Care Home: Chollacott House Nursing Home

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What the care home does well What has improved since the last inspection? Care plans now contain all the information necessary to inform staff what people need and want and how they are to provide assistance and care to meet those goals. People`s person items of clothing is now better cared for. People are now protected from hazards, such as access to medicines that would harm if taken, unclean bedpans and sluice area and poor separation of soiled from clean laundry. What the care home could do better: Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. People arriving at the home should always be able to make their arrival known. A bell or intercom system is needed.Chollacott House Nursing HomeDS0000064645.V376498.R01.S.doc Version 5.2 The home must inform the Commission of all events which affect the wellbeing of people who use the service, including any pressure sore. Key inspection report CARE HOMES FOR OLDER PEOPLE Chollacott House Nursing Home 61 Whitchurch Road Whitchurch Tavistock Devon PL19 9BD Lead Inspector Anita Sutcliffe Key Unannounced Inspection 14th July 2009 09:30 DS0000064645.V376498.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chollacott House Nursing Home Address 61 Whitchurch Road Whitchurch Tavistock Devon PL19 9BD 01822 612811 01822 614076 chollacott@stone-haven.co.uk WWW.stone-haven.co.uk Stonehaven (Healthcare) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robert Edward Rotchell Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31), Physical disability (31) of places Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) 2. Physical disability (Code PD) The maximum number of service users who can be accommodated is 31 12th July 2008 Date of last inspection Brief Description of the Service: Chollacott House is a large Edwardian building near to the market town of Tavistock. The home is registered to provide nursing care to a maximum of 31 people who may have a physical disability. The home has been under the ownership of Stonehaven (Healthcare) Ltd since October 2005. The accommodation is presented on two floors accessed via a passenger lift; there is level access throughout the building; there are 25 single rooms and 3 double rooms. There is a large dining and lounge conservatory area leading on to a further smaller lounge, all on ground floor level. There is a café area and a hairdressing room. Information about the home was found in the entrance hall and is available for people to take away. There is also a web site. Both include all recent reports on the home and much other information pertaining to the service. The current range of fees is from £480 to £800 a week. This relates to ‘private residential and nursing fees’. An additional fee is made for: Hairdressing, chiropody and any other health care professional visiting privately, a fee to accompany a person to hospital visits, trips away from the home, phone calls, stamps and stationery, newspapers, clothing, toilet requisites and items of luxury or of a personal nature. General information about fees and fair terms of contracts can be accessed from the Office of Fair Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 5 Trading web site at http:/www.oft.gov.uk . Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Information about Chollacott has been collected towards this inspection since the last key inspection July 2008. This key inspection included two unannounced visits the home, one during an evening. Surveys were sent to people who use the service, staff and health care professionals. Very few were returned from people living at the home. The information sent to us each year by the care provider gave us some numerical information about the service, such as how many people are resident and how many staff employed. It also gave the home the opportunity to tell us what they believe they do well, barriers to improvement and improvements they have planned. As part of the visit to the home we looked at all communal areas, and several bedrooms. We spoke with several people who use the service and observed staff going about their work. We also asked the community nursing service for their opinion on the home. We talked to several people using the service, and asked staff about those people’s needs. We also looked at the care plans, medical records and daily notes for some people. This is called case tracking. Since the last key inspection was completed on the 12th July 2008 a Random Inspection was carried out on 4th December to look at compliance with unmet regulations identified when we did our key inspection. The Random Inspection report is not published but is available on request from the Commission. Reference to the findings of the Random Inspection is made within this report. People who use the service may be described within this report as patients, residents, clients or service users. What the service does well: The organisation ensures that there is a lot of information available for people about the home. Before people are admitted an assessment of their needs is undertaken and their care is planned. Staff are informed about people’s physical, emotional and social needs and how to meet them. