Care Home: Chilton House Nursing Home

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What the care home does well Prospective residents are assessed and provided with the key information on the home to ensure that the home can meet their needs. Residents have detailed care plans in place which ensures that their diverse needs are identified and met in a safe and consistent way. Risk assessments are in place to address potential risks and safeguard residents. Residents health care needs are identified and met which promotes their health and well being. Residents privacy and dignity is promoted which safeguards residents. Residents are provided with a varied programme of individual and group activities which promotes their well being. Residents are being supported to make choices and decisions in aspects of their life. Residents are supported to maintain contact with family and friends. Residents are provided with a choice of sufficient quantities of nutritionally balanced, varied and well presented meals, which promotes their health and well being. Policies and procedures are in place to ensure that complaints are handled appropriately to safeguard residents. Policies and training are in place to safeguard residents from potential abuse. The home is clean and maintained to a very high standard which promotes a homely and comfortable environment for residents. The home has a good skill mix of staff in sufficient quantities to meet residents needs which promote their health, safety and well being. Staff are suitably inducted, trained and supervised in their roles which safeguards residents. Staff have the required mandatory training and a number of staff having achieved a National Vocational Qualification to safeguard residents. The home has a registered manager who works alongside staff and covers vacancies where required. She is approachable and accessible to residents and staff and is committed to the development of the home to benefit residents. The staff in all departments work well together to provide a holistic service to residents. What has improved since the last inspection? Improvements have been made to how controlled drugs are managed and how the medication administration records are recorded on to safeguard residents. A first aider is on duty on each shift which promotes residents health and safety. Systems are in place to ensure gaps in employment have been explored to safeguard residents. A host has been appointed to provide individual person centred activities for residents with the aim being for this to be expanded on in the New Year. Improvements have been made to the environment of the home, internally and externally to benefit residents. What the care home could do better: Improvements are required to medication practices and medication monitoring to safeguard residents. A log of complaints should be put in place to ensure that complaints received are handled appropriately to safeguard residents. The required recruitment checks must be in place for staff prior to them commencing work at the home to safeguard residents. Effective quality monitoring systems must be put in place to monitor practices and safeguard residents. A quality assurance tool should be put in place to get feedback from residents, staff and other stakeholders at least annually to measure the quality of care being provided and to ensure that the aims and objectives are being met to benefit residents. Key inspection report Care homes for older people Name: Address: Chilton House Nursing Home Chilton House Nursing Home Chilton Aylesbury Buckinghamshire HP18 9LR     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: Maureen Richards     Date: 1 7 1 1 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 33 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 33 Information about the care home Name of care home: Address: Chilton House Nursing Home Chilton House Nursing Home Chilton Aylesbury Buckinghamshire HP18 9LR 01844265200 01844265202 susanw@chiltonhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chilton House Limited care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 45. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Chilton House is a grade two listed Manor House set in extensive landscaped grounds in the rural village of Chilton. Due to its location the home is isolated from shopping facilities and local amenities, and is not served by local public transport networks. However, the home possesses a car for use by the activity organisers, which are used to take residents out for meals, shopping and activities at their request. The home is registered to provide care for 45 older people, up to ten of whom may also receive nursing care. The main part of the home is utilised to provide residential Care Homes for Older People Page 4 of 33 Over 65 45 0 Brief description of the care home care, and nursing residents are accommodated in a separate wing where nursing care is used to provide intermediate care to older people who are recovering from surgery or illness. The home provides individual accommodation, decorated and furnished to an extremely high standard, on three floors, with reception, lounge and dining areas on the ground floor. There are extensive and well maintained grounds with large patio areas accessible to mobile residents and wheelchair users. An experienced team of nursing, care, catering and housekeeping staff supports the manager. The proprietors live adjacent to the home and visit staff and residents on a frequent basis, and as a result are easily accessible. The home has an internet web site, which provides information as to the services provided at Chilton House. Please contact the home for the current range of fees for care. Additional charges are made for hairdressing, physiotherapy, chiropody, beauty treatments and escorting. Care Homes for Older People Page 5 of 33 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: This unannounced key inspection was conducted on the 17 th November 2009. It commenced at 09.40 and finished at 18.30 hrs. The inspection covered all of the key National Minimum Standards for older people. Prior to the inspection, a detailed self assessment questionnaire known as an Annual Quality Assurance Assessment document was sent to the registered manager for completion and was returned within the required timescale. This was informative and clearly demonstrated what