Care Home: Chilton Croft Nursing Home

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What the care home does well The garden offers a comfortable place for residents to sit out, and is accessible for wheelchair users. Staff are welcoming, and we witnessed friendly `banter` between residents and staff as they prepared to watch England play their world cup match. Monitoring systems have been put in place to ensure residents do not miss out on their medication. What the care home could do better: Staff need to continue to develop their knowledge of dementia, and person centred care to ensure they include more information in care plans on how they are ensuring residents well-being, including social stimulation. Random inspection report Care homes for older people Name: Address: Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN one star adequate 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: Jill Clarke Date: 2 3 0 6 2 0 1 0 Information about the care home Name of care home: Address: Chilton Croft Nursing Home Newton Road Sudbury Suffolk CO10 2RN 01787374146 01787374333 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Chilton Care Homes Limited care home 31 Number of places (if applicable): Under 65 Over 65 6 31 dementia old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 Chilton Croft is situated about one mile from the centre of Sudbury. It offers nursing care to thirty-one residents in a large two-storey house that has been developed for the purpose. A variation to the registration allows the home to offer care to up to six residents with a diagnosis of dementia. The home has two large lounges that both have a conservatory which overlook pleasant garden areas. There is a separate dining room, close to the kitchen. Corridors have been redecorated and fitted with new carpets, and memorabilia cases provide points of interest throughout the home for the benefit of the residents. The home has recently redeveloped their rear garden space Care Homes for Older People Page 2 of 11 Brief description of the care home with new grassed areas and gardens, and which is wheelchair accessible by access paths. There are twenty-seven single bedrooms and two shared rooms. Eleven bedrooms are on the ground floor with eighteen on the first floor. There is a passenger lift between the floors. Nineteen rooms have en-suite toilet facilities and there are toilets and bathrooms situated on both floors. The fees for care in the home range from £387.00 to £750.00 per week. This figure was obtained from the provider of the home. Care Homes for Older People Page 3 of 11 What we found: We (The Commission) visited the home unannounced on Wednesday 23 June 2010 (12.15pm to 3.35pm) to undertake a focused inspection, to see how the home has addressed the requirements made following our last Key Inspection (24 November 2009). The manager, who we gave feedback to at the end of our visit, was available throughout the inspection to answer any questions or provide any records. During our visit we spent time talking to three residents, to hear their views on the level of service they receive, and observing the general routines of the home. We also spent time talking to two members of staff to gain feedback on their knowledge of the residents they look after. Records we looked at have been mentioned in the relevant areas of this report. Since our last inspection the home has received an unannounced visit (June 2010) from Adult Care Services, following two Adult safeguarding referrals being made about concerns over care practices at the home. The allegations were not upheld. The Commission has also been contacted three times (between April and June 2010), either by e-mail or verbally, raising concerns over different aspects of the management and care practice. The manager felt that the concerns were from x-members of disgruntled staff and were not justified. Where as part of this inspection we covered some of the regulatory issues raised by the complainant, we have given feedback of our findings within the report. When we arrived residents were getting ready for lunch. We asked one resident in the privacy of their bedroom, their views of the meals provided. They told us they liked the breakfast and supper but were not so keen on the mid-day meal. Further discussion identified that they preferred to have their food plain, without any sauces or strong flavorings. An anonymous concern raised directly with the CQC stated that there never seems enough at supper time, always two or three half dried sandwiches. When we asked a resident what they thought about the quality of supper, they said they normally have three sandwiches (which they were given a choice of) and a cup of tea, which they had no problem with. Discussions with a member of staff identified that the home has been addressing feedback from a relatives meeting, over wanting to see more variety in the supper menu, by introducing some hot dishes. Due to the dishes needing to be prepared before the catering staff go off duty (just before supper time), they have to be meals that care staff just need to serve up. However, discussions with the member of staff also identified that staff will cook a simple dish such as cheese on toast if they are able to. We discussed with the Manager the feedback we had received, that care staffs decisions over how they are supporting residents with their nutritional needs, were sometimes being overridden or challenged by the catering staff. Two people felt that it negatively affected staff morale. The Manager confirmed that they are aware of the