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 7 The standard of care and health provision ensures that people’s health and wellbeing is optimised. The home provides end of life care in a thoughtful and professional way. A Macmillan nurse told us: “Great improvement since Rob’s become manager.” A district nurse said: “The home’s really pulled itself up”. An enthusiastic approach to activities at the home now provides people with more opportunity to lead fulfilled lives and relieve boredom or isolation. Meals are enjoyed at Chollacott and dietary needs are met. People are protected from abuse and the home is keen to hear their views and prevent the need for complaint. The home environment is clean, fresh, now well maintained and more interesting. There has been continual upgrading and improvement including a ‘café’ where people can socialise with family. Staff have the equipment and protective clothing they need to ensure needs are met safely. Staff are properly recruited, trained and supervised. Staff work hard to provide a good level of care and are enthusiastic about their work. There are sufficient levels of staff available now but this has to be continued. Staff have good management and leadership. The home is well run in people’s best interests. Quality is closely monitored and health and safety needs are met. What has improved since the last inspection? What they could do better: Before people are admitted the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person working on their behalf. This information is required so that people who are unable to make their needs known are properly represented and their rights protected in law. People arriving at the home should always be able to make their arrival known. A bell or intercom system is needed. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 8 The home must inform the Commission of all events which affect the wellbeing of people who use the service, including any pressure sore. 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. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Standard 6 does not apply as Chollacott does not provider Intermediate Care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well informed about the home and their needs are assessed and understood prior to admission. EVIDENCE: We looked at the arrangements for admitting new people to Chollacott. The written information, which should inform people about the service on offer so they can make a decision as to whether the home will suit them and meet their needs or not, is well displayed at the entrance of the home. On this occasion the information was up to date and informative. This had been a Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 11 previous requirement. There is also a web site containing a lot of information on the service. We looked at how the home undertook the admission of the last person to move there. Their needs had been assessed by the home’s manager, who said he always visits himself unless on holiday. Pre assessment and assessment information was comprehensive and included care, nursing, social and emotional needs. Nursing tools had been used to assess risks, such as falls, pressure sores and moving and handling. There was also information available to the home from the hospital from which they moved. We saw that the home had written to the person confirming that, following the assessment, the home is able to meet their needs. This protects both the person and the home. We visited the person and saw, in their room, a plan of how their needs were to be met. We asked a member of staff if they knew the needs of the person and what care they were to provide. They were able to describe those needs in detail; they knew how to care for them. We were unable to hold a conversation with the person but they looked comfortable and well cared for. Their room was large enough for specialist equipment they needed and was fresh and clean. We looked for information relevant to the recent legislation which protects vulnerable adults. We found that people are asked whether they have made an advanced decision (living will), but as yet there is no record of whether people have a Lasting Power of Attorney, Independent Mental Capacity Advocate or Relevant Person. This information is required so that people who unable to make their needs known are properly represented and their rights protected in law. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s health care needs are well met. EVIDENCE: We looked closely at the care of two people who use the service, spoke with two others and received information from health and social care professionals who know the home. At the Random Inspection December 2008 we found that the assessment and care planning records of the last two people admitted were not fully completed. Care plans should inform staff how to provide the care that a person needs and wants. At this inspection we saw that the plans describe the person as a whole, therefore including all aspects of their needs, such as emotional and social, not just physical care and nursing needs. They contained some very good detail, for example, about the equipment necessary to move a person Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 13 safely. The plans were reviewed monthly, or as necessary as their needs changed. Most care plans are kept in the person’s room and care staff told us that they do refer to them. The three staff who returned surveys told us they are usually given up to date information about the needs of people. One, asked what the home does best, said: “The nursing care and time spent on individuals.” The standard of personal care provided appeared to be good. People looked well cared for. We asked one person about this and she said it was always the case. One person has developed a pressure sore at the home since the previous key inspection. We discussed this with the manager who told us that preventing pressure sores is: “a matter of vigilance”. There has been a lot of investment in pressure relieving equipment, including specialist mattresses and electric nursing beds. We saw that people receive health care from outside agencies