has been achieved over the previous twelve months and the plans for improvement over the next 12 months. Comment cards were sent to twenty one residents, twenty eight staff, three health and social care professionals and seventeen relatives. Replies were received from ten residents, six relatives, twelve staff and two health and social care professionals. The feedback received was positive with residents, relatives, professionals and staff telling us they were happy with the quality of care provided. The feedback that has been Care Homes for Older People Page 6 of 33 received has helped to form judgements about the service and have been reported on under the relevant sections of the report. The inspection consisted of discussions with the registered manager, four staff on duty, informal discussions with four residents, examination of some of the homes required records, observation of practice and a tour of the premises. Information received by the Commission since the last inspection was also taken into account. Feedback on the inspection findings was given to the registered manager during the course of the inspection. The registered manager, staff and people who use the service are thanked for their co operation and hospitality during this unannounced visit. No requirements were made at the previous inspection with all recommendations of good practice addressed. This inspection has resulted in three requirements to improve outcomes for residents. Care Homes for Older People Page 7 of 33 What the care home does well: Prospective residents are assessed and provided with the key information on the home to ensure that the home can meet their needs. Residents have detailed care plans in place which ensures that their diverse needs are identified and met in a safe and consistent way. Risk assessments are in place to address potential risks and safeguard residents. Residents health care needs are identified and met which promotes their health and well being. Residents privacy and dignity is promoted which safeguards residents. Residents are provided with a varied programme of individual and group activities which promotes their well being. Residents are being supported to make choices and decisions in aspects of their life. Residents are supported to maintain contact with family and friends. Residents are provided with a choice of sufficient quantities of nutritionally balanced, varied and well presented meals, which promotes their health and well being. Policies and procedures are in place to ensure that complaints are handled appropriately to safeguard residents. Policies and training are in place to safeguard residents from potential abuse. The home is clean and maintained to a very high standard which promotes a homely and comfortable environment for residents. The home has a good skill mix of staff in sufficient quantities to meet residents needs which promote their health, safety and well being. Staff are suitably inducted, trained and supervised in their roles which safeguards residents. Staff have the required mandatory training and a number of staff having achieved a National Vocational Qualification to safeguard residents. The home has a registered manager who works alongside staff and covers vacancies where required. She is approachable and accessible to residents and staff and is committed to the development of the home to benefit residents. The staff in all departments work well together to provide a holistic service to residents. Care Homes for Older People Page 8 of 33 What has improved since the last inspection? 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 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 33 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 33 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. Prospective residents are provided with the key information on the home and are assessed prior to admission to ensure the home can meet their assessed needs. Evidence: The Annual Quality Assurance Assessment document tells that that the home has had six admissions in the previous twelve months and that pre assessments are carried out by qualified staff. The registered manager confirmed that prospective service users visit the home prior to admission or they are assessed in hospital or their own home. They make a decision as to whether they want to come to the home. The statement of purpose outlines the procedure for assessment and admission. The home has a pre assessment tool in place for short stay and long stay admissions. This covers all aspects of health, personal and social care with a dependency profile included to outline the prospective residents dependency levels. The assessment documentation for three residents was viewed and found to be informative, Care Homes for Older People Page 11 of 33 Evidence: comprehensive and in place prior to admission. The home provides convalescent care packages to residents who are recovering from an operation or illness, with the necessary equipment and specialist staff being made available to promote their independence to enable them to return home. The home has a number of short stay residents who frequently return for short stay care with some residents on short stay moving into long term care. Written feedback from nine residents confirms that they were given enough information about the home. One resident indicated they were not given enough information about the home. Six residents fed back that they were given written information about the homes terms and conditions (sometimes called a contract). Two residents fed back that they did not know if they were given written information about the homes terms and conditions (sometimes called a contract) and one resident fed back that they were not given this information. One resident did not answer this question. The registered manager confirmed during the inspection that each resident has a copy of the service user guide provided in their bedrooms. Care Homes for Older People Page 12 of 33 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. Residents personal and health care needs are well met, privacy and dignity is promoted which promotes their health and well being however improvements are required to medication practices to safeguard residents. Evidence: The home uses the Standex system of care planning documentation. Four residents care plans were viewed, which included a care plan