was excellent and that they were always made welcome when visiting. Care Homes for Older People Page 16 of 27 Evidence: We saw that as part of the assessment when a person moves into the home, their likes and dislikes concerning their daily routines and food were recorded. The relatives and residents we spoke with told us that there was a very good standard of food provided in the home. We looked at the records of food provided. We saw that a specialist diet of pureed food was supplied for one resident and that another resident who is diabetic has an appropriate diet. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well-publicised complaints procedure and through staff being trained in the protection of vulnerable adults. Evidence: The homes complaints procedure is well publicised. The procedure is displayed in the main hallway and within each residents bedroom an information pack is provided that informs residents of how to make a complaint. Since the last key inspection no complaints had been made to the management and none have been brought to the attention of the Commission. There have been no safeguarding referrals made to the local authority for investigation. The home has copies of all the relevant policies and procedures relating to the protection of vulnerable adults. At the last key inspection a requirement was made that staff and the providers undertake training in adult protection. We found at this inspection that all the staff and both providers had been on training provided by the local authority and the requirement was therefore met. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well maintained and homely environment. Evidence: As part of the inspection we carried out a tour of the premises. The returned AQAA informed us that since the last key inspection, six bedrooms have been redecorated and new carpets laid in five bedrooms. The entrance hall, stairwell and landing areas have also been redecorated. A new front door has been fitted and the exterior of the property repainted. Seven windows have also been replaced with double glazed units. At the last inspection a requirement was made concerning uncovered radiators. We saw at this inspection that all the above work been undertaken and that all radiators in the home have now been covered, eliminating the risk of residents receiving burns. On the day of our visit the home was found to be clean with furniture and fittings in good repair and the home in good decorative order. We were able to view some of the residents bedrooms and it was evident that they could bring their own furniture and possessions to personalise their rooms. Although many of the residents accommodated are now very frail, we recommend that wardrobes are risk assessed as to their likelihood of being able to be pulled over and where such a risk is identified, the wardrobe should be bracketed to the wall. The home has adequate communal assisted bathing and WC facilities. Within the downstairs communal bathroom, we saw that paper towels and liquid soap were Care Homes for Older People Page 19 of 27 Evidence: provided. One of the WC s on the first floor of the home has no hand washing facilities, however this WC is only used by the resident in the adjacent bedroom. We were told that thermostatic mixer valves are fitted to the hot water outlets of the baths, to protect residents from scalding water. The home has a small, paved and enclosed garden to the rear of the home with furniture and planted areas provided. Residents are able to access the garden. The laundry facilities for the home are located in an outhouse at the back of the home. The returned AQAA informed there were plans to have the walls plastered so that they are more easily cleaned. We saw that there were adequate machines for the laundry needs of the home and that hand washing facilities are available in the laundry area. Currently the laundry room is also used for storage. We recommend that the walls be re plastered and in the interests of infection control this area is used solely for the laundry. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from staffing levels being in place that meet their needs and through the staff being suitably trained. Evidence: The registered providers live in private accommodation above the registered part of the premises. They are available at all times and provide much of the staffing as the home only employs to other members of staff. We were provided with staff duty rosters that showed that there were two members of staff available to support residents throughout the daytime period. During the night-time staffing is provided by the registered providers with one of them being awake and one being sleep. During the inspection we spoke with three residents, with one resident being able to provide an account of what it was like to live at the home. They told us that their needs were met and staffing levels were adequate. The relative we spoke with during the inspection also told us that they thought the staffing levels were adequate to meet residents needs. The registered providers told us that should occupancy levels increase and needs of residents also increase, additional staffing would be provided as necessary. Since the last key inspection no new members of staff have been recruited to the staff team. The two members of staff have both been employed at the home for a long period of time. Care Homes for Older People Page 21 of 27 Evidence: At the last key inspection a requirement was made concerning training in first aid and adult protection. As we have already reported adult protection training has been provided to both the registered providers and both members of staff. We saw training certificates that the staff had received training in first aid. Both members of staff have now gained qualifications in NVQ level 2. We saw that a range of training had been provided to meet core mandatory training and also specialist training needs. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well managed home that is run in their interests. Evidence: Mr Aston and Mr Adams have been registered providers of Chalfont residential home since 1980. They therefore have many years experience of running and managing this service. Neither have undertaken NVQ level 4 or the registered managers award and both are reluctant at this stage in their career to undertake such training. Since the last key inspection Mr Aston and Mr Adams have employed the services of a management consultancy firm to make sure that requirements are met and improvements continue to be made. At this inspection we found that all the requirements of the last inspection had been met and that the home was well managed and run in the interests of the residents. The returned AQAA informed us that quality assurance surveys had been used to seek views of residents, relatives and health and social care professionals to make sure that the home continues to run and be improved to meet the needs of residents. This Care Homes for Older People Page 23 of 27 Evidence: meets a requirement made at the last inspection. The providers look after a small sum of cash on behalf of one resident. We looked at the records and the balance of money held. We found that the records tallied with the balance of money held. We looked at the accident book and saw that accidents were being recorded complied with data protection requirements. We also saw that the Commission was being notified of incidents and events that occurred within the home. The returned AQAA informed us that tests of equipment in the home were being carried out as required. We looked at the fire logbook. We saw that a fire risk assessment of the home had been carried out and that tests and inspections of the fire safety system were being completed to the required timescales. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 We recommend that where a care plan tells staff to records fluid intake, a satisfactory fluid intake level also be recorded with an action plan that should be taken should the resident not achieve this level of hydration. We recommend that you request a health care team member also signs risk assessments where bed rails are used. We recommend that where hand entries have to be made to the medication administration records, a second member of staff checks and signs that the entries have been made correctly. We recommend that the walls of the laundry be re plastered so that they can be easily cleaned and all the items currently being stored removed. 2 7 3 9 4 26 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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