when needed. These include optician, podiatry and tissue viability specialists. A district nurse with knowledge of the home told us: “The home has really pulled itself up”. A senior care assistant said: “There had been a good improvement in care”. The home uses a specific approach when providing end of life care, which optimises the person’s care and comfort. We found that staff had received training in the method and were able to describe it. A cancer specialist nurse said: “The home identifies individual needs, supports patients at end of life. They are willing to take on new learning and take advice when uncertain. They demonstrate good care for the patients”. People’s family are able to stop at the home when their health deteriorates. We looked at how the home manages medicines for people. We found that they were kept securely and under the required conditions. The clear and complete records meant that each medicine could be fully accounted for. We looked at whether medicines described to be given ‘as necessary’ or ‘as required’ were part of care planning so that staff can be consistent in their use. We found that they are not yet part of the care plan and discussed the need for this with the manager. A person told us he is treated with respect. The home has no shared rooms at this time so all personal care is fully private. Staff appeared kind and respectful to people and knocked before entering their room. We saw several letters from people thanking the home for the care provided. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 14 Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead fulfilled lives within their capabilities but vigilance is needed to prevent boredom. EVIDENCE: At the Random Inspection December 2008 we found that care plans did not show that people were consulted about their interests and whether arrangements had been made to enable them to engage in local, social and community activities as they wish. This visit there was person centred information in people’s assessment and care records. This included emotional needs and personal history where this was relevant to them and would help staff plan appropriate care in those areas. The one person who responded to survey told us they usually have activities available that they can take part in. Another told us he always likes to go to the lounge for what activity is arranged. However, staff told us: “Not enough for them to do when sitting in the day room” and “There should be more time Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 16 given to activities to prevent boredom. This would also lead to constant monitoring in the lounge and conservatory”. A health care professional said: “Increased staffing levels would enable more time to allow staff to spend time with people”. We met the home’s activities worker, who was enthusiastic about her work. There is a list of shared activities displayed at the home. Some people have one to one individual time, for example, reading to them. We saw many photographs of recent activities and thank you cards from family who are included and involved in activities at the home. These events have included ‘Jazz on the lawn’ and cream teas. We were told that arranged activities are usually held in the afternoon and include: bingo, quizzes, music and movement, arts and crafts, sing along and reminiscence. People now benefit from a ‘coffee shop’ which is a kitchenette facility with café style tables. It is in one corner of the lounge, attractive and available for people and their family to use as they wish. There is also a new hairdressing salon and the manager told us that the home’s own transport will be available to people in the near future. We saw that people’s rooms are very individual to them. The gardens appeared attractive, well tended and accessible for use. The home works hard to involve people’s family in activities. However, when we arrived at 9:30 pm the front door was locked and there was no way of alerting staff that we were there; no bell or other arrangements in place. Clearly, people who wish to visit must be able to do so. This needs to be addressed. At the Random Inspection December 2008 we saw that the menu was more varied and offered more choice than previously. The one person who responded to survey for this inspection said they always liked the food. One person told us about the variety of foods available and how much he likes it. The manager reports that the Head Cook has attended an Advanced Food Hygeine course at Exeter University. We saw that the menu is varied. There is always a choice and if that is not wanted the cook has additional meals available. We heard her asking people what they want to eat and the menu for the day is displayed on a notice board in the dining room/lounge. We were told by one person that they can get up and go to bed when they want. However, staff feel this isn’t always the case at bedtime due to a lack of time. During our evening visit we found staff extremely busy trying to get people to bed as they requested. (See the outcome called Staffing). Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 17 The home reports that they intend to: • To continue with the comprehensive activities programme. • To continue to encourage the outside world to come to Chollacott House by ensuring that they have a positive experience whilst with us. • To implement the mini bus and outings. • To continue to seek feedback on meals and menus and adjust as per that feedback. • To ensure that our residents have constant opportunity to let us know what their choices are and for us to help them to achieve those choices. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected through the home’s complaints and safeguarding arrangements. EVIDENCE: We saw that the home’s complaints policy is in the Service User Guide and displayed around the home. It contains up to date contact details for the Commission and the provider organisation. The providers are very keen to get opinion of the service. To this end there is a ‘commendations and concerns’ book by the entrance to the home. The manager reports that they have received no formal complaints and there have been no complaints about the service received by the Commission. We asked the Manager to describe the correct procedure for responding to a concern which might be abuse and he was able to do so. He told us of how the home supported somebody to leave and return to their own home. Staff receive training in how to safeguard people from abuse. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 19 We asked a person if they felt safe at the home and they said yes. There have been no safeguarding alerts relating to Chollacott which could have indicated abuse. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment meets the needs of people who live at the home. EVIDENCE: In June 2008 there was an application to increase the registered numbers of people at the home with the additional of 3 single bedrooms. The home is registered for three double/shared rooms but we were told these would never be used unless people made a positive choice to share. We visited the building twice and on both occasions it was clean and fresh. The kitchen cleanliness was improved and the laundry was also clean. There had been previous issues with the standard of cleanliness of equipment in use at Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 21 the home but this had been addressed by the Random Inspection December 2008. The home is well decorated, domestic and yet functional as a nursing home. There are hand rails to help people with poor mobility and some pictorial signage to help people find their way around. The home is registered for people with nursing needs who may also have a physical disability. We asked staff if they have the equipment they need. They said it was of a very good standard and much is new. We saw specialist nursing beds and pressure relieving mattresses in use, which promote the health of people needing nursing care. All of the lounge chairs are new, including two sofas. Staff have the personal protective clothing they need, such as gloves and aprons. All areas have a staff hand washing facility, paper towels and gel. There was a notice for people regarding the swine flu epidemic. The laundry system has been improved with the introduction of colour coding to inform staff of the level of risk. In addition, there is a non touch method for handling soiled laundry and a new efficient washing machine. We saw that people’s laundry is now better cared for. People now have a ‘coffee shop’ and hairdressing room available to them. There are large cooling fans for people for when it is hot in the lounge. Bedrooms look individual and comfortable and all equipment was clean. One staff told us: “Cleanliness has improved.” A person using the service said: “The home is always fresh and clean.” A new member of staff told us she has been told she must keep washing her hands. We were told the home has the required fire risk assessment. However, during the evening visit we saw a gap in two sets of fire doors. The manager was able to provide evidence that this had already been noted and was being corrected. The manager reports these improvements: • Redecoration and refurbishment extensively. • Maintenace program up to date. • Additional Housekeeping and Laundry hours implemented. • Upgraded cleaning products introduced. • New fans installed in Conservatory and Lounge area. • Sluices upgraded. • Secure storage for cleaning materials implemented. • New laundry equipment purchased. • New infection control system implemented. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 22 Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff which is properly recruited, trained and now in sufficient numbers to meet their needs. EVIDENCE: The manager reports that: • We have a full staff team and maintain this by recruiting all of the time, as good people come along we make a place for them. • Staff numbers on duty has increased. • All staff undergo extensive training programs. • We have a company training policy that clearly details the mandatory courses for all team members, each team member is measured against this and we can see what training has been done and what is outstanding. Training is listed in the statement of purpose to enable prospective residents to compare our home to others on this key topic. • We provide ad hoc training as needs arise. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 24 Our first visit to the home was 9:30 pm. There were 28 people resident at the time. We found one nurse, one senior carer and one person new to care on duty. They were very busy getting people ready for bed and attending to other needs. We were told that this ‘twilight’ shift is new to the home, having been “promised for along time”. Those evening staff told us: “Previously people might not have been in bed before midnight regardless of when they wanted to go, sometimes it has been desperate”. During our visit, despite the third staff on duty, one person was still up at nearly 11 pm and asking for assistance to go to bed. However, staff, asked about the adequacy of staff at the home said: “Fine, they (the management) really have addressed that”. Staff told us that staff induction was “very thorough”. A new carer at the home told us how she shadowed an experienced carer when new and is totally satisfied with the induction