Care Home: Churchfields Nursing Home

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What the care home does well The home has a very welcoming atmosphere and is clean and tidy. Residents and relatives all spoke about Churchfields being a nice place. All of the bedrooms were personalised and are a testament to their way of life prior to moving into the home. Residents were complimentary and stated, "they look after me, I wouldn`t want to live anywhere else", another resident stated, "The staff are very good, nothing is too much trouble". Relatives were also complimentary, "Gladys and the staff are fantastic", another stated, "I visit every lunchtime and I am very happy with the care". Staffing retention is good and staffing levels are appropriate. All of the nursing and care staff are aware of the residents` needs. One member of staff stated, "I really enjoy working here". What has improved since the last inspection? Since the last inspection the previous manager has left and the new manager has been registered with the Commission. An advocacy service has been identified for one of the residents who has no relative/representative. All staff prior to appointment have undergone a Criminal Record Bureau (CRB) check and all staff are receiving regular supervision and yearly appraisals. Some refurbishment of the home has taken place and this task is ongoing. Activities within the home have improved and residents are now able to access the community. What the care home could do better: There was evidence that care plans are being evaluated monthly, however these evaluations need to be in more detail and relate to the goals and outcomes for the resident. Daily logs are being written, however there is variance in the information that is recorded, some of the staff wrote in a `person centred` away whilst other staff write notes that are brief and impersonal. There needs to be more consistency in the recording o the daily logs.Any change in medication needs to be detailed and state who requested the change i.e. GP the date of the change and the signature of the person recording the change. Regulation 26 visits are undertaken by the responsible individual to monitor and report on the quality of the service being provided, however these reports must ensure that necessary improvements identified one month are factually reflected in the following month`s report. CARE HOMES FOR OLDER PEOPLE Churchfields Nursing Home 37 Churchfields South Woodford London E18 2RB Lead Inspector Julie Legg Unannounced Inspection 10:00 30 October – 6 November 2007 th th 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 Churchfields Nursing Home DS0000062553.V353925.R02.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. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchfields Nursing Home Address 37 Churchfields South Woodford London E18 2RB 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) 0208 559 2995 0208 554 6982 churchfields37@btinternet.com Yewtree Care Ltd. Gladys Makarawo Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Date of last inspection 24th April 2006 Brief Description of the Service: Churchfields Nursing Home is a privately owned 25-place care home with nursing. The home is situated in a residential part of South Woodford, a short walk from local bus routes and about 15 minutes walk from the tube station. The building is a two-storey house, with a large, three storeys, purpose built, extension. There is a lift to the first and second floor, as well as a staircase. The home is similar in nature to other properties in the street, as they are a combination of traditional and new build. There is a large dining room, three lounges, and five bedrooms on the ground floor, with the remaining bedrooms being on the upper floors. Offices, the utility room, treatment room, kitchen and stores are also on the ground floor. Twenty-one bedrooms are single and two are double. All of the bedrooms have washbasins, but do not have en-suite toilet or bath/shower. There are bathrooms and toilets on each floor. The doors from one of the lounges leads to a pleasant patio area and garden. Nursing and personal care is provided on a 24hr basis. The Statement of Purpose and the Service User Guide are issued to every prospective service user and both of these documents are displayed on the residents, notice board, which is situated in the entrance hall of the home. A copy of the most recent inspection report is also displayed on the residents’ notice board. A resident or relative/representative could ask for his or her own copy which the manager would make available. The fees for the home are £595. The manager made this information available on 6th November 2007. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which commenced at 10.30 and took place over 7.5 hours. The registered manager was present throughout the inspection and was available for the feedback at the end of the inspection. Discussions took place with the manager, members of the nursing and care staff, as well as one of the domestics and the cook. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A number of residents were asked for their views on the service and their experience of living at the home. Relatives and a lay preacher who were visiting the home at the time of the inspection were also asked their views and social care professionals were also contacted. A tour of the home was undertaken and all of the rooms were clean and free from any offensive odours. Random samples of residents’ files were case tracked, together with the examination of staff and other records. These records included administration of medication, staff rotas, training schedules, maintenance records and staff recruitment procedures and files. The home is currently undergoing extensive building work; an extension is being built on the side of the house, which will accommodate ensuite bedrooms. Currently the building works have not caused any disruption to the residents. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment, monthly Regulation 26 reports and Regulation 37 notifications. The inspector had a discussion with the manager on the broad spectrum of equality and diversity issues and she was able to demonstrate an understanding of the varied needs around religion, sexuality, culture, disability and gender, The inspector had a discussion with the manager about how the people living at the home would like to be referred to during the inspection and in this report. The manager expressed a view that they would prefer to be called residents and this is reflected accordingly in this report. The inspector would like to thank the residents, the manager and staff for their input during the inspection. What the service does well: Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 6 The home has a very welcoming atmosphere and is clean and tidy. Residents and relatives all spoke about Churchfields being a nice place. All of the bedrooms were personalised and are a testament to their way of life prior to moving into the home. Residents were complimentary and stated, “they look after me, I wouldn’t want to live anywhere else”, another resident stated, “The staff are very good, nothing is too much trouble”. Relatives were also complimentary, “Gladys and the staff are fantastic”, another stated, “I visit every lunchtime and I am very happy with the care”. Staffing retention is good and staffing levels are appropriate. All of the nursing and care staff are aware of the residents’ needs. One member of staff stated, “I really enjoy working here”. What has improved since the last inspection? What they could do better: There was evidence that care plans are being evaluated monthly, however these evaluations need to be in more detail and relate to the goals and outcomes for the resident. Daily logs are being written, however there is variance in the information that is recorded, some of the staff wrote in a ‘person centred’ away whilst other staff write notes that are brief and impersonal. There needs to be more consistency in the recording o the daily logs. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 7 Any change in medication needs to be detailed and state who requested the change i.e. GP the date of the change and the signature of the person recording the change. Regulation 26 visits are undertaken by the responsible individual to monitor and report on the quality of the service being provided, however these reports must ensure that necessary improvements identified one month are factually reflected in the following month’s report. 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. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 8 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 Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 9 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives have detailed information on the home, which assists them to make an informed choice about moving into the home. A pre-admission assessment is undertaken of all prospective residents and they and their relatives are able to visit the home prior to their admission. This will ensure that the home and the prospective resident know that their needs can be met. EVIDENCE: The Statement of Purpose sets out the objectives and philosophy of the service and states what the home can provide. This document is regularly revised and Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 10 updated. The Service User Guide is informative and written in plain English, a copy of this document has been given to every resident. It would be good practice if the Service User Guide were also produced in pictorial format. This is Recommendation 1. The files of three residents were looked at. The manager had undertaken an assessment, which includes sections on; personal care mobility, transfers, communication, medical history covering physical and mental health and personal safety. An assessment from the funding authority has also been obtained as well as information from families and health professionals. From all of this information a comprehensive care plan is devised. See standard 7. Residents and relatives are able to visit the home prior to them moving in. The majority of visits are undertaken by relatives due to the frailty of the prospective resident. Relatives stated, “I looked at a number of other homes and this is by far the best I found. I just turned up and Gladys (manager) invited me in and showed me around, she even introduced me to the cook”. “I visited other homes but decided on Churchfields as it’s not too big, I felt welcomed and there was a nice atmosphere”. One resident stated, “They made me feel so welcome when I visited, I knew that I would be happy here”. A social care professional stated, “The manger undertook her own assessment and ensured that she could meet the needs of the prospective resident” The home does not provide Intermediate Care. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 11 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): 7,8,9,10 and 11 People who use this service receive good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The health, social and personal care needs of each resident are set out in individual care plans. These plans provide staff with information to ensure that their needs are being met on a daily basis. These care plans are being regularly reviewed but the reviews need to be in more detail to ensure that residents are receiving appropriate care. There are clear medication policies and procedures for staff to follow and most of the time medication records are being completed correctly. Residents are treated with respect and the arrangements for their personal care ensures their right to privacy is upheld. Residents and relatives can be assured at the time of the resident’s death that they are treated with sensitivity and respect. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has their own care plan; the inspector examined three of these plans. There has been improvement in the care planning since the last inspection and care plans now identify areas, such as, personal care, mobility, continence, catheter care and social activities. There was evidence that care plans are being evaluated monthly, however these evaluations need to be in more detail and relate to the goals and outcomes for the resident. This is Requirement 1. Daily logs are being written, however there is variance in the information that is recorded, some of the staff wrote in a ‘person centred’ away e.g. ‘Y had a good night’s sleep; he only woke once, Y was offered a drink, which he declined and soon went back to sleep’ other staff write notes that were brief and impersonal. The inspector discussed this with the manager and she is going to arrange for some of the staff to spend some time in looking at what constitutes good recording of notes. This is Requirement 2 All of the care plans examined clearly recorded referrals to specialist health care professionals, such as, diabetic nurse specialist, tissue viability nurse, speech & language therapist. There were well detailed care plans relating to specific health care needs such as management of diabetes; care and support for a resident with an indwelling catheter; weight management and pressure care. Records indicated that residents have access to GP, dentist, optician, chiropodist and hospital outpatient appointments. Residents and relatives confirmed that appropriate action is taken. One relative stated, “they were concerned because she wasn’t eating and they called the GP and advised me”. All residents are being weighed on admission and then generally on a monthly basis. The home has recently purchased new weighing scales, whereby residents can be weighed whilst sitting in their wheelchairs. Where there has been concerns, such as weight loss due to reduced appetite, the GP has been advised, the resident’s weight has been monitored weekly and a detailed food chart is kept stating what they have eaten and how much. Risk assessments are routinely carried out on admission for all residents around nutrition, moving and handling, falls and pressure sore prevention. Residents where possible and relatives have been consulted in formulating these risk assessments. These risk assessments are being reviewed regularly and updated. There are policies and procedures for the handling and recording of medication. The manager undertakes regular medication audits to ensure that Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 13 staff comply with the policies and procedures. Currently there are no residents who self-medicate. Random samples of Medication Administration record (MAR) charts were examined. Medication storage was satisfactory and medication records were on the whole being fully completed. One of the records showed a handwritten increase in a medication, the manager must ensure that any changes are signed and dated by the nurse and who authorised the change. This is Requirement 3. The wishes of some of the residents around dying and the arrangements they want after death have been sensitively discussed during the development of their care plans with residents, where possible and relatives. These wishes are recorded in the individual’s care plan so as to be respected and known to the staff in the home. However it is strongly recommended that ‘End of Life’ care plans be developed for all service users and this should include information about the individual’s wishes, choices and decisions. This is Recommendation 2. The manager advised the inspector that all of the nursing staff would be attending training over the next eight weeks on ‘Introduction to Palliative Care’, which is being run by the McMillan Specialist palliative Care Nurse. Information was also given to the manager on the NHS initiative ‘End of Life’ and details of the programme manager. The inspector spoke to a number of residents and relatives who all said that staff were respectful when attending to their personal care. One resident stated, “They are very gentle when helping me”. A relative stated, “Standards of care are high”. Another relative stated, “She always looks nice and clean, they treat her really nicely”. Staff were spoken to and observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as, the way they addressed residents and knocking on bedroom and bathroom doors before knocking and giving them time to answer. Residents’ privacy and dignity are covered during the staff’s induction programme. Churchfields Nursing Home DS0000062553.V353925.R02.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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The activities programme is now more varied and residents’ individual preferences are taken into consideration. Visiting times are flexible and people are made to feel welcome, this ensures that residents are able to maintain contact with relatives and friends. The meals in the home are well presented and nutritionally balanced and they offer both choice and variety to the residents. EVIDENCE: Residents and relatives were asked their views and care plans were examined. Visitors are invited to join in activities such as, weekly film shows and monthly entertainment. Care plans contain information about preferred activities, including spiritual activities. Regular church services are held in the home; including Church of England, Methodist and Roman Catholic. Residents are Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 15 encouraged to go out with their relatives, which a few are able to do. One resident is Chinese; who has no family only speaks Cantonese. The