situation, and would look into it further. Care Homes for Older People Page 4 of 11 It was a hot, sunny day when we inspected, and all the residents we visited in their bedrooms had a cold drink close to hand. When passing one residents bedroom we could hear a member of care staff gently encouraging/assisting a resident to have a drink. Another residents care plan showed that staff are monitoring their nutritional input, which includes giving prescribed food supplements. Information sent to the CQC, raised concerns that the manager, and Deputy Manager, have no medical or care qualifications. The Commission are aware of this, and we made reference to it in our last key inspection report that a Clinical Lead Nurse has been appointed, to oversee the care and nursing element of the home. We also mentioned that the Homes Statement of Purpose and Service users Guide did not clearly give people information of the management roles at the home, including the role of the Clinical Lead Nurse. Therefore not everyone would be aware of the managements delegated responsibilities. To address this requirements were made following the last inspection, to ensure that the home reviewed their Statement of Purpose and Service Users Guide to ensure the information given is accurate, reflects current practice, and includes information on the fees. The action plan sent following the inspection, and their Annual Quality Assurance Assessment (AQAA) we received in April 2010, confirmed that the home had undertaken this work. They told us that their new brochure and Statement of Purpose contains clearly written information about the services offered by the home and the fees charged. We were given a copy during the inspection to take away with us, which showed the information on the management responsibilities had been included. The home does not currently have a manager who has been registered by The Commission. During our last key Inspection, the Responsible Individual Mr Diwan was undertaking the day to day management of the service, and told us they would be submitting their application to apply to be registered with the CQC. In March 2010, we wrote to the service, stating that the home was being managed by an unregistered manager, setting out what action needed to be taken. During this inspection Mr Diwan confirmed that he has still not put in his application, as he was unsure if to do it now, or wait until the new Health and Social Care Act 2008 comes into place in October 2010. Two of the six requirements made following the last inspection concerned medication. They were made to ensure residents were receiving their medication as prescribed, and staff is being given clear guidance on when as and when required (PRN) medication is to be given to support residents with dementia related behaviors. We looked at a sample of eight peoples medication administration record (MAR) sheets. The MAR sheets had been completed by staff to confirm that they had given residents their medication, and if not, had entered a code to say why it had not been given. Discussions with the duty nurse confirmed that they were re-ordering new stocks of residents medication in time, to ensure they did not go without. At our last inspection we identified where a resident had not had their patch applied which gave them their pain relief. This had not been picked up by the nurses working the shifts before the next patch was due to be applied, 3 days later. To ensure this did not happen again, further monitoring checks were put in place by the Clinical Lead Nurse. During this inspection we looked at the MAR sheet and controlled drug register to check that another resident who is having their patches applied once a week was receiving them. The records kept showed that they were being applied as prescribed. Care Homes for Older People Page 5 of 11 Where we raised concerns during the last inspection, that a resident was automatically being given as and when medication to reduce periods of anxiety, which had a sedating effect. We found that there was no clear guidance for staff, on other interaction they could take first to relieve the persons anxiety, and resolve a situation rather than relying on medication. On looking at the residents care plan during this visit, we fed back to the management that further work still needs to be undertaken in this area. To address this, the nurse started work on this during the inspection, and reassured us that they would write an overall guidance policy for the nurses in the use of PRN medication, with more individualised aims and objectives as part of individual residents care plans. In the AQAA, the home informed us that the service had obtained a stock of controlled drugs for use in the home (instead of individually prescribed for named residents). As previous inspections had not identified the home was doing this, we doubled checked with the manager. They confirmed that the home does not keep a stock of controlled drugs, and a mistake had been made when completing the form. To address the situation they will re-send the page, ensuring the correct information is given. During the inspection male residents we spoke with, told us they were looking forward to watching the England World cup match. Staff had arranged for residents to enjoy a beer whilst they watched the game in the lounge, or their bedroom. There was an air of excitement around the home, as football became the major talking point between residents and staff. In the garden, six female residents were enjoying a cup of tea in the sport free zone. Discussions with staff