Care Home: Churchfield Care Centre

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What the care home does well Staff were well trained including a good induction programme. Staff spoken with were skilled and knowledgeable. People spoken with were very positive about staff. One person said, "Staff are brilliant" another person described staff as ""good people". A visitor spoken with said that staff were, "very caring when dealing with service users". The manager and management team communicated a clear sense of direction and strived to continually improve the service provided. There were effective quality assurance systems with regular audits being undertaken by the manager and the operations manager who oversaw the service. People`s individual bedrooms were generally spacious with good-quality furniture provided and people were encouraged to personalise their rooms. People were encouraged to express any ideas, concerns and complaints and these were recorded, including any action taken. Activities were generally good, particularly within the nursing/residential unit and regular outings were arranged. The manager and staff were very aware of the importance of treating people with respect and upholding people`s right to privacy. There were safe systems for managing medication. People`s health, personal and social care needs were set out in a detailed plan of care that focused on each person as an individual. What has improved since the last inspection? The outside areas on both units had been improved with the use of a grant. This included a new decking area for the dementia unit and raised planters in this and other areas. Staff had received training in person centred planning and had worked hard to improve people`s documentation that was now more person centred. Meals had improved with a new system that ensured that menus were nutritionally balanced. One persons spoken with said that, "food did not used to be good in the past but it now has better presentation and quality". Staff numbers had increased at night on the dementia unit to ensure that people were safe. The number of hours provided for activities had been increased from 30-45 hours between the two units. Domestic hours had also increased by 20 hours between the two units, which had improved cleanliness of the service. The relative support group held on a bi-monthly basis by the community psychiatric nurse was very popular. What the care home could do better: There were several issues of concern with the environment on the dementia unit. This included an unsecured lift door that people were accessing unsupervised in an unsafe way. Several areas around the home were in need of re-decoration and the main bathroom required refurbishment to improve the bathing facilities. The toilet and bathroom areas smelt of urine. It was explained that this was likely to be due to urine seeping under the flooring rather than lack of basic cleanliness. There were also several areas of concern regarding poor access on both units. This included inadequate ramp facilities and steps leading up to the main entrance on the dementia unit that were potentially unsafe. There was insufficient signage to assist people with dementia to orientate around the home, causing unnecessary confusion and anxiety. Staffing levels on the dementia unit in the day time did not always meet the needs of people living there. There was a lack of adequate supervision of people, causing a high number of accidents and incidents. Although activities were provided on both units, on the dementia unit activities could have been improved. CARE HOMES FOR OLDER PEOPLE Churchfield Care Centre Churchfield Drive Rainworth Nottinghamshire NG21 0BJ Lead Inspector Jill Wells Unannounced Inspection 29th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchfield Care Centre Address Churchfield Drive Rainworth Nottinghamshire NG21 0BJ 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) 01623 490109 01623 795060 www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Vacant Care Home 60 Category(ies) of Dementia (21), Dementia - over 65 years of age registration, with number (21), Old age, not falling within any other of places category (60) Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Southern Cross Care Homes No2 Limited is registered to provide accommodation and personal care at Churchfield Care Centre for persons of both sexes whose primary needs fall within the following categories:Old age, not falling into any other category (OP) 60. Dementia aged 55 to 65 (DE) 21. Dementia over 65 (DE(E)) 21. Within the maximum number of 60 people, the following have been agreed :i) Up to 5 service users in the category of OP, over the age of 60 years (under 65 years) ii) Only service users in the category of OP are to be admitted to the residential unit (Cedar Grove). Iii) Service users falling within the category of Dementia aged 55 years and above can be admitted to the part of the home known as Pine Tree Lodge. Iv) One person aged 55 years named in application dated August 2006 may be admitted for nursing care. Date of last inspection 16th June 2006 2. Brief Description of the Service: Churchfield Care Centre, situated within the mining community at Rainworth, close to local amenities, provides care within two separate units. The grounds surrounding these units are extensively landscaped and surrounded by large, mature trees. There is car parking and also extensive garden areas for people to use during the warmer weather. The first unit provides up to 21 places for people with dementia. The nursing/residential unit provides up to 37 places for older people. People living in the dementia unit with nursing needs arising from their dementia cannot be admitted to the nursing unit. Fees within the centre range from £295 through to £539 depending on whether their needs are for dementia care, residential care, nursing needs and whether a person is self-funding. These do not include hairdressing, newspapers private chiropody, visits from a physiotherapist, aromatherapist or other alternative Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 5 therapies. These additional fees are clearly stated in the home’s service user guide. Churchfield Care Centre DS0000024635.V369123.