Care Home: Chichester Court Nursing Home

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What the care home does well The staff collect information about the person before anyone moves into the home to make sure that they can meet their needs. People can visit the home before moving in so that they can be confident that it where they want to live. Staff talk with a range of healthcare professionals to make sure the health and well being of people living in the home is regularly reviewed to make sure staff can continue to meet people’s needs. Staff are respectful and sensitive with people when helping them or speaking to them. Visitors are always welcome and there are links to the local community. A programme of activities is available so that people can enjoy social and leisure events. People have brought small personal items with them which has made their bedrooms homely and reflective of their lifestyles. The recruitment procedures are properly followed so that people are protected. Staff have completed safeguarding training so that they would be able to raise an “alert” should there be any suspicion of abuse. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. Staff receive on going training so they can care for the different needs of people living in the home. There are good arrangements for supporting people keep their personal monies in a safe place should they wish to do so. There are generally good maintenance checks and records so that people can be kept as safe as possible.Chichester Court Nursing HomeDS0000000272.V378324.R01.S.docVersion 5.2 What has improved since the last inspection? Staff have worked hard to make sure the care plans are clear and detailed about the care provided. People and their representatives are now being involved in planning their care with staff. Information about people’s past lifestyles and choices are now written down so that staff can continue to support them or help them access help from others. Medication storage had improved and the administration of medicines is generally well managed by qualified nurses. The mealtime experience has improved with menus offering a variety of wellcooked nutritious meals. People can enjoy a healthy, well-balanced and interesting diet. Quality assurance and quality monitoring systems are in place and followed so that the home can continue to develop. Regular meetings with people living in the home and their representatives is making sure people feel valued and listened to. There is now consistent management and the manager gives clear direction to staff so that they understand what is expected of them. The Home Manager has completed her application to be Registered Manager and is awaiting a date for her “Fit Persons Interview” What the care home could do better: Further work is needed to ensure staff understand a “person centred” approach to care delivery and evidence this through care planning. The registered person must produce a clear refurbishment plan with timescales for completion. This must include all of the items identified in this report. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety. The registered person must provide suitable furniture, carpets and fittings in communal areas and bedrooms. This will provide a comfortable environment for people to live in. The registered person must source and eradicate the odours in the home, repair the broken dusty, noisy extractor fans, repair the broken window restrictors and make sure the utility room door is kept locked.Chichester Court Nursing HomeDS0000000272.V378324.R01.S.doc Version 5.2 Staffing levels should be based on the layout of the home and dependency of those living in the home. Additional staff should be provided at peak times. A programme of regular effective formal staff supervision must be in place to ensure that staff are clear about their role and responsibilities. A copy of the wiring certificate must be sent to the Commission. Key inspection report CARE HOMES FOR OLDER PEOPLE Chichester Court Nursing Home Chichester Road South Shields Tyne And Wear NE33 4HE Lead Inspector Irene Bowater Key Unannounced Inspection 4th November 2009 11:00 DS0000000272.V378324.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 2 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 Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chichester Court Nursing Home Address Chichester Road South Shields Tyne And Wear NE33 4HE 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) 0191 454 5882 0191 454 6455 chichester.court@fshc.co.uk www.fshc.co.uk Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Manager post vacant Care Home 52 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (52), of places Physical disability (15) Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th November 2008 Brief Description of the Service: Chichester Court was designed and built in 1997. It is registered to accommodate up to 52 older people with personal care and nursing needs. The building is single storey with wide corridors and doors providing good access for people with mobility difficulties, or wheelchair users. All bedrooms have en-suite toilet facilities. A variety of lounges and sitting areas are available, also two dining rooms, and two internal courtyards that provide outdoor seating areas. An additional, paved outdoor seating area is provided at the top end of the home. The home is located close to public transport facilities including the Metro railway system, and buses, and is within easy reach of local shops and amenities, and the town centre. Local parks and the seacoast are approximately two miles away. Fee rates vary as follows: Local Authority rates vary from £349 with the free nursing care contribution added. That contribution is set nationally. Private fee rates for personal and social care is £441.00 Private nursing care fees are £513 with the free nursing care contribution added. Toiletries, hairdressing, chiropody, clothing, newspapers and magazines are not included in fee rates. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. Before the visit: We looked at: • Information we have received since the last visit on the 25 November 2008.How the service dealt with any complaints and concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and their relatives, staff and other professionals. • Annual Quality Assurance Assessment (AQQA). The AQQA gives the Care Quality Commission (CQC) evidence to support what the home says it does well, gives them an opportunity to say what they feel they could do better and what their future plans are. • We have reviewed our practice when making requirements, to improve national consistency. • Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. • In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Visit: An unannounced visit was made on the 4 November 2009.This visit was carried out by one inspector and started at 11:00 and was completed at 18:30. During the visit we: • Talked with people who use the service, relatives, staff and the manager. • Looked at information about the people who use the service and how well their needs are met. • Looked at other records, which must be kept. • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. • Looked around the building to make sure it was clean, safe and comfortable. • Checked what improvements had been made since the last visit. • We told the Manager what we found. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 6 What the service does well: The staff collect information about the person before anyone moves into the home to make sure that they can meet their needs. People can visit the home before moving in so that they can be confident that it where they want to live. Staff talk with a range of healthcare professionals to make sure the health and well being of people living in the home is regularly reviewed to make sure staff can continue to meet people’s needs. Staff are respectful and sensitive with people when helping them or speaking to them. Visitors are always welcome and there are links to the local community. A programme of activities is available so that people can enjoy social and leisure events. People have brought small personal items with them which has made their bedrooms homely and reflective of their lifestyles. The recruitment procedures are properly followed so that people are protected. Staff have completed safeguarding training so that they would be able to raise an “alert” should there be any suspicion of abuse. Clear information is available should anyone have a concern or complaint about the care or service they are receiving. Staff receive on going training so they can care for the different needs of people living in the home. There are good arrangements for supporting people keep their personal monies in a safe place should they wish to do so. There are generally good maintenance checks and records so that people can be kept as safe as possible. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Further work is needed to ensure staff understand a “person centred” approach to care delivery and evidence this through care planning. The registered person must produce a clear refurbishment plan with timescales for completion. This must include all of the items identified in this report. This is so that people who live in the home have an acceptable level of comfort, hygiene and safety. The registered person must provide suitable furniture, carpets and fittings in communal areas and bedrooms. This will provide a comfortable environment for people to live in. The registered person must source and eradicate the odours in the home, repair the broken dusty, noisy extractor fans, repair the broken window restrictors and make sure the utility room door is kept locked. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.2 Page 8 Staffing levels should be based on the layout of the home and dependency of those living in the home. Additional staff should be provided at peak times. A programme of regular effective formal staff supervision must be in place to ensure that staff are clear about their role and responsibilities. A copy of the wiring certificate must be sent to the Commission. 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. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 9 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 Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5. Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive clear information about the service and good assessment of need before admission. This helps them make the right decision about using the service. EVIDENCE: The Company have a new tool called the Care and Health Assessment Profile (CHAP).This is used by the manager to complete a preadmission assessment for an individual who wants to move into the home. This information, along with care plan from the care managers and nurse assessors helps the staff produce plan of care for that person on admission. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 11 Next of Kin are also asked about their relatives’ current and past history so that a “life history” can be written and staff can start to deliver a more “person centred” approach to care. People are able to visit the home before they are admitted and are welcome to have a meal, join in any activity and are able to talk to staff and others living in the home. This helps them understand what the home has to offer and also helps them decide to move in or not. Intermediate care is not provided at this home. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is now being planned and delivered in a more person centred way which enables people to fully access heath care and other services. This demonstrates that people’s health is being promoted and safeguarded. EVIDENCE: Each person has a plan of care based on the admission information which was carried out by care managers, the manager and where needed the nurse assessor. Staff complete a Care and Health Assessment Profile (CHAP) which is very detailed and covers all aspects of peoples heath and social care needs. Risk Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 13 tools include pressure ulcer prevention using the Waterlow scoring system, dependency, moving and handling, nutritional assessments, using the Malnutrition Universal Screening Tool (MUST), continence and fall risk assessments. This information help the staff understand the level of risk and help them complete care plans based on individual need. The staff have worked hard to improve the care plans since the last visit to the home. There is evidence that they are working with the person and their representatives to find out about previous lifestyles and histories. This information is now showing how they are starting to promote peoples independence and choices about how they wanted to be cared for. The care plans looked at were easy to follow and were up to date. Information from other professionals is sought and their advice followed. For example contact with GPs, Palliative Care Specialists, Tissue Viability Nurses, Speech and Language Specialists, Consultants, Psychiatrists, and other NHS services. Several people have food and fluid charts to