for long stay, short stay and nursing care. A plan of care was put in place for problems/needs identified in the need assessment document with objectives in place and outcomes identified to address that need, including diverse needs. Records viewed evidence that care plans are reviewed monthly or as needs change. The care plans viewed were signed by staff but did not include residents signatures. The registered manager confirmed that this was due to the frailty of individuals. Daily records are maintained to indicate personal care needs are met. The care plans viewed included a pressure sore and nutritional screening assessment with a risk assessment in place where a risk was identified. These were reviewed Care Homes for Older People Page 13 of 33 Evidence: monthly or as need change. Risk assessments were also in place for other individual risks identified in relation to residents medical and mental health and falls. Care plans included a moving and handling assessment. Residents are registered with a local General Practitioner who visits the home weekly and was present on the day of the inspection. Residents who require physiotherapy can access a physiotherapist on site which they pay for privately. Residents have access to a visiting chiropodist and opticians and can be supported to see a community dentist when required. The continence adviser visits the home yearly and continence assessments are completed for residents who require continence aids. The home access specialist nursing services through the General Practitioner when required, for example the district nurses and Macmillan nurses. Individual records are maintained in care plans of appointments with all health professionals and the outcome of those visits. The home has a medication policy in place, which outline the procedure in relation to the ordering, receipt, administration of medication, which includes controlled drugs, covert medications and homely remedies. The registered manager and deputy are responsible for the ordering and receipt of medications with nurses and carers responsible for the administration of medication. Residents who are able to are supported to self medicate with residents in short term and convalescent care being encouraged to take responsibility for their medication in preparation for discharge. Staff involved in medication administration complete a pharmacy managed training programme which consists of three units of theory and practical assessments with staff being observed and signed off as being competent prior to administering medication. A completed medication assessment document was viewed to evidence this. The majority of residents medications are stored in a locked tin in their bedrooms with excess stock and some individual medication stored in secure medication cupboards kept in offices on each floor. Medication administration records for six residents were viewed. Handwritten medication records for short stay residents were signed by two staff on admission and signed off by the General Practitioner, on his next visit. Two recommendations were made at the previous inspection in relation to medication that the registered manager should ensure that Temazepam medication be treated as a controlled drug and a record on its administration is maintained. This has been addressed and the records and stock of Temazepam viewed was found to be correct. That registered manager should ensure that scribbled over entries on the medication administration record sheets be ceased. This has been addressed with changes crossed out and initialed. Two of the six medication administration records viewed were found to be in good order with no gaps in administration of their prescribed medication. In the other four medication administration records viewed Care Homes for Older People Page 14 of 33 Evidence: there were gaps in the administration of prescribed pain relief and laxatives with medication prescribed regularly being administered as an as required medication. In one residents medication administration records viewed a prescribed medication was not administered on the two nights prior to the inspection and in another residents medication administration records medication that was prescribed four times a day was being administered three times a day with no explanation as to why the fourth dose was not administered. Another residents medication administration record indicated that they had ran out of stock of medication for two days. At the inspection the registered manager was asked to make a safeguarding of vulnerable adults referral in relation to the missed medications and to liaise with the General Practitioner in relation to those omissions and how pain relief and as required medications are administered. The registered manager confirmed by email the day following the inspection that she had contacted the adult protection team in relation to the medication errors. She had also contacted the General Practitioner who confirmed that the identified medication omissions had no adverse effects for the residents concerned and he was happy with the way pain relief was being managed for one resident but he would amend the medication administration record on his next visit to reflect the practice and allow the nurses to use their judgement as to whether a particular medication was required. The registered manager confirmed by email the day following the inspection that she had disciplined the staff responsible for the missed medication, she was in the process of re assessing their competencies and she was sending them on further medication training. Alongside this she has introduced an extra check on medication records mornings and evenings with a record maintained to evidence that this has been done. It was noted for one resident that the instructions on prescribed cream was to store in a refrigerator until opened. This was not being followed and was addressed during the inspection. The registered manager must ensure that all prescribed medication is in stock, stored as per instructions and administered as prescribed with effective monitoring systems in place to pick up discrepancies in a timely fashion to safeguard residents. The statement of purpose outlines the aims and objectives of the home to promote residents rights, privacy, dignity, independence, security, civil rights, choice, fulfillment, diversity and lifestyle. Staff induction records