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 the service is two star. This means the people who use the service experience good quality outcomes. The inspection visit was unannounced and took place with two inspectors over 8 hours. There were 44 people living at the home on the day of the inspection. 20 people in the dementia unit, 14 people being provided with nursing care and 10 people being provided with personal care only. 10 Residents, 6 staff, 4 visitors, and the manager were spoken with during the visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. We also looked at all the information that we have received, or asked for, since the last key inspection on the 16 June 2006. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service after the inspection visit. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. • What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. • The previous key inspection report • The previous annual service review (ASR) completed by us 22nd January 2008. The ASR is a report written after a review of all the information that we have received. Completed surveys from people living at the home, staff, relatives and professionals that visit received after the inspection visit. Records were examined, including care records, staff records, maintenance, and health and safety records. A tour of the building was carried out. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? The outside areas on both units had been improved with the use of a grant. This included a new decking area for the dementia unit and raised planters in this and other areas. Staff had received training in person centred planning and had worked hard to improve peoples documentation that was now more person centred. Meals had improved with a new system that ensured that menus were nutritionally balanced. One persons spoken with said that, food did not used to be good in the past but it now has better presentation and quality. Staff numbers had increased at night on the dementia unit to ensure that people were safe. The number of hours provided for activities had been increased from 30-45 hours between the two units. Domestic hours had also increased by 20 hours between the two units, which had improved cleanliness of the service. The relative support group held on a bi-monthly basis by the community psychiatric nurse was very popular. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Churchfield Care Centre DS0000024635.V369123.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 Churchfield Care Centre DS0000024635.V369123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. EVIDENCE: The statement of purpose and service user guide were available for prospective people wishing to live at the home. These documents provided all the information that was necessary. The service user guide was also in bedrooms. Prospective residents or their family and friends were encouraged to visit prior to making a decision about whether the home will meet their needs. A relative of a person recently admitted to the home was spoken with and said that they did not recall the service user guide but had a leaflet about the home. Another relative said that at such a stressful time any information Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 11 given was often quickly forgotten. Another relative that was spoken with described how they had been given a lot of information and advice when they first looked around and were given an information pack that was useful. Copies of assessments carried were seen on peoples records. These were detailed and included information concerning each persons health and personal care needs, social interests, relevant history and family involvement. The home does not provide formal intermediate care and therefore standard 6 was not assessed. Churchfield Care Centre DS0000024635.V369123.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples health and personal care needs are met and the principles of respect, dignity and privacy are put into practice. EVIDENCE: The care records of 8 people living at the home were seen. The care plans were written in a person centred way. There was a personal preferences plan for each person which stated for example preferred time to get up and have breakfast and things people liked and disliked. One person’s plan said that they disliked being on their own and liked to watch activities rather than take part. Records included individuals life history, hobbies and interests, as well as information about their health. They were written in plain language, and were easy to understand. The manager told us that the great deal of work had been done on these records to ensure that they were person centred. There was not a record of each persons consent to care plans in every case however some people had signed some of the documentation, which showed their Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 13 involvement. One person spoken with said that they have looked at their own care files once and had been told that they could see them whenever they wanted to. Individual records also included moving and handling plans, falls risk assessment, nutritional assessment and tissue viability risk trigger tools. Peoples weight was monitored and appropriate action taken if a person significantly lost or gained weight. Care plans had been reviewed and updated on a regular basis. They were available for care staff to read to ensure that they were aware of each persons needs, however a care worker spoken with said that they had not had time to read care plans but they could give details of individual care required. Records, staff and people living at the home were all able to confirm that GPs and other health professionals were contacted and visited when required. A relative spoken with said that they had been telephoned about their relative refusing medication and the GP being called. They were then told that they would be contacted after the GP visit. They were pleased that staff had quickly called a GP. One person spoken with said that they had, terrible bed sores in hospital but the home got them better There were two separate medication systems, one for each building. Medication in the home was stored securely. Either the team leader or a senior carer administered medication on the dementia unit and nurses on the nursing unit. Staff had received medication training. The medication administration records