Care Home: Chilworth House

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. We spoke with some people who were receiving a service at Chilworth House and visiting relatives and they told us that they were given good information before they moved into the service. One visiting relative said "I chose the home because it is local to me and I can visit at any time. I am always made welcome" People told us that the information they received about the home was sufficient, and that staff of Chilworth House and social care professionals had explained to them the service that the home provides. One person said they had been able to bring their relative to visit the home and the staff had been very welcoming and answered all their questions and they had liked the lively atmosphere of the home. There is a motivated and established staff team who respond to service users in a respectful and appropriate manner. Two comments received tell us, " Most of the staff have been there some time and there is good continuity of staff which is helpful for the residents" and "the staff work hard and meet my relatives needs. Most of the staff have been working in the home for many years and know my relative well". The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Four residents who spoke to the expert by experience all expressed their individual views on living at the home and they ranged from "I really hope I can stay here, I love it", "we seem to get on so well together", "the staff are so kind" and "our daily papers are obtained by the staff and then we share them among ourselves" to "If I cannot stay in my own home then this is the next best thing." Communication between people who use the service and staff was observed to be positive and open. One visiting relative talked to us on the day of the visit. They said "I can`t find any fault with this home. The staff are all helpful and friendly and the new manager is very good". One person using this service asked to speak to an inspector and told us, "I am very satisfied. The staff are very good indeed and I think they do their job excellently". The provision of meals and mealtimes are of a good standard. Comments made about the lunch in returned surveys included, the food is always lovely and I always enjoy my lunch. They make some of my favorite meals". The numbers and skill mix of the staff team meet the current needs of the resident group. Comments received in surveys said that staff are "friendly, helpful and patient with the residents" and "the staff are patient and interested in everyone." Staff training is good and updated regularly ensuring staff have the skills to look after people using the service. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? Care plans have been improved and identify and describe the changing needs of people using the service. On-going improvements to the environment have been made to ensure the home is safe, homely and clean The recruitment process has improved to ensure all newly employed staff do not commence work until all necessary employments checks have been undertaken. Risk assessments are in place and up to date covering falls, nutrition, moving and handling and pressure area care. What the care home could do better: Arrangements must be in place for the recording, handling, safekeeping, safe administration and disposal of medicines. The home should ensure that they make people using the service aware of the alternative range of meals to ensure they are given a choice. The home needs to maintain a record of all complaints received by the home to ensure the views of people using the service are listened to. Key inspection report Care homes for older people Name: Address: Chilworth House 7 Rectory Avenue High Wycombe Buckinghamshire HP13 6HN     The quality rating for this care home is:   one star adequate 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: Barbara Mulligan     Date: 0 8 0 4 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Chilworth House 7 Rectory Avenue High Wycombe Buckinghamshire HP13 6HN 01494526867 01494526140 simon@lloydscott-healthcare.co.uk www.chilworthhouse.com Lloyd Scott Healthcare Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Care home only (PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 29 Care home only (PC) to service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 29 Date of last inspection Brief description of the care home Chilworth House is a care home providing personal care and accommodation for 29 older people. It is privately owned. The home is situated in High Wycombe and is a short drive away from the amenities that a large town can offer. The home has been owned and operated by Lloyd Scott Healthcare since 1998 and has undergone many Care Homes for Older People Page 4 of 30 Over 65 0 0 Brief description of the care home improvements since then. It is a well-maintained Edwardian building and the improvements are in keeping with the style of the building. The home has two lounges and a pleasant conservatory. There is a sheltered outside sitting area and well-kept garden. The fees for the home range from £580 per week low dependency to £950 per week high dependency. Care Homes for Older People Page 5 of 30 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: one star adequate 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 over the course of two days and covered all the key National Minimum Standards for Older people. Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) which is completed by the service. This document, which includes information from a variety of sources, was received in good time, was fully completed and contained the information we needed. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document is referred to throughout the report. The home has responded positively to the issues raised in the previous inspection report with demonstrating a positive approach to the inspection process. At the time of the visit there was no registered manager in post. An Operational manager has been employed in the home since January 2010. In the absence of a Care Homes for Older People Page 6 of 30 registered manager the Operational manager has been acting as the homes manager. She was available to assist with the inspection throughout the two days. As part of its equalities and diversity work the Commission has established an external stakeholder group made up of people who use services. This group is known as the Experts by Experience Equalities and Diversity Group. On the day of the visit the inspector was joined by an expert by experience, who was asked to join residents for a lunch time meal, look at menu choice, the range of activities available in the home and seek the views of people using the service. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the registered provider at the end of the inspection, by the Regulation Inspector and the expert by experience. The registered provider, the ops manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 30 What the care home does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. We spoke with some people who were receiving a service at Chilworth House and visiting relatives and they told us that they were given good information before they moved into the service. One visiting relative said I chose the home because it is local to me and I can visit at any time. I am always made welcome People told us that the information they received about the home was sufficient, and that staff of Chilworth House and social care professionals had explained to them the service that the home provides. One person said they had been able to bring their relative to visit the home and the staff had been very welcoming and answered all their questions and they had liked the lively atmosphere of the home. There is a motivated and established staff team who respond to service users in a respectful and appropriate manner. Two comments received tell us, Most of the staff have been there some time and there is good continuity of staff which is helpful for the residents and the staff work hard and meet my relatives needs. Most of the staff have been working in the home for many years and know my relative well. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. Four residents who spoke to the expert by experience all expressed their individual views on living at the home and they ranged from I really hope I can stay here, I love it, we seem to get on so well together, the staff are so kind and our daily papers are obtained by the staff and then we share them among ourselves to If I cannot stay in my own home then this is the next best thing. Communication between people who use the service and staff was observed to be positive and open. One visiting relative talked to us on the day of the visit. They said I cant find any fault with this home. The staff are all helpful and friendly and the new manager is very good. One person using this service asked to speak to an inspector and told us, I am very satisfied. The staff are very good indeed and I think they do their job excellently. The provision of meals and mealtimes are of a good standard. Comments made about the lunch in returned surveys included, the food is always lovely and I always enjoy my lunch. They make some of my favorite meals. The numbers and skill mix of the staff team meet the current needs of the resident group. Comments received in surveys said that staff are friendly, helpful and patient with the residents and the staff are patient and interested in everyone. Staff training is good and updated regularly ensuring staff have the skills to look after people using the service. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. Health and Safety procedures are thorough and records are well maintained. Care Homes for Older People Page 8 of 30 The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. 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 30 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 30 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. The assessment process works well and potential residents and their families have information about the home to help them decide whether their needs can be met, before they decide to move permanently. Evidence: Four completed needs assessments were examined, including those for people newly admitted to the home. Each file had a completed needs assessment and showed that all areas and conditions of people using the service were assessed prior to offering them a place in the home. The home has introduced a booklet called All about me which records peoples personal history and provides background information about the persons family and friends, a life history, likes, dislikes and preferences. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. We spoke with some people who were receiving a service at Chilworth House and visiting relatives and they told us that Care Homes for Older People Page 11 of 30 Evidence: they were given good information before they moved into the service. One visiting relative said I chose the home because it is local to me and I can visit at any time. I am always made welcome. People told us that the information they received about the home was sufficient, and that staff of Chilworth House and social care professionals had explained to them the service that the home provides. One person said they had been able to bring their relative to visit the home and the staff had been very welcoming and answered all their questions and they had liked the lively atmosphere of the home. The assessment process demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not provide intermediate care, so this standard is not applicable. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets the health, personal and social care needs of the residents, by developing good quality care plans and responding to their changing needs, as appropriate. Staffs practice in the administration and recording of medication is not consistent and could pose a risk to peoples health and welfare. Evidence: Four care plans were examined during this inspection, including people newly admitted to the home. A Statutory Requirement Notice was issued to the home following the previous key inspection for the home to; 1) Ensure that service users care plans are sufficiently detailed in order to provide staff with the guidance they require to ensure that service users needs are fully met. 2) Ensure that service users care plans are sufficiently detailed to include all aspects of daily living needs, their preferences and their likes and dislikes. 