identified the home no longer has a dedicated Activities Organiser, instead staff incorporate this into their shift. At our last inspection, we noted that activities were being arranged for residents who like to join in with communal events. However, for the more physically and mentally frail residents who spent most of their time in their bedrooms, we identified that they were not getting the same level of quality social interaction, and therefore could become isolated. We visited a resident in their bedroom, who we had met during the last inspection. The care plan held in their bedroom contained a life history, which gave a small amount of useful information about the persons life. For example, where they were born, lived, and holidays they had enjoyed which we found useful as topics to initiate conversation. Their care plan held a daily record sheet, where staff record any interaction they have had with the resident. The record sheet for the day before our visit (22 June 2010) showed seven entries between 6.30am and 9pm. During each visit staff had written down what care task they had undertaken, however there was only one entry which evidence that staff had spent time chatting with the resident. There was no information on how staff are ensuring the residents well-being and mental stimulation during the day. When we asked the nurse where this would be written down, they directed us back to the daily log sheet. We then went to the office where the full care plans are located, but the nurse could not find the information we were asking for. The nurse looked in the homes memory clinic book, but they could not find a form made out for the person. However, later they came back with a list showing that the resident had received nine, hand and foot aromatherapy massages during the last four months. Care Homes for Older People Page 6 of 11 Anonymous concerns raised with the CQC stated staff had been told that disposable gloves and aprons were to be worn only when dealing with faeces. During the inspection we asked a carer, and a nurse about the homes infection control procedures, and when they would use protective clothing. Both said straight away when handling any bodily fluids, and confirmed that there are plentiful supplies of gloves and aprons available at locations around the home. The training spreadsheet we were given during the inspection showed out of the thirty six staff listed, fourteen had undertaken infection control training. The AQAA informs us that twenty seven staff has received training in prevention and control of infection. The home also informs us in the AQAA that they have an action plan to deliver best practice in prevention and control of infection which we did not look at during the inspection. However, we did note that in one bathroom there was two used bars of soap in the sink. There was no indication to which person they belonged to, therefore could be a source of passing on infection. Another concern raised directly with the CQC was that a resident was found with their head stuck between the safety bars of their bed. We were not given the name of the resident. When we fed this back to the Manager and Nurse, they were aware of an incident over eighteen months to two years ago with bed rails, which had led to them purchasing new beds, but no recent incidents. Whilst visiting a residents bedroom, we noted that they had bed rails fitted, which included a safety bumper, to offer extra protection. In their care plan we found a full risk assessment had been completed, to ensure that they were safe for use, and the reason for their use. The nurse confirmed that all the measurement checks stated on the risk assessment to be carried out, to ensure there are no gaps that can injure or trap a person, had been carried out. During the inspection we pointed out to the manager that they had not completed the last review dates on the policies and documents page. They apologised and said they would complete this and send it on, which will enable us to check that policies and documents are being regularly reviewed, and updated to reflect current practice. Over the last year residents and staff commented that there has been quite a change over of staff, which the manager said is now settling down. We asked a resident, who had mentioned the changes if it had affected the standard of care they received. They said no, its pretty good really its just that as they get to know the staff, they leave. Another resident when we asked about the standard of care they receive told us that they have no problems. What the care home does well: The garden offers a comfortable place for residents to sit out, and is accessible for wheelchair users. Staff are welcoming, and we witnessed friendly banter between residents and staff as they prepared to watch England play their world cup match. Monitoring systems have been put in place to ensure residents do not miss out on their medication. Care Homes for Older People Page 7 of 11 What they could do better: 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 8 of 11 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 9 of 11 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 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 30 The home should look at the dementia training available which would support staff to understand what person centred care is, and how it can be Incorporated in to the way they work, and write care plans. Care Homes for Older People Page 10 of 11 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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