were generally in good order apart from on the dementia unit there were some gaps where staff had not recorded whether medication had been administered. An audit trail was attempted but it was not possible to conclude whether this medication had been given, refused or returned to the pharmacist. There was a locked fridge for medication that required refrigeration. There were photographs in place of individuals, however one person that had been at the home for four weeks did not have a photograph to assist staff to easily recognise them. Although the temperature in the medication room on the dementia unit was being monitored, this was being done at the coolest times of the day and records did not show high temperatures. On the day of the inspection visit the room temperature with the window fully open was 29°C, which was over the required temperature for storage of medication. It was likely that this room had been at a similar temperature on previous days. People spoken with said that were treated with respect by staff. One person said, Staff would almost always knock before they came into bedrooms unless they were really worried about you. Another person said that, “staff don t disturb you when you are having a rest which I like” Staff were observed treating people in a dignified way. The manager told us in our annual quality assurance assessment (AQAA) that the home uses ‘Liverpool Care Pathways’ to support people that are terminally ill and staff receive training in palliative care. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities and standard of meals offered was good, which met the needs and wishes of people living at the home, although activities could be improved on the dementia unit. EVIDENCE: There was a wide range of activities that people could be involved with. This included painting, flower arranging, embroidery, sketching, board games, baking and gardening. The manager told us that activity time had been increased from 30 hours to 45 hours per week between both units, although one person from the nursing care unit wrote in our survey, “I find the day very boring because there are not activities every day”. On the day of the inspection visit there were people from the nursing/residential unit making key rings ready for the summer fayre. However although the hairdresser and nail care was planned on the dementia unit, this did not occur due to a communication error. Records were kept of activities offered. On the dementia unit there were often 5-7 days in individual records where no activities had Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 15 been recorded. The notice board on the dementia unit showed a regular art and craft day, pet day where two dogs came into the home and a regular visit to the local church coffee morning for 2-3 residents. Several people living on this unit said that they were bored and under stimulated. The homes statement of purpose says that, service users can expect to receive therapeutic interventions that will include, reminiscence therapy, life story building, reality orientation and simulated presence therapy. There was little evidence of this being provided although the team leader explained that life story building had been done for three people and there was usually a reality orientation board, recently taken down that was due to be replaced. The manager and team leader were not aware what was meant by, simulated presence therapy. There were regular visits by staff from the local older persons mental health team who would spend some time with individuals and advised staff concerning challenging behaviour. The activities co-ordinators had not had training in providing activities for people with dementia. Staff spoken with said that they tried to provide some activities themselves but there often was not time. There were several trips planned throughout August including the Newark Air Museum, a meal out and a visit to White Post Farm. One person spoken with said that there were, now more smaller group visits rather than one large one which was better. Peoples religious needs were met by a church service with communion once a month on each unit. People were encouraged to bring their own personal possessions with them and bedrooms that were seen were comfortable and had been personalised. There was a choice of food at mealtimes. A new system had been implemented to ensure that meals were nutritionally balanced. On the dementia unit staff were observed asking each person which meal they preferred. However on the nursing/residential unit one person said and another confirmed that people were served the main meal unless staff knew that a person did not like this, rather than offering a true choice to people. They did however say that this did not concern them, as they were pleased with the quality of food. One person was vegetarian and was provided with a suitable alternative including vegetarian gravy. All the people that were spoken with said that the food was of a very good standard. One person spoken with said that, the food is excellent. Another person said that, the food quality is good, it didnt used to be in the past. There is now better presentation and quality. The cook was spoken with. She said that they always try to cater for preferences and would talk to new residents about this. A roast dinner was provided twice a week and a cooked breakfast was provided at least three times per week. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns. There are good systems and procedures for responding to safeguarding adult issues. EVIDENCE: Information provided was that there were 18 referrals through the safeguarding adult system within 12 months. Most of these referrals were due to service users physically assaulting other service users. Incidents had been recorded and treated seriously. It was of concern that there were such a high number of incidents. This may have been due to low staffing levels on the dementia unit leading to inadequate supervision of individuals, particularly people with challenging behaviour (see information concerning staffing levels within this report). Records showed that there were 14 complaints recorded at the home in the last 12 months. This high number was partly due to efficient recording of lowlevel concerns. Record showed that all concerns and complaints were treated seriously. For example an odorous carpet was reported in the communal area and the manager had requested a quote to replace this carpet. A visitor said that, I have not had to make complaints but staff generally respond positively to any comments or concerns. Three complaints have been received by CSCI. Two were concerning staffing levels, and as a result staffing was increased at night time on the dementia Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 17 unit. The second was concerning lack of security on the stairs in the dementia unit. As a result a door with a security pad had replaced a gate. The complaints procedure was displayed at the home. Comment cards are available for anyone to complete. The manager told us that all staff had received safeguarding adults training at induction and ongoing although these training records were not seen during this visit. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21, 22,23,24, 25, and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home would benefit from improved access, redecoration and refurbishment to some areas of the home in order to improve their safety and comfort. EVIDENCE: The home has two separate buildings. One is a dementia unit and the second is for older people with or without nursing needs. All bedrooms are for single occupancy and have a minimum of a wash hand basin, several having ensuite facilities. A tour of the building showed that the nursing unit was clean and well maintained. People spoken with said that they were happy with the level of cleanliness on this unit. The manager told us that domestic hours had increased by 10 hours per unit. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 19 There were a number of issues concerning the environment on the dementia unit. There were odorous bathrooms and toilets. Staff believed that this was due to urine soaking underneath the flooring rather than poor cleanliness. All bathrooms and toilets required re-decoration. There were signs of toilet holders and soap dispensers being removed and the decoration not being made good. The toilet on the ground floor had previously been used as a hairdressing salon but as this was not suitable, it was being used again as a toilet but still had the ‘salon’ sign in place and salon pictures and was in need of re decoration. A toilet on the 1st floor was locked and was being used as storage but still had a toilet sign and symbol in place, which may be confusing for people. The shower room had previously had a sign on the door but this had gone missing. The pull cords for the lights in the bathrooms and toilets were all dirty and needed replacing to minimise risk of cross infection. Bedroom doors were colour-coded and all bathrooms and toilet doors were painted blue to assist people with orientation. Some people’s families had made signs for individual’s bedroom doors but others did not have this assistance with orientation. The building was confusing and people were seen throughout the day looking for toilets. Additional directional signage was not provided. There was only one bathroom and one shower room on the dementia unit for up to 21 people. Staff said that the shower room was not regularly used, therefore the one bathroom was the main area for bathing. There was a standard bath in place with a manual hoist. The positioning of the bath did not allow for staff to access either side of the bath or the end of the bath. Staff spoken with said that the manual hoist was used for every person and was very tiring for staff. Incontinence pads were openly on display in bathrooms and toilets rather than discreetly stored in cupboards. In one toilet on the dementia unit a hot pipe was only half covered. The day of the inspection visit was a warm summers day. The heating was on in the old part of the dementia unit. Staff said that this could not be fully turned off. The heat was unpleasant in this area and affected bedrooms as well as other areas. Several people spoken with complained about the heat. There were grab rails and other aids around both units to assist people and maximise their independence. Communal areas included lounges, dining areas, and conservatory. Several people chose to eat in their bedrooms or in the lounge areas. The dining room in the dementia unit had scuffed paintwork, dirty wallpaper and the border had been pulled off. There were several enclosed outside areas with seating. People enjoyed sitting at the main entrance of the nursing/residential unit. A decking area had recently been made on the dementia unit. Raised planters had been placed in the outside areas of both units. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 20 There was a second small courtyard on the dementia unit described by staff as the, smokers courtyard’. There was not a smoking shelter and staff described how they had to go out with one person 15-20 times per day whatever the weather and hold an umbrella if it was raining. There was a lift on the dementia unit that had been used as a toilet by people at the home that were confused and therefore smelt of urine. Staff described how one person had gone into the lift on several occasions and damaged the lift, on one occasion had to be assisted from the lift with the lift floor several inches from the ground. The lift doors had not been made secure and people were not being adequately supervised to stop these incidents occurring. There were child safety gates being used on the dementia unit on stairs. Staff had described how one person with challenging behaviour had on several occasions shook the gate and the gate had come off. Staff were seen using the gate to go up and down stairs. This was potentially unsafe, as the gate had been placed on the second step, which meant that staff had to overstep whilst going through a small area in the gate. There were several access issues around both units. On the dementia unit there were four steps leading up to the main entrance. This had not been made fully accessible and the steps had worn and torn rubber matting that was potentially unsafe. There was a side entrance with a ramp but this had no bell. The ramping leading to the outside areas on both units was potentially unsafe. If this ramp was accessed from the side, the slope was too steep. One relative commented that the ramp made people lean over and they were fearful of