evidence that staff are made aware of these basic principles and how they promote them. Residents have telephones in their bedrooms, wear their own clothes, and are called by their preferred term of address with care plans making reference to this. The registered manager confirmed that all medical examinations, consultations and treatments take place in private. Staff were observed during the inspection to knock on residents bedrooms and address residents in a polite, friendly and dignified manner. Residents spoken with during the inspection confirmed that staff always promote their privacy Care Homes for Older People Page 15 of 33 Evidence: and dignity. Written feedback from one staff member commented that the home caters for individuals keeping them safe but also trying to give them independence. It is very good at giving back confidence after a trauma such as fall, operation, illness. Another staff member commented that all staff are involved in the welfare of each resident and it works well. Written feedback from the hairdresser indicates that in their opinion the home runs an excellent service for residents. They commented that they were extremely impressed with their high standards and services and very much enjoy working there. Written feedback from a health professional involved with the home indicates they were always happy with all aspects of care and commented that the service provides a comfortable, secure, friendly environment. Excellent nursing and care standards. Exceptional standards of cleanliness care and food and they endeavor to give residents as much independence as possible. Written feedback from residents indicate they are happy with the care provided and included comments such as they make me pretty comfortable, first class service, welcoming to visitors. Six residents fed back that the home always makes sure they get the medical care they need, three service users fed back that they usually get the medical care they need and one fed back that they sometimes get the medical care they need. One person commented under what the home does well everything. One person commented under what the home could do better was weekend care, but did not include any comments as to why they thought this. This should be explored further by the home as part of their quality monitoring of the service. Written feedback from relatives confirms that they are happy with the care provided and include comments such as high standards of care, accommodation, food and hygiene. Happy to recommend Chilton house. Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a varied programme of activities, their choice and autonomy is promoted, visitors are welcomed and they are provided with a nutritious and varied diet which promotes their well being. Evidence: The home has an activities organiser known as a host who takes responsibility for planning and organising the programme of activities. The Annual Quality Assurance Assessment document tells us that residents are informed what activities are taking place and are given a weekly planner and monthly diary of activities that are available. The activities are varied including in house lectures, quizzes, board games, and exercise classes and they have monthly themed afternoon teas, one which took place on the day of the inspection. The host organises and participates in trips out which includes trips to local gardens, theatres, pub lunches, afternoon teas at places of interest and shopping. The weekly and monthly programme of activities for November and December was viewed and was found to be full and varied. The Annual Quality Assurance Assessment document tells us that the home have relative and resident special events, which include previous short stay residents and relatives are encouraged to be involved at Christmas and can have a Christmas dinner with their relative if they want to. In the last year the home introduced a specific host to provide Care Homes for Older People Page 17 of 33 Evidence: one to one support to residents who are less able to join in the programme of activities on offer and in the New Year aim to increase this staff members hours to develop it further. The Annual Quality Assurance Assessment document tells us that they also plan to discuss with all residents an evening entertainment programme which may also include extending the dining room opening hours to accommodate group suppers. Residents who choose to can access Holy Communion at the home and are supported to pursue their specific religion if they wish to. Residents care plans include a record of what activities individuals have participated in. Four residents fed back that the home always arrange activities that they can take part in, three residents fed back that they usually arrange activities that they can take part in and two people fed back that they sometimes arrange activities that they can take part in. One service user commented that the activities list reads well but how many residents actually do any of them. Under what the home could do better they commented that they should encourage residents who are able to go to the lounges instead of sitting in their rooms, more socialising. One staff member commented that there are activities and trips out to local attractions and theatres for those residents who wish to take part. Another staff member commented under what the home could do better is maybe more activities for those able to participate or more one to one time with residents. Another staff member commented that at times there could be more occupational care but then when they are organised residents are not bothered about going. Also residents who are less able in their rooms can seem to be on their own a lot but in most cases their physical or mental state prevents their participation in much. The registered manager confirmed that there are no restrictions on visitors with visitors able to visit at times convenient to them and the resident. Relatives can see the resident in private in their bedrooms or wherever the resident chooses to entertain them. Written feedback from relatives raised no issues in relation to visiting their relatives. Residents spoken with confirmed that their relatives are made to feel welcome. Residents are encouraged to take responsibility for their finances and are able to bring their personal possessions into the home if they choose to. None of the current