home has employed a care worker and organised a volunteer who both speak Cantonese. The home has recently had some new residents, one of the new residents is Afro-Caribbean and the other two are Italian, the home must be mindful that the cultural needs (in relation to activities and spiritual needs) of these residents are met. Regular activities are available within the home; monthly – entertainment and church services, weekly - hand & facial treatments, film shows and armchair exercises, daily – newspapers, games, puzzles, talking to residents about their lives and families and manicures. Outings to the local shops and park (weather permitting) and during the summer a BBQ was arranged and on Guy Fawkes Night there is to be fireworks and hotdogs. Christmas festivities are also being planned. One relative told the inspector, “I can’t fault the home but I would like Mum to have the opportunity to paint as she loves art”. During the inspection staff were seen singing and talking to residents, two of the residents (accompanied by two care staff) went shopping for Christmas presents and one of the residents was sitting painting. He advised the inspector that he has always painted and found it very relaxing. I asked him if he thought of running ‘art classes’ at the home, he said he hadn’t but liked the idea. The inspector discussed this with the senior care and the manager. The signing in book shows that there is a steady stream of visitors to the home on most days indeed on the day of the inspection five residents received visitors. Visiting times are very flexible and visitors confirmed that they could visit at any time. Residents have the choice of where they see their relatives and friends, either in one of the lounges, the garden or in the privacy of their own bedroom. All of the relatives spoken to said that they were made to feel very welcome and offered tea or coffee. One relative stated, “I visit three or four times a week and everyone always says hello”, another relative stated, “I always feel comfortable when I come in and I feel welcome”. The lay preacher stated, “I am always made to feel very welcome, Gladys has made a real difference; she leads from the front”. Residents’ care plans indicate their preferred name and their wishes regarding their death. Residents are encouraged to handle their own finances and this they do with the support of their families. The home only holds small amounts of cash. Residents are encouraged to bring into the home some of their own possessions and this was evident when visiting residents’ bedrooms. Resident/relatives meetings are taking place, one of the residents has been referred to an advocacy service and another resident has been referred to the Royal National Institute for the Deaf. Meals are mostly served in the dining room, though residents can take their meals in their bedroom if they wish. The cook has worked at the home for a couple of years and has previous catering experience. She is very aware of residents’ likes and dislikes and meets with all new residents and their Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 16 relatives. She also keeps a daily book of residents’ meals and this assists her in planning future meals. One of the residents is Chinese and food is bought in from a local Chinese restaurant. As stated earlier three new residents have recently come to live at the home; one is Afro- Caribbean and the other two residents are Italian. The cook needs to be mindful that their cultural dietary needs are being met. New menus, in consultation with the residents and relatives have recently been devised. On the day of the inspection there were two choices at lunchtime and the residents were having a ‘picnic’ for tea, which was sandwiches, sausage rolls and individual homemade cakes. The cook confirmed that if a resident did not like either of the choices then she would cook something different. One of the residents was eating a cooked breakfast at 10.30 as she is not an early riser and another resident came into the dining room and asked for tea and toast. He advised the inspector that he doesn’t like rushing in the morning and has a late breakfast. The dining tables are set with small vases of flowers and jugs of fruit juice, staff were seen to offer gravy from a gravy boat, rather than every dinner being served with gravy already on it. Some of the residents require assistance with eating their meals and others need encouragement, those who required assistance received this from staff that were taking their time, talking to them and asking if they wanted a drink. Staff rotas have been altered so that there is an extra care worker on early in the morning and directly after lunch. Both residents and relatives were complimentary of the food. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 17 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents and relatives can be confident that their complaints will be listened to and acted upon. There are policies and procedures on safeguarding adults and staff have undertaken training, which ensures there is an appropriate response to any allegations or concerns regarding abuse. EVIDENCE: The complaints book was examined during the inspection and four complaints were recorded. All of the complaints have been dealt with appropriately and there were copies of letters confirming what the investigation had found and the actions that had been taken. The complaints procedure is on the notice board and residents and relatives were asked, ‘If you were unhappy about anything in the home, who would you complain to’. All of the relatives said they would talk to Gladys (manager) and felt confident that their concern or complaint would be listened to. Indeed one relative stated, “we did have a minor concern but Gladys dealt with it straight away”. Two of the residents do not have any family; one of