record their daily nutritional intake. These were being completed properly and could be cross referenced to the care plan. Staff should make sure they are completed at the time food and drink are consumed and not later in the day. This will make sure accurate information is always available. People who have low body weight or poor appetite have their weight regularly checked and staff contact the dietician should there be any concern. Anyone who has restricted mobility and requires staff to help them have very comprehensive risk assessments and care plans which inform staff very clearly of what hoist, sling and action to take so that everyone is kept safe. Everyone has access to all NHS facilities to ensure their healthcare needs are met. There are regular visits from GP’s and other health professionals including, dentists, opticians and chiropody services. Qualified nurses are detailing the action they are taking to prevent and heal pressure ulcers. People have the appropriate equipment and the wound care records show when dressings have been changed, if there has been any improvement or other wise. The instructions and advice from the Tissue Viability Nurse (TVN) and the GP are followed. The qualified nurses are responsible for the administration of medicines and have had safe handling of medication training. The home has proper arrangements for the storage and administration of medicines in the home. The Medicine Administration Records (MAR) and Controlled Drug Records (CD) showed no discrepancies. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 14 Since the last visit there is no longer any excess stock prescribed fortified foods and the storage facilities were much better organized. Qualified nurses wear red tabards when dispensing medicines, this prevent the nurse being distracted during medicine administration. Observation on the day of the visit showed administration to be well managed and followed practice guidance. Staff knocked on doors before going into people’s bedrooms and made sure that any personal care was carried out in private. Staff knew people’s care needs well and were respectful and kind. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities to take part in meaningful activities and keep control of everyday decisions are good and improvements to the mealtime experience means people can enjoy full and active lives. EVIDENCE: The home benefits from an activities organiser who plans events both in and out of the home. There is a four week programme and lots of photographs of various events that have taken place over the last year. Since the last visit the small dining room has been changed into an activity room where various activities can take place in small groups. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 16 These activities have included helping maintaining the garden areas, painting, board games, audio and DVD equipment, some trips out in the shared mini bus, crafts and using various musical instruments. On the day of the visit the activity person was supporting one person to go out in the evening. People have also enjoyed having special events planned such as Halloween and are looking forward to various Christmas activities. Records are available to show who has taken part or otherwise in activities and outings. Should anyone not wish to take part this is respected by the staff. Further work should continue to develop a person centred approach with care staff including social care into the personal and health care delivery. People spoken to said that family and friends are always made welcome and can visit at any time. Information about advocacy is available in reception. People have brought small items with them making their rooms homely and reflective of their previous lifestyles, religious beliefs and cultural backgrounds. There has been a good improvement into making the meal time experience better. There are “protected mealtimes” which means people can have sufficient uninterrupted time to eat their meals. And staff are available to support those who need help and qualified staff can monitor individual’s nutritional intake. There are two dining rooms, one was previously a lounge. This room was in the process of being redecorated and was not a pleasant place to have a meal. Although tables were set, there were no curtains and the carpet was seriously stained, dirty and had lots of debris from a previous meal and from old wallpaper that had been taken off the wall. There have previously been concerns about the quality, choices and quantity of the food provision at the home. Following discussion with those living in the home and their relatives menus and timings of meals have changed. The menus show a good variety of food for each meal. People can have a full English breakfast and also choose from various cereals, juices, toast, bread, preserves and hot drinks. They can choose from having a main meal at lunch or in the evening with alternatives and snacks also on offer. For example, lunch included roast chicken dinner, egg and chips, baked potatoes with cheese or other fillings, with dessert choices of banana and custard, ice cream and yoghurts. Fresh fruit was always available. Various hot and cold drinks were available at all times. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 17 Choices for the evening meal included home made soup, sandwiches, corned beef hot pot followed by a hot dessert or fruit and cream. Supper was also being prepared and included sandwiches, crumpets, tea cakes, and cheese and biscuits. Food is prepared in the kitchen and taken to the dining rooms in “hot locks.” The kitchen staff service the meals taking into account the choices and portion size people need. All of the meals were of ample portion size, nicely cooked and presented. Staff gave assistance in a quiet, unhurried manner. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good complaints and protection procedures are in place and effectively followed to ensure that people and their representatives are listened to and protected from harm. EVIDENCE: The Company has a comprehensive complaints procedure, which is displayed in all areas of the home. It is also available in the Service User Guide which is available in reception. The complaints records show that all complaints and concerns are taken seriously and there is written evidence of investigations and outcomes. There have been five complaints since the last visit to the home. The complaints related to individual’s care. Records demonstrated that there had been a thorough investigation and meetings to address people’s concerns. All have been resolved at home level. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 19 Staff complete Safeguarding training during Induction and also complete training which links into the Local Authority Procedural Framework. Staff would be confident to raise an “alert” should there be any suspicion of abuse. There are currently no ongoing complaints or safeguarding investigations. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical standards are varied, which means that some areas are comfortable and pleasant places to spend time, but other areas are shabby, and do not always suit the needs of the people living in the home. EVIDENCE: The home is a single storey purpose built home, which is close to all local facilities and the sea front. There are wide corridors and level access throughout the home making it easy for those with restricted mobility to get around. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 21 Inner courtyards offer safe external areas which have been well maintained and planted throughout the summer months. There are lounges and two dining rooms which are close to all bedrooms. Since the last visit in November 2008 one dining room has been changed into an activities room and one lounge into the second dining room. The manager needs to ensure that there are enough lounge areas for people as on the day of the visit some lounges were very cramped with lounge chairs placed around the walls with no space between each one. On the day of the visit work was in progress to redecorate the corridors, one dining room and some bedrooms. The reception area had been redecorated and was nicely furnished. In two lounges carpets were stained and dirty, lounge chairs were stained had not been cleaned and many were very worn. The vinyl has been worn away where people’s heads had rested and cushions were split. Both these rooms were in need of refurbishment with walls and woodwork marked and damaged from chairs being up against the walls, and constant use of hoists and wheelchairs. They both were very smelly. The lounge that has been changed into a dining room was being decorated. There were no curtains and the decorators were working around people completing their meals and then going back into restart work. This resulted in the carpet which was already very, stained, marked and black in places becoming more of a mess from decorating debris. There is a designated smoking room for people who live in the home to use. It has had a coat of paint but is sparsely furnished and had an overpowering odour of cigarette smoke which was obvious even outside the room. There are adequate bathrooms, toilets and shower facilities throughout the home. One shower room is out of use and it is being used to store the decorators’ equipment, drills and wood. The room was not locked. There is damage to all of the wood and paint work throughout and some damage to the boxed in pipe work in bathing areas. One bathroom remains out of use as the hoist has been condemned. Many of the extractor fans were dusty, noisy and some were not working. Several of the window restrictors were not working properly. Lighting in the corridors is very dim and there are plans to have these light replaced. All of the bedrooms have an en-suite toilet and hand wash basin. There is wheelchair and hoist damage to walls and paint work and carpets flooring in the en-suite still need replacing. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 22 There are profiling beds with integrated safety rails in many bedrooms. Some of the bedroom have been nicely personalised and are homely and comfortable. The laundry is separate from all communal areas. All of the equipment was in working order and staff were able to discuss how they would manage soiled or infected linen. The room is full of various linen, unmarked clothing and cardboard boxes and would benefit from a good clean out. Staff were following infection control procedures and had access to hand wash facilities in all areas. There is a sluice disinfector but this room was not locked. However hard the domestic staff were working there was a distinct odour in the home especially in the lounge areas. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems around recruitment and training are satisfactory but staffing levels only adequately meet the range of needs of those using the service. This means people’s lifestyles are restricted and overall affects their quality of life. EVIDENCE: On the day of the visit there were forty four people living in the home. The manager is supernumerary although there is an expectation that she will work as a nurse should there be any shortfalls. Staffing levels consist of two qualified nurses and six carers during the day. Overnight there is one qualified nurse and four care staff. Ancillary staff include domestics, laundry, cook, kitchen assistants, administrator, activities organiser and maintenance person. Historically this home has had many managers since it was registered with the Commission. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 24 This has meant there has been a lack of consistent management and only adequate staffing levels. There has also been problems retaining care staff and lack of management dealing with people telephoning in at short notice that they would not be coming to work and poor management of sickness levels. The home appointed a manager in August 2008.She has not yet been registered with the Commission. A deputy manager has now been appointed which should help in addressing some of the ongoing staffing issues. Information from the Annual Quality Assurance Assessment (AQQA) shows that there have been lots of changes in the staff team since the last visit to the home. It also identifies that the majority of the people have high dependency nursing and care needs with two staff needed to assist with all essential care. This was observed on the day of the visit as the focus again was on providing personal care and making sure people had enough to eat and drink. There was no time for staff to stop, talk and spend quality time with anyone. Although improving several people still had to wait for some time for help to the toilet and to be taken back and forth the dining rooms. Staff records show that recruitment and selection processes are followed. There is evidence of Enhanced Criminal Record Bureau checks,(CRB), Protection of Vulnerable Adult checks, two written references ,proof of identity, and professional identity numbers(PIN) for registered nurses. There is training and development programme in place. New staff complete an induction and are given a “Staff Handbook” .This covers employment matters and care practice. Information is also provided about equality and diversity and valuing that everyone has a contribution to bring to the home. Records show that mandatory training is completed and specialist training includes: Dementia care, Deprivation of Liberty, Mental Capacity, Catheterisation, Wound care, Nutrition, and Care Planning. Care staff are completing National Vocational Training level 2. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now has an experienced manager who is ensuring that the service is effectively run in the best interests of the people living in the home. EVIDENCE: As stated in the previous Standard and previous Inspection Reports this home has had difficulty in retaining managers. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 26 An experienced first level nurse with management experience was appointed in August 2008. She has completed her application to be Registered Manager and is awaiting a date for her “Fit Persons Interview During the last year many improvements to the service have been implemented. Regular meetings are held and people living in the home and their representatives are actively involved in the development of the service. For example, improving the mealtime experience. Staff views are sought and meeting are held to discuss Clinical Governance in line with the Royal College of Nursing Guidance. This is to help to continually improve quality and safeguarding with in the home. There is a Team Audit Process(TAP) which regularly monitors the quality of management and care provided. The Regional Manager visits on a monthly basis and completes a separate report which is available in the home. The AQQA was returned when asked for and gave a reasonable picture of the service and how it hopes to improve over the coming year. Peoples personal finances are managed well. The details are kept of all deposits and withdrawals on the computer system and paper records are also kept. Receipts of all transactions are available and monthly reconciliation checks of balances and cash are completed. Although systems are in place to make sure all staff have regular formal supervision this has not yet been brought up to date. Accidents and incidents are clearly recorded and monthly analysis has been completed to examine and track any trend. Records show that staff have completed training in moving and assisting (the deputy is completing the training course), infection control, fire prevention, food hygiene and first aid. In house maintenance checks, apart from cleaning and checking the extractor fans are up to date. Inspections have been carried out by the Fire Officer on the 3 November 2009 and Environmental Health on the 7 August 2009. Since the last visit the cooker, hot lock and laundry press have been replaced and improvements made to food storage in the kitchen. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 27 External service contracts are available apart from the wiring certificate. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 28 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 1 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 2 Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19 Regulation 23 Requirement The registered persons must submit a refurbishment plan for the home with timescales for completion. This will ensure that people can live in clean and safe surroundings. The registered persons must replace to worn, torn lounge chairs, replace the carpets and redecorate the communal areas. This is to ensure people are able to sit in comfortable, good quality, domestic style, communal rooms. The registered persons must ensure that there is sufficient and suitable communal space for people to use. This is to ensure people have choices of where to spend their day whilst not sat right next to someone else. The registered persons must ensure that the damage to walls and paintwork in bathrooms, toilets and en suites is repaired and redecorated. Timescale of 01/06/09 not DS0000000272.V378324.R01.S.doc Timescale for action 31/01/10 2 OP20 16,23 01/04/10 3 OP20 23 31/01/10 3 OP21 23 01/04/10 Chichester Court Nursing Home Version 5.3 Page 30 4 OP21 23 5 OP24 16,23 6 OP24 23 7 OP25 23 8 OP26 13,16,23 9 OP38 13,23 met. The registered persons must ensure that the bathing/shower facilities that are out of use are repaired. The registered persons must ensure that the stained, smelly carpets in bedrooms are replaced. Timescale of 01/06/09 not met. The registered person must ensure that the bedrooms are redecorated and damage to the doors and other paintwork repaired. This is so people can have pleasant, private rooms. The registered person must ensure that the lighting throughout the home is sufficiently bright and pipe work in bathrooms guarded and repaired. This is to ensure people live in safe, comfortable surroundings. The registered person must source and eradicate the odours in the home, repair the broken dusty noisy, extractor fans and make sure the utility room door is kept locked. The registered person must provide to CQC a copy of the up to date wiring certificate and ensure all the window restrictors are repaired. 01/04/10 01/04/10 01/04/10 01/04/10 31/01/10 31/01/10 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 Good Practice Recommendations DS0000000272.V378324.R01.S.doc Version 5.3 Page 31 Chichester Court Nursing Home 1 Standard OP8 2 OP12 3 4 5 OP15 OP26 OP27 6 OP36 It is highly recommended that all fluid balance and food charts are completed at the time of ingestion. This will ensure accurate records are kept to monitor people’s dietary needs. It highly recommended that the social care needs and previous life histories are incorporated into the care plans so that staff can continue to develop a “person centred” care delivery. It is highly recommended that the mealtime experience continues to develop. It is highly recommended that the excess and stock of various linen is checked and worn and torn items thrown out. Linen belonging to the hospital should be returned. It is highly recommended that staffing levels in the home are based on the geography of the building and dependency of people living in the home. Additional staff should be provided at peak times. It is highly recommended that formal supervision of all grades of staff is carried out at least six times a year with records kept. Chichester Court Nursing Home DS0000000272.V378324.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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