3) Ensure that where a service user has been prescribed (PRN) as required medicines, that the guidelines regarding the administration of this medicine are fully recorded in the service users care plan. Care Homes for Older People Page 13 of 30 Evidence: A Random inspection was undertaken following the issue of the Statutory Requirement Notice and the Statutory Requirement Notice was assessed as met. Four care plans were examined during this inspection, including those for people newly admitted to the home. The home has continued to further develop the care plans and training for staff has been provided about the care planning process. The care plans examined contain good details about the person using the service and how staff are to meet their identified needs. The care plans identify and describe the changing needs of people using the service. Individual preferences, likes and dislikes and reference to end of life care are recorded in care plans and describes how these will be met. Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish. People were seen to be wearing the aids needed, for example hearing aids and clean glasses. One visiting relative talked to us on the day of the visit. They said I cant find any fault with this home. The staff are all helpful and friendly and the new manager is very good. One person using this service asked to speak to an inspector and told us, I am very satisfied. The staff are very good indeed and I think they do their job excellently. In surveys received about the home, some concerns were raised bout the frequency of bathing. The comments told us, my relative only has a bath once a week and that is often put off till the next day and under the section what the home could do better one response was A regular bath. Sometimes there is a staff shortage which means my relative goes without. Daily notes were examined and these are detailed and informative and record the personal care received and activities that the individual has undertaken throughout the day. The daily notes record when people receive a bath, or a wash and if an individual refuses this is recorded. The frequency of bathing recorded in the daily notes does appear to be on a weekly basis and if people require extra bathing the home should be able to facilitate this. This should be addressed. A Statutory Requirement Notice was issued to the home following the previous key inspection for the home to; 1) Ensure that all handwritten entries on medication record sheets are checked for accuracy by a second person qualified to do so. 2) Ensure that there are clear written guidelines for staff regarding the administration of (PRN) as required medicines. 3) Care Homes for Older People Page 14 of 30 Evidence: Ensure you provide clear written guidance to staff for each service users who is prescribed (PRN) as required medication, as to when to administer the medication and any triggers or indicators known that shows the medication is needed. 4) Ensure that where a service user has been prescribed (PRN) as required medicines, that the guidelines regarding the administration of this medicine are fully recorded in the service users care plan. The Medication Administration Records (MAR) were examined for all people who use this service during this visit. There were several handwritten entries on the MAR charts and these were signed by two staff and dated. The Medication Administration Records (MAR) showed numerous gaps and omissions. The medication was checked to ascertain if it had been given and not signed for, or if the medication had not been administered. In all cases the medication had been given but staff had not signed to say they had given the medicines. A requirement is issued for improvement in this area. On the second day of the visit the Operational manager had put a system into place where the senior staff will check the Medication Administration Records (MAR) at every handover meeting, three times a day. The operations manager has produced a policy regarding the safe administration of as needed (PRN) medicines and she said the home has been working closely with the supplying pharmacist. There is specific guidance regarding the administration of as needed medicines and this is contained in the care plans. These include information about when to administer the medication and any triggers or indicators known that shows the medication is needed. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some activities taking place in the home and plans have been implemented to improve the range of activities for people living in the home. Service users are encouraged and supported to remain in contact with their families and friends. The presentation and standard of food is good and meets the nutritional needs of people who use the service. However people using this service should be made aware of the alternative range of meals to ensure they are given a choice. Evidence: The expert by experience was asked to provide a general overview of the home and to spend their time talking to residents and ensuring their needs are being met by the staff. More specifically, the expert by experience was asked to observe any activities that were going on in the home on the day of the visit and to share lunch with the residents. This is an overview of the findings by the expert by experience. The home was clean, quite well decorated and odor free and most of the residents were sitting in the lounge or the conservatory. Care Homes for Older People Page 16 of 30 Evidence: I spoke to four residents who were sitting together who all expressed their individual views on living at the home and they ranged from I really hope I can stay here, I love it, we seem to get on so well together, the staff are so kind and our daily papers are obtained by the staff and then we share them among ourselves to If I cannot stay in my own home then this is the next best thing. The gardens both at the front and the rear of the property were well maintained and full of bright coloured flowers. The grassed area at the rear of the property was quite well kept and there was a patio area with garden furniture available. The residents obviously appreciated the garden and can be quoted as saying we can use the garden when we want to, and I like being out there in the summer and I saw one member of staff picking flowers for a resident because it was her birthday and it was felt it would be nice if she had flowers in her room. I visited some clients in their rooms and noticed that they had all been encouraged to personalise their bedrooms with pictures, ornaments and pieces of furniture. I also took the opportunity of pressing a call button although the resident in the room was a little bit concerned that the staff are always so busy and now its nearly lunch time they may not come so quickly. However, this proved not to be the case and a staff member responded to the bell quite quickly. The resident did say she did not like to call the staff because she knew they were busy. I did notice that