the residents has a volunteer who speaks her language and the other resident has been referred to an Advocacy Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 18 service. The inspector spoke to a lay preacher who was visiting the home and she confirmed that she would talk to Gladys (manager) if she had any concerns regarding the welfare of the residents. The manager stated that she welcomes any suggestions, concerns and complaints as she feels this can only improve the service that is being provided at Churchfields Nursing Home. Families or representatives administer most of the residents’ finances. The home holds small amounts for hairdressing, chiropody and toiletries. Three of the residents’ monies were checked and all were accurate with receipts tallying with the amount of money spent. There is a written procedure and policy for dealing with ‘safeguarding adults’ and whistle blowing. The home also has a copy of the department of Health’s ‘No Secrets’ and the local authority (London Borough of Redbridge) documentation on ‘safeguarding adults’. There is in-house and external training for all staff in ‘safeguarding adults’ and recognising and reporting abuse. All staff have received this training and this is also included in induction training for all new staff. Those staff spoken to during the inspection were aware of the action to be taken if they had any concerns about the safety and welfare of the residents. This knowledge is regularly reinforced and discussed through supervision and staff meetings. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 19 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, 23 24, 25 and 26 People who use this service receive good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents live in a home that is welcoming, comfortable, clean, safe and well maintained. There are sufficient toilets and bathrooms for the number of residents and their bedrooms meet their needs and are furnished with their own personal possessions. EVIDENCE: A tour of the home was undertaken and all areas of the home were inspected including the kitchen and laundry room. Both of these rooms were maintained to a good standard. Environmental Health has recently inspected and no recommendations were made. There was a good supply of food within the Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 20 refrigerators and freezers and this was stored appropriately. There was evidence that refrigerator and freezer temperatures are being regularly recorded. The living area of the home consists of a large dining room and three lounges; one of these lounges is seen as the ‘quiet room’ and the large lounge has a large plasma screen, where the residents enjoy their weekly film show. All of these rooms are appropriately furnished and the dining room tables are small tables that sit up to four residents. The manager advised the inspector that the home is in the process of buying new dining room chairs. The patio and rear garden are reached via one of the lounges. None of the bedrooms are en-suite but all have washbasins and are appropriately furnished, the majority of the beds have been replaced with specialist beds and hoists were also available. All of the bedrooms seen were personalised and reflective of the residents’ interests, culture and religion. One resident’s bedroom was a testament to her culture with appropriate wall hangings and soft furnishings and DVDs and Videos in her language. There are two double bedrooms and a married couple is currently using one of these. There are sufficient toilets and bathrooms on all floors, all were very clean and tidy. Each bathroom has an assisted bath and all of the toilets are wheelchair accessible. The manager advised the inspector that all of the bathrooms and toilets are duet o have new flooring laid. The home has an ongoing redecoration and refurbishment programme as well as a daily and weekly maintenance programme, which ensures that the residents live in a safe and comfortable home. The home employs a maintenance person and there is an effective system in place for staff to report items that require repair or attention. The manager has also placed in each bedroom a form for residents/relatives to complete if they see anything that requires attention. The home is cleaned on a daily basis and throughout the inspection the standard of cleanliness was very high and there are adequate control systems in place to ensure that the home is free from any offensive odours. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 21 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s staffing levels are satisfactory and there are sufficient staff on duty whop have the appropriate skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: The staffing levels of qualified nurses and care staff were sufficient to meet the nursing and care needs of the residents. Staff were being deployed effectively to ensure that residents choosing or needing to remain in their bedrooms were being cared for appropriately. The home is fully staffed however bank staff are employed to cover holidays and sickness. The residents know the bank staff and this provides consistency of care. The duty rota was examined and this concurred with the designation and number of staff on duty at the time of the inspection. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 22 A random sample of staff personnel files were inspected and these were found to be in good order with necessary references, Criminal Records Bureau (CRB) checks and application forms duly completed. All newly appointed staff undertake an induction programme that covers all areas of the Skills for Care induction. Further training has taken place in safeguarding adults, nutrition awareness, administration of medication, and bereavement in the care home, care for you, dementia care, fire prevention, catheterisation, supervision in the care home, risk assessment, infection control, health & safety, basic food hygiene. Four of the staff have been on supervision courses for supervisors. Further training has been booked for wound management and introduction to palliative care. Five staff have attained their NVQ 3 and two of these are to commence their NVQ 4 in health and social care. Two members of staff have attained their NVQ 2 and are commencing their NVQ 3 and one member of staff is commencing her NVQ 2. More than 50 of the care staff have attained their NVQ2/3. An individual record is maintained of staff training and staff have completed a self appraisal were they have also identified their training needs, which includes equality and diversity, first aid, dementia awareness, wound management and first aid. Staff that were spoken to stated that they enjoyed working at the home, comments were, “Things have improved since Gladys (manager) has been the manager”, another stated, “I really enjoy working here”. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 23 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): 31,33,35,36 and 38 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. The responsible individual regularly undertakes monitoring visits, however these reports are lacking in information and detail. Staff are appropriately supervised and the health and welfare of the residents and staff are promoted and protected. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 24 EVIDENCE: It was evident during the inspection that the home is being well managed and the manager is keen to work in collaboration with the Commission and external agencies. Through staff supervision, training and good management, staff are ensuring that residents receive a high standard of care and that the home is run in their best interests. The registered providers also spend some considerable time at the home and are very involved in the running of the home. All staff that were spoken to throughout the visit spoke positively about how they felt supported by the manager. Staff receive regular supervision, direct observation of care practices, annual appraisals and regular staff group meetings. She is very resident focussed and works continuously to improve the service and provide an increased quality of care for the people living at the home with the support of a committed staff team and in partnership with other health and social care professionals. The home undertook a Quality Assurance Survey in August 2006 and from this developed an annual development plan. Residents are also sent a satisfaction questionnaire every three months and views of relatives are also sought at resident/relatives meetings, as well as the comments form in each resident’s bedroom. Recommendations from these surveys have already acted upon. As stated in the last inspection report the home is expanding to accommodate another seven residents. The building work has commenced and the providers must be mindful to keep residents and relatives informed of the progress of the extension. Regulation 26 visits are undertaken by the responsible individual to monitor and report on the quality of the service being provided. The inspector saw these reports during the inspection and they are not consistently providing the information that is required. Every month the reports are stating that all areas of improvement identified the previous month have been dealt with, however this is not the case. The registered provider must ensure that necessary improvements identified one month are factually reflected in the following month’s report. This is Requirement 4. The home has an appropriate policy and procedures regarding the safeguarding of residents’ finances and secure facilities are provided for their safekeeping, with records being maintained. A wide range of records were looked at including fire safety, emergency lighting, gas and electrical checks, Portable appliance Test (PAT, nurse call water temperature checks health and safety checks and accident/incident reports. These records were found to be detailed and up to date. Staff have Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 25 undertaken moving & handling and risk assessments are updated yearly or when a risk is identified. Churchfields Nursing Home DS0000062553.V353925.R02.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 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 3 3 3 X 3 3 3 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 X 2 X 3 3 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 17 Requirement The registered persons must ensure that evaluations of care plans should be in more detail and relate to the goals and outcomes for the residents. Daily report sheets need to be more informative and relate to specific goals and outcomes in residents’ care plans. Previous timescale of 31/07/06 not met. The registered persons must ensure that any changes on the Medication Administration Records are signed and dated by the nurse and who authorised the change The registered provider must ensure that necessary improvements identified one month are factually reflected in the following month’s report. Timescale for action 29/02/08 2 OP7 17 (1)(a) 31/01/08 3 OP9 13(2) 30/11/07 4 OP37 26 30/11/07 Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 28 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. Refer to Standard OP1 OP11 Good Practice Recommendations It would be good practice if the Service User Guide was produced in pictorial format. It would be good practice to develop ‘End of life’ care plans for each resident to include information on resident’s wishes, choices and decisions. Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Churchfields Nursing Home DS0000062553.V353925.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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