Care Home: Cheriton

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What the care home does well Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish. People were seen to be wearing the aids needed, for example hearing aids and clean glasses. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for two people whose care was being looked at as part of this inspection. The home uses a monitored dosage system (MDS) and medicines are stored appropriately in a mobile, lockable trolley which is kept in a locked staff office. Medication administration records (MAR) were examined and show no omissions. There is guidance in place for `when required/when needed` (PRN) medicines should be given and these include information about when to administer the medication and any triggers or indicators known that shows the medication is needed. Records demonstrate that all senior care staff and night staff have completed medication training. A tour of the premises was undertaken with the deputy manager. Continued improvements to the environment have been completed and include the installation of a new shower room, the provision of electronic hoists to assist in bathing, the addition of en suite facilities to a number of bedrooms, replacing the hot water system with a new system to ensure a continuous supply of hot water and the redecorating and re-carpeting of some bedrooms and one of the communal lounges. Further refurbishment plans are in place and scheduled to be undertaken in the near future. A requirement set at the previous key inspection was that used gloves and aprons are not disposed of in generalwaste bins. The registered manager and the deputy manager confirmed that used gloves and aprons are now disposed of appropriately following Infection Control guidance. At the previous key inspection a requirement was issued for references for overseas employees to be checked for authenticity to ensure that people using services are not put at risk. The file for the most newly employed staff member was examined at this visit. This contained evidence of all the necessary employment checks as required by the Care Homes Regulations for Older people. Surveys received from people who use the service as part of the previous Annual Service Review contained some concerns regarding the provision of activities in the home. The range and variety of activities were examined as part of this visit fand the registered manager said they have been exploring different types of activities following the Annual Service Review. Activities are displayed on a notice board. Various visiting entertainers visit the home on a weekly and fortnightly basis. An arts and craft instructor and Pets for Therapy visit the home fortnightly. The inspector was informed that there are no designated care staff who undertake activities but staff do carry out activities with people using the service in the afternoons. These include Bingo, board games and shopping trips. Involvement with the local community includes visits by the local schools, a visiting hairdresser and a monthly church service. There are regular residents meetings and it is noted that feedback about the recent activity programme has been sought and recorded. What the care home could do better: Two care plans were examined as part of the inspection for people who have recently been admitted to the home. Care plans are written every month. Although these cover a wide range of areas such as personal care, health care needs and socialisation, the care plans lack details and do not fully inform the care worker how the service user needs will be met. For example, in the first care plan under the section for personal care the entry reads, "1 carer to assist with all personal care" and under the section for socialisation the entry reads "likes to chat" and there is no information about the support required for oral healthcare. In the second care plan under the section for personal care the entry reads, "1 carer to assist with personal care" and "1 carer to assist with applying cream to body". The second entry does not give the name of the cream, what it is used for and how often the cream is to be applied. Overall the care plans are not person centered and entries are vague. They do not describe in detail the actions staff need to take to fully meet the needs of the individual. This should include peoples individual preferences likes and dislikes. A requirement is issued for improvement in this area. Surveys received from people who use the service as part of the previous Annual Service Review contained some concerns regarding the provision of meals. Comments included, "less able residents are rushed during mealtimes" an example being given of some staff filling peoples drinks to the brim and hurrying them to drink their drink before they have managed to swallow their food. As part of this visit a lunch time meal was observed inthe quiet lounge which is where people who are more dependant take their meals. The menu is displayed on a board in the main hallway. This does not display an alternative choice of meal. However the weekly menu is also displayed on the notice board and this states, alternatives offered, salad, baked potato and soup. The lunch time meal is the main meal of the day and the choice or alternative meal offered must be of the same nutritional value as the main meal. This should be addressed. Some people required assistance to eat their meal and during the lunchtime meal the inspector observed several areas of poor practice. Several residents had pureed meals. These had all the portions of the meal pureed together resulting in a grey mass which was indistinguishable. The meals were put in front of the service users and staff failed to inform individual what their meal was. The presentation of pureed food should be improved and the home should address this. One staff member was assisting two people to eat their meal. She gave the two residents a spoon of their meal in turn. She was observed to get up from her chair several times whilst assisting both service users to eat. This resulted in an uncongenial and impersonal mealtime. The individual techniques of staff when providing assistance to service users must be enhanced and the home should ensure care staff are aware of this. It was observed that overall staff interaction with service users was good. One person at the dining table appeared disorientated and was becoming anxious. Staff`s approach was positive, they knew how to approach the person in an appropriate manner and were able to provide the necessary support required. Random inspection report Care homes for older people Name: Address: Cheriton 9 Stubbs Wood Chesham Bois Amersham Bucks HP6 6EY two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Barbara Mulligan Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Cheriton 9 Stubbs Wood Chesham Bois Amersham Bucks HP6 6EY 01494726829 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Kanapathipillai Thirumalthasan Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Sushma Nayer,Mr Vipin Parkash Nayar care home 27 Number of places (if applicable): Under 65 Over 65 0 0 27 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 27 27 0 27 The maximum number of service users who can be accommodated is: 27. The registered person may provide the following category/ies of service only: Care Home only (PC) to service users of the following gender:Either Whose primary care needs on admission to the home are within the following category/ies Old age- not falling within any other category (OP) Dementia (DE) Mental Disorder- excluding Care Homes for Older People Page 2 of 9 learning disability or dementia (MD) Physical Disability (PD) Date of last inspection Brief description of the care home Cheriton home for older people is a detached property located in Chesham Bois. The home is registered for 27 older people. The accommodation consists of all single rooms. There are two large lounges and a separate dining room. One of the lounges allows pleasant views over the grounds. The home is equipped with a passenger lift and grab rails around the home for those who are less physically able. Public transport is easily accessible and is in walking distance from the village and a short drive from Amersham. The home is supported by a local general practitioner (GP) surgery and other health care resources are available through a referral from the general practitioner. There is an established staff team who support the care of residents. Care Homes for Older People Page 3 of 9 What we found: This random inspection was undertaken to assess if requirements set at the previous key inspection have been complied with and to ensure that areas of concern raised in the previous Annual Service Review have been addressed. The inspection was undertaken by Regulation Inspector Barbara Mulligan on the 27th May 2010. The inspection focused specifically on care planning, staff recruitment, activities in the home, the provision of meals and meal times, the administration of medicines and the environment. The home has responded positively to the issues raised in the previous key inspection report and the Annual Service Review with all requirements met, demonstrating a positive approach to the inspection process. Whilst there were a small number of areas identified for improvement, the service provision remains good and the outcomes for service users was seen to be mainly positive. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. What the care home does well: Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish. People were seen to be wearing the aids needed, for example hearing aids and clean glasses. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for two people whose care was being looked at as part of this inspection. The home uses a monitored dosage system (MDS) and medicines are stored appropriately in a mobile, lockable trolley which is kept in a locked staff office. Medication administration records (MAR) were examined and show no omissions. There is guidance in place for when required/when needed (PRN) medicines should be given and these include information about when to administer the medication and any triggers or indicators known that shows the medication is needed. Records demonstrate that all senior care staff and night staff have completed medication training. A tour of the premises was undertaken with the deputy manager. Continued improvements to the environment have been completed and include the installation of a new shower room, the provision of electronic hoists to assist in bathing, the addition of en suite facilities to a number of bedrooms, replacing the hot water system with a new system to ensure a continuous supply of hot water and the redecorating and re-carpeting of some bedrooms and one of the communal lounges. Further refurbishment plans are in place and scheduled to be undertaken in the near future. A requirement set at the previous key inspection was that used gloves and aprons are not disposed of in general Care Homes for Older People Page 4 of 9 waste bins. The registered manager and the deputy manager confirmed that used gloves and aprons are now disposed of appropriately following Infection Control guidance. At the previous key inspection a requirement was issued for references for overseas employees to be checked for authenticity to ensure that people using services are not put at risk. The file for the most newly employed staff member was examined at this visit. This contained evidence of all the necessary employment checks as required by the Care Homes Regulations for Older people. Surveys received from people who use the service as part of the previous Annual Service Review contained some concerns regarding the provision of activities in the home. The range and variety of activities were examined as part of this visit fand the registered manager said they have been exploring different types of activities following the Annual Service Review. Activities are displayed on a notice board. Various visiting entertainers visit the home on a weekly and fortnightly basis. An arts and craft instructor and Pets for Therapy visit the home fortnightly. The inspector was informed that there are no designated care staff who undertake activities but staff do carry out activities with people using the service in the afternoons. These include Bingo, board games and shopping trips. Involvement with the local community includes visits by the local schools, a visiting hairdresser and a monthly church service. There are regular residents meetings and it is noted that feedback about the recent activity programme has been sought and recorded. What they could do better: Two care plans were examined as part of the inspection for people who have recently been admitted to the home. Care plans are written every month. Although these cover a wide range of areas such as personal care, health care needs and socialisation, the care plans lack details and do not fully inform the care worker how the service user needs will be met. For example, in the first care plan under the section for personal care the entry reads, 1 carer to assist with all personal care and under the section for socialisation the entry reads likes to chat and there is no information about the support required for oral healthcare. In the second care plan under the section for personal care the entry reads, 1 carer to assist with personal care and 1 carer to assist with applying cream to body. The second entry does not give the name of the cream, what it is used for and how often the cream is to be applied. Overall the care plans are not person centered and entries are vague. They do not describe in detail the actions staff need to take to fully meet the needs of the individual. This should include peoples individual preferences likes and dislikes. A requirement is issued for improvement in this area. Surveys received from people who use the service as part of the previous Annual Service Review contained some concerns regarding the provision of meals. Comments included, less able residents are rushed during mealtimes an example being given of some staff filling peoples drinks to the brim and hurrying them to drink their drink before they have managed to swallow their food. As part of this visit a lunch time meal was observed in Care Homes for Older People Page 5 of 9 the quiet lounge which is where people who are more dependant take their meals. The menu is displayed on a board in the main hallway. This does not display an alternative choice of meal. However the weekly menu is also displayed on the notice board and this states, alternatives offered, salad, baked potato and soup. The lunch time meal is the main meal of the day and the choice or alternative meal offered must be of the same nutritional value as the main meal. This should be addressed. Some people required assistance to eat their meal and during the lunchtime meal the inspector observed several areas of poor practice. Several residents had pureed meals. These had all the portions of the meal pureed together resulting in a grey mass which was indistinguishable. The meals were put in front of the service users and staff failed to inform individual what their meal was. The presentation of pureed food should be improved and the home should address this. One staff member was assisting two people to eat their meal. She gave the two residents a spoon of their meal in turn. She was observed to get up from her chair several times whilst assisting both service users to eat. This resulted in an uncongenial and impersonal mealtime. The individual techniques of staff when providing assistance to service users must be enhanced and the home should ensure care staff are aware of this. It was observed that overall staff interaction with service users was good. One person at the dining table appeared disorientated and was becoming anxious. Staffs approach was positive, they knew how to approach the person in an appropriate manner and were able to provide the necessary support required. 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 set out on page 2. Care Homes for Older People Page 6 of 9 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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, 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 1 7 15 Care plans must set out in 30/07/2010 detail the action which needs to be taken by care staff. To ensure all aspects of the health, personal and social care needs of the service user are met. 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 Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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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