resident group have advocacy involvement but the registered manager is aware of how to access advocates for individuals who may require this. Care plans include a mental capacity assessment which is completed on admission and outlines support individuals may need on handling their affairs. Residents are encouraged to exercise choice and control over their lives and this is evident in every day practices and daily records maintained in care plans. Care Homes for Older People Page 18 of 33 Evidence: Residents are provided with three meals a day, the lunch and evening meal consist of three courses and mid morning coffee, afternoon tea and biscuits are made available. Fresh fruit salad is available daily. The home has separate hospitality staff who is responsible for serving food to residents, with a hospitality staff member on duty on each floor. The breakfast and supper is taken to residents bedrooms and residents have the option to eat their lunch in their bedroom or in the dining room. Residents have a range of choices of meals. They make their choice the day before but can change it on the day if they wish to. An alternative menu is available if the main menu choice is not to their liking. Residents who require assistance with meals is provided with this in the privacy of their bedrooms and aids and equipment is provided where required. Specialist diet and soft diets are catered for and residents care plans viewed outlined the support required with meals. All staff including the catering staff have attended nutritional training and the Annual Quality Assurance Assessment document confirms that the menus are based on healthy eating and dietary guidelines. The cook confirmed that she is able to cater for any religious or cultural dietary need and at the time of the inspection this was not required. The inspector sampled the lunch meal options and observed practices in the dining room. The meals were unhurried and relaxed with staff being attentive and polite. The food sampled was of good quality, nicely presented and tasty. Six residents fed back that they usually like the meals at the home, three residents indicated they always like the meals at the home. One person commented that the food is good, there is good choice and variety and nicely presented. One service user commented that I could cook a bit better than the cook sometimes. Feedback from residents spoken with during the inspection confirmed that the food provided was excellent. The inspector went into the kitchen immediately after lunch and found it to be calm, well organised with the catering and hospitality working well together to clean up and get organised for the afternoon tea and cakes. Records are in place which were found to be well maintained and accessible. Care Homes for Older People Page 19 of 33 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. Policies, procedures and training is in place to enable residents to raise concerns and be safeguarded from potential abuse. Evidence: The statement of purpose includes the complaints policy and procedure which outlines who to complain to and the time frame for response to complaints. It includes up to date contact details for the Commission. This is included in the booklet on the home which is provided to each resident in their bedroom. The Annual Quality Assurance Assessment document tells us that the home has had one complaint.This was recorded incorrectly and referred to an allegation of lost property which was reported and dealt with appropriately. Therefore the home has not received any complaints in the period under review. The home does not keep a log of complaints and as a good practice recommendation this should be addressed and put in place. The home has received a high number of compliments and thank you cards. Written feedback received from staff confirms that they know what to do if someone has concerns about the home. Written feedback from residents confirms that six out of the ten residents who responded know how to make a complaint. Two residents indicated they did not know how to make a complaint and two residents did not answer this question. Written feedback from relatives confirms that five out of the six relatives that responded know how to make a complaint. The home has an up to date safeguarding of vulnerable adult policy and whistle Care Homes for Older People Page 20 of 33 Evidence: blowing policy in place, with a copy of the Local Authority Safeguarding of vulnerable adults policy available. The Annual Quality Assurance Assessment document tells us that the home has had no safeguarding of vulnerable adults referrals or investigations in the previous twelve months. Staff training records indicate that staff have up to date safeguarding of vulnerable adults training and staff spoken with during the inspection confirmed that they know what to do if they witness bad practice or potential abuse. Some medication practices observed during this inspection resulted in a referral by the registered manager to the Local Authority safeguarding team, which they have agreed to keep on file, with monitoring systems now put in place to further safeguard service users. The home has a finance and violence and aggression policy in place. Care Homes for Older People Page 21 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and well maintained to a high standard and is comfortable and homely which promotes a positive environment for residents. Evidence: Chilton house is a Georgian Manor set in the rural village of Chilton. The home is set over three floors. All of the bedrooms are en suite and provide single accommodation with the option to be made into a double bedroom if this was required. The bedrooms viewed were noted to be clean, personable, warm, cosy and well maintained. The home has a range of communal areas which include the reception area, drawing room, dining room and sitting room. All areas of the home is furnished to a high standard and in keeping with the age and character of the home. The home has well maintained extensive gardens and patio area. The Annual Quality Assurance Assessment document outlines a range of improvements that have been made to the environment internally and externally and outlines the plans for further improvement over the next twelve months. The home has its own maintenance staff who is responsible for the maintenance of the home and gardens. The home