This is the latest available inspection report for this service, carried out on 10th March 2009.
CSCI found this care home to be providing an Good service.
The inspector found no outstanding requirements from the previous inspection report,
but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Other inspections for this house
Inspecting for better lives Random inspection report
Care homes for older people
Name: Address: Chestnut Court Care Home Frizlands Lane Dagenham Essex RM10 7YD two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Tony Brennan Date: 1 0 0 3 2 0 0 9 Information about the care home
Name of care home: Address: Chestnut Court Care Home Frizlands Lane Dagenham Essex RM10 7YD 02085969249 02089849643 Debbie.Sutton@carebase.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Carebase (Dagenham) Ltd care home 62 Number of places (if applicable): Under 65 Over 65 0 14 dementia old age, not falling within any other category Conditions of registration: 48 0 The maximum number of service users who can be accommodated is: 62 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (maximum number of places: 14) Dementia - Code DE (maximum number of places: 48) Date of last inspection Brief description of the care home Chestnut Court is a purpose built care home providing nursing and personal care for 62 adults. The home is registered to care for people who are physically frail or who have a diagnosis of dementia. The home is operated by Carebase (Dagenham) Limited who operate a number of similar homes. The home is situated in the London Borough of Dagenham and has good access to local facilities and transport links. The home Care Homes for Older People
Page 2 of 10 Brief description of the care home operates over three floors and each floor has a lounge and dining room. All bedrooms are single with en suite facilities and colour televisions. There is a pleasant wellmaintained garden with seating areas for residents and their visitors; and car parking facilities. On the day of the inspection the range of fees for the home was between #525.00 and #850.00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and their family. A copy of both these documents are available at the main reception and can also be obtained on request. Care Homes for Older People Page 3 of 10 What we found:
As part of the annual service review we found that there had been a number of safeguarding strategy meetings that raised concerns about the care provided at Chestnut Court. There had also been a suspension of placements by one local authority as a result of these allegations. This random inspection was carried out to confirm that the home was continuing to provide good outcomes for residents. This random inspection will be used to inform our annual service review of the home. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. The inspection took place over one day. We were assisted by Colum OSullivan, the acting manager, with the inspection. We spoke with five residents, three members of staff and four relatives. We observed care practice and interaction between staff and residents. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the acting manager, and areas for improvement were discussed. We found that there are a number of areas that need to be improved to make sure that the home continues to provide good outcomes for residents. These included care planning, activities for people with dementia and the provision of training for staff. Currently, there is no registered manager for Chestnut Court. A new manager will be starting work at the home shortly. This should improve the outcomes of care for residents. What the care home does well:
Residents and relatives with whom we spoke were generally please with the home. We observed that staff were attentive and available to meet residents needs. A resident told us, People are very nice here, and the staff are brilliant. The rota showed that two nursing staff are on duty throughout the day. Staff spoken to told us that they felt there was enough staff available to care for residents. We saw that staff was available in sufficient numbers to assist residents at meal times. Residents were given assistance to eat and drink if they needed it. The acting manager explained that two new full-time nurses had recently been appointed. He agreed that the staffing level would be reviewed regularly. Sufficient numbers of staff are available to meet the needs of residents. A relative said, You can go to staff and they will help you out. Records showed that people were receiving medical attention that they needed. Medication records have been updated when there had been changes in residents medicines. We could see that people were getting the medications that they had been prescribed. A relative said, I feel well-informed as they explain any changes in care needs. Care Homes for Older People Page 4 of 10 What they could do better:
There are a number of areas where Chestnut Court needs to improve the care provided to residents. We case tracked residents, a number of whom had dementia. We found that the care plans regarding residents dementia needs were not individualised. This meant that the care plans for these residents did not tell staff how dementia affects them as individuals. Staff spoken to could describe dementia care in general terms, but did not relate this to the individual needs of residents. Two of the care plans seen consisted of a general description of dementia. The acting manager told us that this was a quote from a book. The care plans did not relate to the individual residents dementia care needs. The acting manager confirmed that care plans for dementia were generally not specific to the individual residents. Residents who have dementia need to be supported in ways that promote their individual well being. We looked at the incident reports, and found that these highlighted a number of occasions where residents behaviour had resulted in concerns about how residents safety is promoted. We case tracked residents and found that care plans were not clear or specific about how to address residents behaviour that might challenge the service. There was no guidance on how staff are to support residents in this area. Staff spoken to could generally describe how they responded to residents behaviour that might challenge the service. They did not show that they understood how to respond to individual residents needs in this area. Residents need to be supported to maintain their well being. The safeguarding meetings had raised the issue of how well Chestnut Court is meeting the terminal care needs of residents. We