she received. Staff spoke in detail about the training they receive and that they are encouraged to undertake qualifications in care. Training has included all aspects of health and safety, safeguarding vulnerable adults from abuse, diet, end of life care and specialist feeding”. However, one added, with regard to moving and handling training: “A little bit more in depth might be useful”. Staff appeared to be skilled and knowledgeable in their work. At the Random Inspection 2008 we looked at the records of the last three care staff employed and found the required recruitment checks had been completed and so staff recruitment protected people at the home. The manager now comfirms that the recruitment processes continue to be robust and says: “We ensure all care team members complete a standard application form, have an interview, have POVA and CRB checks, that 2 references are obtained and all records are kept for future reference”. We found this to be the case when we visited and examined staff records. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run efficiently and with good outcomes for people who use the service. EVIDENCE: The current manager, Mr Robert Rotchell, is a qualified Registered Mental Nurse and Registered General Nurse. He is also been a Community Psychiatric Nurse. He has demonstrated to the Commission that he is qualified to run this care home and that he understands his responsibilities. Mr. Rotchell spoke with clarity about his role as manager and described his further planned Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 26 improvements and told us that he has commenced a training course on, Leadership and Management. Asked about the home’s manager staff told us: “Good management. He runs the home lightly but will tell you what he wants. He knows exactly what he wants. The home is very, very good at this minute”. People who use the service told us he is very helpful. A district nurse told us: “The home has really pulled itself up. Rob really seems to know what he is doing.” A Macmillan nurse said: “Great improvement since Rob’s become manager.” We found at the Random Inspection 2008 that a lack of nursing staff was impacting on the time which is required to manage the home. This difficulty appears to have been overcome and Mr. Rotchell is fulfilling his management role well. We looked at the attitudes and spirit of the home. A new member of the care staff told us: “The staff actually do care” and talked of the good team work and the support she has received. We saw that staff were working together and well led. We looked at how the quality of the service is monitored. A company director visits once a month for the required unannounced visit to look at the standard of service provided. There is a Quality Assurance Programme that consists of: ‘annual audit, 6 monthly audit, quarterly audit, monthly audit and weekly audit’. This is sent to Directors, we are told: “so that any concerns etc are raised to all necessary parties”. People are encouraged to provide opinion on the service; a compliments and complaints book is at the entrance to the home for this purpose. The home reports that they only handle small amounts of people’s monies on site and in a secure way. Each person has a lockable cupboard in their own room for valuables. The company provides insurance up to £500.00 for people’s possessions and “pocket monies”. We looked at whether the home was up to date on legislation which protects vulnerable people who do not have capacity to make judgements relate to their safety. We found that steps had been taken to understand the Mental Capacity Act deprivation of liberty safeguards and the home has the codes of practice in place for reference. They report that, to date, they have not needed to make application for this. We looked at whether the home provides the required information about the service to the Commission. In doing so they are further protecting the people in their care. Although we are notified of events, to date this has not included where a person has developed a pressure sore as it must. Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 27 Staff told us that they receive supervision of their work and the home reports: ‘We have a bi-monthly staff supervision system, generally each team member has a book of two years worth of supervisions. These are carried out by the Manager or Clinical Lead or Administrator as per a set rota’. We saw no concerns regarding health and safety and all areas that might pose a risk to people, such as medicines and cleaning chemicals were kept behind locked doors. Staff receive the required health and safety training and the manager reports: ‘We ensure all regular maintenance is undertaken by qualified professionals, i.e. Annual Fire Risk Assessment, Fire Extinguishers, Fire Alarm, Emergency Lighting systems, Gas Installations, PAT tests, 5 year fixed wiring tests, Legionella controls and tests, Asbestos surveys, Lolar test of lifting equipment etc all carried out and any remedial actions taken as necessary.’ Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP33 Regulation 37 Requirement The home must notify the Commission if a person develops a pressure sore. Timescale for action 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations As part of people’s assessment the home should ascertain whether they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Person acting on their behalf to protect their interests. People arriving at the home should always be able to make their arrival known without delay. 2. OP13 Chollacott House Nursing Home DS0000064645.V376498.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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