complies with the local fire service and environmental health department. It has CCTV installed in the outside of the building to promote safety due to the remoteness of the home. The home is clean, hygienic and odour free with the level of cleanliness maintained to a high standard. The home has a team of housekeeping staff who are responsible for Care Homes for Older People Page 22 of 33 Evidence: the cleaning with separate laundry staff to deal with the laundry. The laundry is sited away from food areas and has coded access. The washing machines and dryers have the specified programmes to meet disinfection standards and the laundry room is impermeable. Hand washing and disinfecting facilities are sited throughout the home and systems are in place to deal with clinical waste. The training matrix confirms that all staff are trained in infection control and health and safety. Written feedback from residents confirms that the home is always clean and fresh. One person commented that the rooms could be more airy. Written feedback from one staff member indicates that an area for improvement is to provide internet access and sky television for residents and air conditioning throughout the home. Care Homes for Older People Page 23 of 33 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. Staff are suitably inducted and trained with staffing levels sufficient to meet residents needs in a safe and consistent way. Improvements are required to recruitment practices to further safeguard residents. Evidence: The registered manager confirmed that there is a nurse on duty 24 hours a day with five carers on the morning shift, three carers on the late shift and two carers on the night shift. The deputy is included on the numbers on three days and has half a day as administration time. The registered manager is not included in the numbers and is able to cover a shift at short notice when this is required. The rota viewed confirmed this. The registered manager and deputy is available for support out of hours if required. In addition to the nursing and care staff the home has a team of hospitality and kitchen staff, housekeeping, laundry and maintenance staff, two physiotherapists, two hosts who takes responsibility for activities and a full time administrator and finance staff member. The use of agency staff is kept to a minimum with gaps in the rota usually covered by the permanent staff team, where possible. The staff team appeared to work well together, with all staff clear of their roles and responsibilities to provide a complete package of care to residents. The Annual Quality Assurance Assessment document tells us that eight out of the eighteen staff have achieved an National Vocational Qualification with two staff Care Homes for Older People Page 24 of 33 Evidence: currently enrolled on this training. Four staff recruitment files were viewed. The files viewed were generally well organised with a tick list at the front of the file to confirm what information had been obtained and when. The files viewed contained a photograph, an application form, job interview assessment, offer of appointment, job description, contract of employment, medical questionnaire, evidence of identify and copies of criminal records bureau checks. Three of the four files viewed included two references and one of the files viewed had only one reference on file. The second reference was applied for but not received. During the inspection the registered manager made arrangements with the staff member concerned to obtain a second reference and made them aware that they could not work any more shifts until such time as the reference had been obtained. Systems must be in place to ensure that all staff have the required checks in place before commencing work. The file for one of the nurses viewed confirmed that a nursing and midwifery check on their registration had taken place. A recommendation was made at the previous inspection that the registered manager should ensure that there is written evidence that gaps in employment history have been explored. In the files viewed this had been addressed. The home has its own induction programme which ensures staff fulfills the aims and objectives of the home and meets residents changing needs. The registered manager and heads of each of the departments confirmed that new staff are supernumerary for a period of two to three weeks and work under the direct supervision of an experienced staff member during this time. The induction booklet is completed as new staff complete specific tasks. The in house induction booklet is detailed and specific as to the task to be done and each section is then dated and signed off by a senior person. A part completed one was viewed which evidences this. The home has a training matrix in place which confirms that all staff have up to date mandatory training and some specialist training in care of the dying, diabetes, and dressings. The registered manager and the deputy have attended mental capacity act training. A recommendation was made at the previous inspection that the registered manager should ensure that there is a nominated first aider on each shift to comply with the Health and Safety (First Aid) Regulations 1981.The qualified nurses have completed this training as there is always a registered nurse on duty which addresses this recommendation. One nurse was booked to go on this training early December and the rota indicates that there was always a first aider on shift with her. Written feedback received from staff confirm that they are suitably recruited, inducted, trained and supported, that there is usually enough staff to meet individual Care Homes for Older People Page 25 of 33 Evidence: needs of all the people who use the service. One staff member commented that the service listens to the people who live there and is a warm and friendly place to work. One staff member commented that the home provides excellent care for the residents in a safe and friendly atmosphere. One staff member commented that it is a happy place to work and they offer a flexible approach. One staff member commented under what the home could do better is meet with night staff. One staff member commented that case presentations once in a while would enhance their understanding of permanent residents elderly care. This feedback should be considered by the registered manager to further improve outcomes for