one of the residents, who was being assisted by a member of staff, had a bedroom door that seemed to be very slow to close and it was possible to see her walking across her bedroom in her underwear thereby not maintaining her dignity. The carer attending to her seemed unaware of this situation. However, on a more positive note, I witnessed members of staff knocking on residents doors before entering thereby showing an awareness of and a respect for the residents privacy. I spoke to one lady who was visiting her mother in law and was told that the home does their very best, the residents do go out on trips occasionally, we are pleased with the home and the staff are very kind and caring. I found an activities list on the wall but the activities timetabled for the day did not match what the residents were being offered. Everyone was being encouraged to join in with a gentle chair exercise session and several seemed quite happy to participate. However it must be said that the member of staff taking the session was very enthusiastic and it appeared to be much more like an aerobic class, even though the residents were sitting down, than gentle chair exercises. I was a little concerned Care Homes for Older People Page 17 of 30 Evidence: about what the residents were being asked to do and probably as a direct result of this the participants of the class seemed to give up before it had finished. I visited the kitchen and was advised that the home has a four week revolving menu but did note that, for the most part there was only one choice for lunch. I was advised that the residents could have an alternative if they asked and that currently there were no vegetarians. The expert by experience joined people for lunch and sat with five residents. Noboby appeared to remember what was for lunch so were told it was steak and kidney pie but the expert by experience had asked for an ommellette. Residents expressed to the expert by experience that they were unaware that they were allowed to ask for something different. An alternative meal is not advertised on the daily menu board and service users do not appear to realise that there is an alternative available.This was an area that was identified during the previous inspection, however the home has not addressed this issue. The home should ensure they have systems in place to provide service users with the information they need about the choice of meals available and this needs to be addressed. After lunch I revisited three residents who choose to spend the majority of their time in their rooms and again was advised lunch just turns up and I never know what it will be its usually good but I dont have a choice. This confirmed the information I had been given over lunch. One resident who spends a lot of time in her room was happy with the care she was given and it was nice to see that after lunch she had been encouraged to spend some time outside on the veranda in the fresh air. The expert by experience concluded, The pleasant comfortable atmosphere which exists within this home can only enhance the wellbeing of its residents and it was apparent that this was a home with a heart and that the residents showed concern for each other. The owner and the Operational Manager seem to be aware of which areas need improving, one being the menu at lunchtime, and appear to be working together and taking positive steps to ensure that changes are made which, in turn, will reflect on the quality of life for the residents. The manager has sent information about the homes planned activity programme that is due to commence at the beginning of May. Care Homes for Older People Page 18 of 30 Evidence: This shows that the staff rota has been adjusted to allow staff to complete key worker responsibilities and can complete one to one sessions with key clients. The change of hours will give the home a staff cross over period of one and a half hours so the home can offer more activities to include community activities. The home has obtained feedback from service users by the All about me booklet and individual discussions held with service users. The home has planned to have a new/updated timetable of activities in place from 3rd May and have said they intend to organise group community activities developing a booking system that individuals and or family/key workers are encouraged to use to allocate their interest, such as theatre trips, seaside, swimming, Garden centre , pub, hairdresser and aromatherapist visits. This will be assessed in more depth at the next key inspection. Care Homes for Older People Page 19 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a safeguarding vulnerable adults and a complaints procedure to ensure that people can be protected from harm and people are able to raise their concerns and action taken to put things right. However, the home needs to ensure a record of all complaints received by the home to ensure the views are listened to. Evidence: At the previous inspection it was identified that the complaints log was found to be disorganised and it was difficult to fully assess the number of complaints received by the home. Separate letters and pieces of paper were placed loosely in a file and for some of the complaints there was no evidence of the action taken and the outcome of the complaint. A requirement was issued for improvement. The recording of complaints was examined during this visit. The home does not have a complaints log. However the home has introduced a new complaints recording form. One complaint was seen recorded on the new form. This was well recorded and included the action taken and the outcome. However, there was no evidence of a complaint received from relatives who made this complaint during a previous visit whilst the inspector was present. The complaints folder remains disorganised and pieces of paper were placed loosely in a file. Procedures are in place for safeguarding vulnerable adults (SOVA) and staff have access to a whistle blowing policy. The home has a copy of the local authority SOVA Care Homes for Older People Page 20 of 30 Evidence: policy. Training records demonstrate that staff have completed Safeguarding training and this is regularly updated. The Annual Quality Assurance Assessment tells us that the home has not had any safeguarding referrals or investigations. However the Care Quality as been notified of three safeguarding investigations. The home must ensure they keep the Care Quality Commission informed of all safeguarding incidents in the home. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: Chilworth House is a care home providing personal care and accommodation for 29 older people. The home is situated in High Wycombe and is a short drive away from the amenities that a large town can offer. The home has two lounges and a bright, spacious conservatory. These are well maintained and nicely decorated, bright and cheerful. There are personal touches around the home such as flowers, pictures, books and mirrors. Dining takes place in the conservatory and a further room attached to the main lounge. There are accessible toilets available for residents, throughout the home and close to each lounge. One comment received from a relative informs us, My relatives room is not always as clean as it could be, there is not enough dusting and hoovering. Care Homes for Older People Page 22 of 30 Evidence: All bedrooms seen are individualised and some contain their own items of furniture, personal possessions, leisure items including televisions, radios, and books. The inspector observed that hand washing facilities were available and also disinfectant hand rub was located throughout the home in order to promote safe practice in regard to infection control. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The Annual Quality Assurance Assessment tells us that all care staff have completed Infection Control training. The inspector was informed that the home are planning to add an extension to the home to increase the size of the laundry and provide improved disabled access to the home. Care Homes for Older People Page 23 of 30 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. The staffing numbers and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are competent to do their job. The management of the recruitment practices have improved to help make sure service users are not being put at risk. Evidence: The homes staff rota demonstrates that there are adequate numbers of staff on duty to ensure peoples needs are met. Comments received in returned surveys inform us, They are trying to bring in a new care plan but there doesnt seem enough permanent staff to implement it at the moment. We hope things will improve as my relative likes living there and the staff do their best sometimes under difficult circumstances and The home uses agency staff and it would be better if they had enough permanent staff as they do get to know the residents better. The staff rota shows that five staff are on duty in the morning and four care staff in the afternoon with the present acting manager extra to these numbers. This was the case on both days of the inspection. The acting manager said the home has just recruited two new care staff so the home has no vacancies at this time. Two further comments received tell us, Most of the staff have been there some time and there is good continuity of staff which is helpful for the residents and the staff work hard and meet my relatives needs. Most of the staff have been working in the home for many Care Homes for Older People Page 24 of 30 Evidence: years and know my relative well. The Annual Quality Assurance Assessment tells us that out of eighteen care staff ten have achieved a National Vocational Qualification level 2 or above and two are in the process of completing this. At the previous inspection poor recruitment practices were identified and a requirement was issued for evidence of all recruitment checks for staff to be available for inspection purposes. During this inspection six staff recruitment files were examined. Four files contained all the employment checks required. In two files for the people new to the service references were not in the files. The inspector was informed that staff files were being transferred to a new location and the references may still be in the previous office. These were located during the inspection. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the files examined. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that staff are up to date with their mandatory training. There is specialist training available for staff, and an example of this is feeding and nutrition in the older person, communication skills and effective team building and care of aging skin and prevention of pressure sores. Care Homes for Older People Page 25 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A change in the management of the home has resulted in improved working practices which need to be maintained, however an application to register a manager must be submitted to the Care Quality Commission. Evidence: At the time of this inspection there was no registered manager in place. An Operational manager has been employed at the home since January 2010 to make improvements to practices in the home. In the absence of a registered manager, the Operational manager has been acting as manager for the home. The registered provider has been reminded that the home must apply to register a manager for the home with the Care Quality Commission. Comments received about the present management system tells us, Things have improved since the new manager took over and I think things are better following a change of manager, plus the owner has been more directly involved. Care Homes for Older People Page 26 of 30 Evidence: There is a suggestion box in the home for staff and relatives to volunteer suggestions on how the service could be improved. The Operational manager said that the satisfaction questionnaire was presently being improved before being sent out to service users and representatives. It is expected these will be sent out before the end of April 2010. There is a health and safety policy in place and health and safety training is completed and up to date for all staff. Records were seen for fire safety. These cover the homes fire procedures, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment that is reviewed annually. The Annual Quality Assurance Assessment tells us that service reports are in place for Portable Appliance testing, gas appliances and electrical installation. Care Homes for Older People Page 27 of 30 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 28 of 30 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 Arrangements must be in place for the recording, handling, safekeeping, safe administration and disposal of medicines. To ensure service users are protected by the homes medication practices. 30/04/2010 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 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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