found that one of residents we case tracked had a diagnosis of a terminal illness. However, there was no end of life plan in place. The other residents case tracked did not have information regarding how they wished their end of life care needs to be met. Staff spoken to could not demonstrate skills and knowledge necessary to identify individuals end of life care needs. We found that assessments relating to the pain management, care of pressure areas and nutrition did not highlight the specific support needed at the end of life in these areas. Residents need to receive the care and support they need at the end of their lives. The diary notes for the residents case tracked did not reflect their support as outlined in their care plans. These diary notes consisted of brief and general descriptions of their daily activities. They did not provide information on how the persons needs might have changed. Diary notes need to provide detailed information about how the care needs of residents are addressed. The information available on the needs of those residents case tracked was not well organised. Folders contained old information and it was not clear how care plans were related to each other. This made it hard to see how the needs of residents were met in a consistent manner. Information on the needs of residents should be accessible. A safeguarding investigation had highlighted that the home used bath books to record when residents were assisted with the bath. This was discussed with the acting manager who said that he had told staff not to use a bath book. He told us that the staff continue to do this. Records should be maintained for each resident and not held together. Records should be maintained in ways that enhance the care of residents. Care Homes for Older People
Page 5 of 10 We saw that activities were taking place on all three floors. However, residents and relatives commented that this was not how things were usually. A resident living on the dementia unit commented that it was usual to, Spend the afternoon watching television. With nothing else to do. A relative also told us. I visit most afternoons and residents are just left watching the television. We looked at the activities programme. It was general and did not provide specific activities for those residents who have dementia. We discussed this with the acting manager who confirmed that there were not enough activities for residents who have dementia. Residents who have dementia need to be provided with activities that meet their needs. We walked round the home and found that on the dementia unit there was still a need for more signage to enable residents to find their way about the home. The acting manager told us that this issue still had not been addressed. We observed that residents sometimes could not find their way about the home. Appropriate signage needs to be in place to support residents to move about the home independently. We looked at the training records and they show that there had only been limited training on dementia. We asked the acting manager if there was an ongoing programme of training in dementia care. He explained that there was not one currently in place. Staff spoken to could explain how they support of people with dementia, but only in very general terms. Staff need to have a range of skills to meet the needs of residents with dementia. We looked at the homes training records and found that not all staff has had training in care planning. Not all staff with whom we spoke had been trained in care planning. Given the issues already discuss in this report regarding planning of support for residents with dementia and behavioural issues, training on care planning needs to be provided for staff. The safeguarding meetings highlighted a number of issues regarding the management and treatment of tissue viability needs. When we looked at the training records. We found that staff had not received training in tissue viability. After this inspection the area manager for the home told us that the tissue viability nurses had been contacted to arrange the training. Staff need to have the skills to meet the tissue viability needs of residents to promote their health and well being. Since the last key inspection the registered manager has resigned. This has created a gap in the leadership needed to make sure that residents receive good care. The issues discussed in this section of the report and those highlighting by safeguarding investigations show that there is a need for consistent management of the home. The acting manager said that staff do not always work in ways he had told them too. For example, he pointed out that staff had not attended training when this had been arranged. The home needs to have consistent management to make sure that the needs of residents are met. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 The registered persons must 27/04/2009 make sure that there is detailed guidance on how to support residents whose behaviour may challenge the service. Residents need to be supported to maintain their well being and safety. 2 7 15 The registered persons must 27/04/2009 make sure that dementia care plans reflect the individual needs of residents. Residents with dementia need to receive person centred care to promote their well being. 3 8 15 The registered persons must 27/04/2009 make sure that end of life plans are in place for residents. Residents need to be involved in planning their end of life needs. 4 18 30 The registered persons must 27/04/2009 make sure that staff are
Page 8 of 10 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action trained in meeting residents tissue viability needs. Staff need to have all the skill need to care for residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 The registered persons should make sure that diary notes provide a detailed description of the care provided to each resident in line with their care plans. Diary notes need to provide detailed information about how the care needs of residents are addressed. 2 8 The registered persons should make sure that information on the needs of residents is organised so that it is easily accessible. Information on the needs of residents should be easily accessible. 3 8 The registered persons should make sure that bath books are no long used in the home. Records should be maintained in ways that enhance the individual needs of residents. 4 16 The registered persons should make sure that there is sufficent signage on the dementia unit to enable residents to orientate themselves to their surrounding. Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