tipping out of their wheelchair. The lip to the entrance of the decking area was too high and may be unsafe for people that have poor mobility or use a zimmer frame. The catering storeroom adjacent from the kitchen in the nursing/residential unit had been converted from a toilet and the floor had not been made good. There was also a hole in the far end wall where pipes entered/exited. The manager said that this was due to be refurbished and made into a preparation room. There were separate laundry facilities for each unit. Relevant equipment had been provided including industrial washing machines with sluicing facility and industrial dryer. People spoken with were satisfied with the laundry service, however the home had received one complaint about missing laundry and previous surveys that we had received had commented about this. The laundry person on the dementia unit said that clothing was labelled, however ladies tights and net pants were not labelled, therefore people often wore these items that had previously been worn by others. This was poor practice and did not promote peoples dignity. Some towels in the laundry area were frayed. The manager said that new towels were on order. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 21 Bedrooms that were seen were comfortable and homely. People had personalised their own room. One person said that, I have everything that I want in here . Another person described their bedroom as small but adequate. Radiators were covered for safety, however several covers on the dementia unit had not been painted. Both units used a keypad system at the entrance of the home to ensure safety of people living there. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29, and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained and recruitment practices ensure that people are safe, however staffing levels may not meet the needs of people on the dementia unit. EVIDENCE: It was evident observing the nursing/residential unit that there were sufficient staff on duty to meet the needs of people living in this unit. A person visiting the home that was spoken with said, There generally seems to be enough staff though they are occasionally short due to sickness but this is not a regular event. On the dementia unit there were three staff on duty in the daytime. The nighttime staff in had recently been increased from two to three due to difficulties expressed in a complaint. In the daytime one of the three staff was either a senior carer or the team leader. They would often be taken away from care duties in the daytime by meetings with families and social workers and other senior duties, reducing staffing to 2 during these times. The manager was based in a separate building. One worker wrote in our survey, “The manager does not come down to the dementia unit to offer staff support, she Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 23 does not come down every day. Staff feel isolated”. As this survey was received after the inspection visit, this concern was not explored with the manager. One worker wrote in our survey, “we are constantly dealing with aggression, it can get too much”. Several people living at the unit did have challenging behaviour, including aggression towards staff and other people living at the home. Although staff seemed experienced and knowledgeable in dealing with this behaviour, it was evident that there were insufficient staff on duty in the daytime to meet everyones needs. The evidence includes a high number of incidents and accidents, particularly incidents of physical assault between service users, as well as people accessing the lift unsupervised and tampering with the safety gates. Several people were seen wandering in a state of high anxiety with no staff available to spend time reassuring them. One carer spoken with said, the work here is full on’, it can be very stressful. There was a high turnover of staff. This may be partly due to the demands placed on staff. Although people usually remained on the ground floor in the daytime, the layout of the building meant that it was not easy to supervise people and ensure everyone’s safety. Staff records that were examined showed a safe recruitment procedure. Application forms were being completed, references and criminal record bureau (CRB) checks were being done. There was a 4 day induction programme in place that met the Skills for Care standards and included food hygiene, moving and handling, hoist training, dementia care, safeguarding adults and customer care. There was a well-developed training programme, with training records to support this. Staff had achieved 43 care staff with National Vocational Qualification, (NVQ), at level 2 or 3. Other staff had started or were registered on the course. Other training was provided including challenging behaviour, person centred care planning and equality and diversity. A health care assistant from the local community mental health team was visiting the dementia unit on the day of the inspection visit. They described the care staff as excellent with a good understanding of the needs of people with dementia. They said that staff were quick to request support. A good standard of training was provided including, Yesterday, Today, Tomorrow which is a recognised dementia training course. They were aware however that due to staffing levels sometimes staff do not have time to chat to people. Visitors spoken with said that, staff are very good, they take good care of people and, they are really good at letting me know if anything is wrong. Another person said that they had seen very difficult residents being coped with patiently. One person on the nursing/residential unit said that they would recommend the home to anyone. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very well managed, with effective quality assurance systems, ensuring that people are listened to and the home continues to develop and improve. EVIDENCE: The manager was going through the registration process with CSCI. She was a registered general nurse (RGN) and prior to taking up the position of home manager she worked as clinical care manager within the company. The management team includes a deputy manager and a team leader who oversees the dementia unit. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 25 There were clear lines of accountability. The operations manager visited regularly to support the manager. Both the manager and the operations manager undertook regular audits of the service and completed action plans of any shortfalls identified. There was continuous self-monitoring using a system provided by the company. The manager held weekly open door sessions for people living at the home and their relatives to discuss any issues. The notice displaying this made it clear that people could talk to the manager at any other time. The manager explained that people preferred this rather than a formal meeting. A relative support group had been set up on a bi-monthly basis. This was run by a community psychiatric nurse and supported by staff at the home. The manager said that this was very popular, with large numbers attending. Records required by regulation and for the effective running of the service were maintained, up to date and accurate. Records were generally secure although there was a storage area for archived files on the first floor of the nursing/residential unit that was not secure. As the manager was based in the nursing care unit, this may leave staff on the dementia unit at times isolated from the manager (see staffing survey comment). There was evidence that fire extinguishers, hoists and other equipment had been regularly serviced. Accidents, injuries and incidents were recorded and reported as required. The manager confirmed that electrical and gas safety tests had recently been undertaken. Records of staff meetings showed that staff were given an opportunity to make suggestions and raise concerns. Staff had recently raised concerns about the holes in the driveway. The minutes also evidenced that the manager encouraged teamwork amongst staff and person centred care for people living at the home. For example staff had requested that night staff bathe some people, but when people were asked they did not want this, therefore day staff continued to assist. Staff meeting minutes showed that the manager regularly reminded staff to think about how you would feel and try to make people feel secure and respected. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 26 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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 3 3 3 2 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 2 3 Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 27 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 OP19 Regulation 23(2)(d) Requirement Timescale for action 21/10/08 2. OP19 23(2)(n) 3. OP19 23(2)(n) 4. OP21 16(2)(k) Re-decoration of the toilets, bathrooms and dining room in the dementia unit must be undertaken to ensure that people live in a well-maintained environment. The access within both units 21/10/08 must be improved. This includes the main entrance, the outside ramp areas and the decking area on the dementia unit as well as the outside ramp areas on the nursing/residential unit. This will ensure peoples health and safety and improve accessibility to all parts of the home. There must be a system in place 21/09/08 to ensure that people living on the dementia unit do not access the lift or the stairs in an unsafe way. This is to improve the health and safety of people. The strong smell of urine in the 21/09/08 toilets and bathrooms on the dementia unit must be investigated and action taken to eliminate the smell in order to improve the comfort of people living on the unit. DS0000024635.V369123.R01.S.doc Version 5.2 Churchfield Care Centre Page 28 5. OP27 18(1)(a) The staffing levels on the dementia unit in the daytime must be reviewed to ensure that people living at the unit are appropriately supervised and kept safe from harm. 21/08/08 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. 2. 3. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Staff should be aware of the content of care plans and other relevant records to ensure that they are fully meeting peoples individual needs. There should be photos in place of all people at the home, including new people, to assist staff with recognition, particularly when administering medication. There should not be gaps in the medication administration records. If any gaps are found these should be investigated and a full audit trail possible to establish whether the medication had been administered. This is to ensure a safe medication system. The temperature of the medication storage room on the dementia unit should not be above 25°C to ensure medication is stored within the Pharmaceutical Society guidelines. Activities provided for people with dementia should be reviewed and improved to ensure that sufficient stimulation is offered to people. All radiator covers should be painted to ensure that the environment is well maintained and attractive. Consideration should be given to providing an outside smoking shelter to improve the comfort for smokers living at the home. The bathroom in the dementia unit should be refurbished with consideration given to better positioning of the bath so that staff can safely assist people when bathing. Incontinence pads should be stored discreetly for peoples privacy and dignity. The hot pipe in the toilet in the dementia unit should be fully covered for peoples safety. DS0000024635.V369123.R01.S.doc Version 5.2 Page 29 4. OP9 5. 6. 7. 8. 9. 10. OP12 OP19 OP20 OP21 OP21 OP21 Churchfield Care Centre 11. 12. OP21 OP22 13. 14 15. OP26 OP36 OP37 The pull cords for the lights in the toilets and bathrooms should be regularly replaced to minimise the risk of cross infection. Signage should be accurate and consideration should be given to providing additional signage around the dementia unit including directional signage to assist people living at the home to find their way around. There should be a system in place to ensure that all clothing including ladies tights and net pants are returned to their owners to ensure peoples dignity. The manager should ensure that enough management hours are spent on the dementia unit so that staff feel fully supported. All records should be secure including archived records to ensure confidentiality. Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Churchfield Care Centre DS0000024635.V369123.R01.S.doc Version 5.2 Page 31 - 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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