residents. One resident commented under what the home could do better is be better organised, and that they feel there should be a head person that come round and see what needs to be done for example organise the shift and organise the whole house. It should not be the resident who says you should do this and that. One resident commented that the staff are nice, generally they are kind and considerate, you get the odd one who isnt which is reasonable. Five residents fed back that there is always staff available when they need them and five residents fed back that there is usually enough staff available when they need them. Residents spoken with during the inspection confirmed that staff were always accessible and available when required and responded to their call bells in a timely manner. Five residents fedback that the staff always listen to them and act on what they say, four indicated that the staff usually listens and act on what they say and one indicated that the staff sometimes listens and act on what they say. Relatives commented that staff are friendly, helpful and very attentive. Care Homes for Older People Page 26 of 33 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. The home is well managed but effective monitoring and quality assurance systems must be in put in to monitor practices to further safeguard residents. Evidence: The home has a registered manager who has been in post for almost two years. She is a registered nurse and is currently undertaking a leadership and management in care National Vocational Qualification course. She has completed a leadership and management course and completes mandatory and other specialist training to enhance her skills. Verbal feedback from residents was that the registered manager was very accessible and had a visible presence in the home. They found her to be approachable and responsive to their requests. Feedback from staff confirms that they feel the home is well managed and the manager is supportive and encouraging. There are clear lines of accountability within the home with team meetings and heads of department meetings taking place regularly to promote good communication and team work. The manager has been proactive in addressing the recommendations of good practice from the previous inspection and in immediately addressing shortfalls Care Homes for Older People Page 27 of 33 Evidence: identified at this inspection. The Annual Quality Assurance Assessment document received in respect of this inspection was informative and gave an accurate reflection of the progress made over the year and identified areas for improvement over the next 12 months. The home has no formal quality assurance audit systems in place other than obtaining feedback from short stay residents in relation to the physiotherapy input they received. As a good practice recommendation this should be addressed to ensure that an effective quality assurance monitoring system is in place to measure success in meeting the aims and objectives and statement of purpose of the home. The registered provider is required to carry out monthly Regulation 26 visits and complete a report. At this inspection the home had no Regulation 26 reports available to evidence that this was taking place. This must be addressed in line with Regulations to monitor practices to safeguard residents. The registered provider is a frequent visitor to the home and chats informally to residents and staff during those visits. She is kept up to date on what is happening in the home and is responsive to requests to improve the service. The registered manager confirmed that she is responsible for ensuring that policies and procedures are reviewed and up to date. The Annual Quality Assurance Assessment document confirms that all policies and procedures were reviewed in November 2008, with the management of service users money, valuables and financial affairs policy reviewed in April 2009. Residents are encouraged to be responsible for their own money with a safe provided in bedrooms for residents to keep their money and valuables safe. Residents care plans outline appointee or power of attorney where this is the case. The registered manager confirms that all staff receive formal supervisions with the aim being for at least six a year for all staff. The registered manager and deputy supervise the nurses and carers whilst the heads of housekeeping and hospitality supervise their staff. Records are maintained of supervision sessions. Staff confirmed that they feel supervised and supported in their roles. Staff have up to date mandatory training with the aim being to introduce more scenario type training for staff to further enhance their learning. A sample of health and safety records were viewed and found to be in good order. The home has a maintenance person who takes responsibility for health and safety checks. Accident and incident reports are completed and filed in individual residents files. The home has kept the Commission informed under Regulation 37 of events that affect the well being of residents. The Annual Quality Assurance Assessment document confirms that equipment is serviced and up to date. A sample of the servicing records were viewed Care Homes for Older People Page 28 of 33 Evidence: and found to be in order. Care Homes for Older People Page 29 of 33 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 30 of 33 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 1 9 13 The registered manager must ensure that all prescribed medication is in stock, stored as per instructions and administered as prescribed with effective monitoring systems in place to pick up discrepancies in a timely fashion to safeguard residents. To safeguard residents 24/12/2009 2 29 19 The registered manager 17/12/2009 must ensure that the required recruitment checks have been carried out and are in place before the staff member commences work at the home. To safeguard residents. 3 33 26 The registered provider must carry out monthly Regulation 26 visits with a report maintained of this visit to monitor practices 24/12/2009 Care Homes for Older People Page 31 of 33 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 To monitor practices and further safeguard residents. 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 32 of 33 Helpline: 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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