Inspection on 29/02/08 for The Chestnuts

This is the latest available inspection report for this service, carried out on 29th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Chestnuts 24/10/05

The Chestnuts 18/04/05

The Chestnuts 09/11/04

The Chestnuts 04/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Chestnuts Wrotham Road Meopham Gravesend Kent DA13 9AH Lead Inspector Jenny McGookin Unannounced Inspection 10:30 29 February 2008 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 The Chestnuts DS0000024032.V359483.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. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address Wrotham Road Meopham Gravesend Kent DA13 9AH 01474 812152 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) chestnutscare@aol.co.uk Mr Michael Knowles Banks Mrs Patricia Banks Mr Michael Knowles Banks Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residential care for two Older Persons with a Dementia condition DE. To `admit persons under the age of 65 years from time to time`. Date of last inspection 15/03/07 Brief Description of the Service: The Chestnuts is a privately owned care home, which first opened in 1983 “to allow older people to stay in the village among their friends and family”. The home is a large detached property standing in its own grounds, which has undergone substantial conversion. It is registered for twenty-nine residents who are over 65 years of age. To the rear of the property there is a large and attractive garden with seating for residents use. Residents’ accommodation is located on the ground and first floors, with the second floor of the home being used for administration purposes. There is a Stannah stair lift and a separate passenger lift serving the first floor, which gives step free access throughout. The home is situated in the village of Meopham and is close to local shops, a Post Office and is on a main bus route. There is a main line railway station in the village, and up to 11 parking spaces for visitors on site - to the front and side of the building. The home employs care staff working a roster, which provides 24-hour cover. Current fees range from £396 to £475 according to assessed personal need. Information on the Home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose / Service User Guide. The e-mail address for this home is: chestnutscare@aol.co.uk The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to inform this year’s key inspection process; to check progress on matters raised for attention at the last inspection (March 2007), given all the timeframes set had run their course. It was also used to review findings in respect of the dayto day running of the home. The inspection process took 9 ½ hours, and involved meeting with three residents over lunch, talking to two senior carers and one carer, the two proprietors (one of whom is also the registered manager) and their daughter, who has been assuming day to day management control, while she obtains the relevant qualifications required for registration by the Commission. Interactions between staff and the residents were observed in passing during the day. The inspection also involved a tour of eleven bedrooms and several communal areas, and the examination of a range of records (including building maintenance records and staffing files). Three residents’ files were selected for case tracking. The had submitted an Annual Quality Assurance Assessment (AQAA) in advance of the site visit, as required. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. This was judged a well written, comprehensive account of the issues raised, which reflected provision fairly. Feedback questionnaires were taken to the inspection for distribution to residents, relatives, staff and visiting professionals (health and social care), but not in time for their submission for this report. However, account was taken of the home’s own most recent quality assurance feedback exercise. What the service does well: This residential care home has been a family business for the past 25 years, and has clearly benefited by the shared vision and continuity of investment this implies. Feedback indicates it has long enjoyed a good reputation in the locality. The last inspection report (May 2007) did not give any score below 2 (minor shortfalls). The location of this home is judged suitable for its stated purpose and offers scope for some good local community links. It has been furnished to a The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 6 satisfactory standard, and was tidy, clean and odour free. There are homely touches throughout. The health and personal care needs of the service users are being addressed to their satisfaction, and the day to day reporting is judged exemplary. The home benefits by the nursing background of one of the proprietors and the acting manager. And there is input from a range of healthcare professionals as required. This is a stable staff team, who report working flexibly to ensure there is good continuity of care. The standard of catering was judged very high. What has improved since the last inspection? 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 The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. The Chestnuts DS0000024032.V359483.R01.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 The Chestnuts DS0000024032.V359483.R01.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 1, 2, 3, 4, 5 The home can evidence that incoming residents (and their representatives) are being given written information about the home, to help them decide whether this home will meet their needs. The home’s Statement of Purpose, Service User Guide and contract will require further attention to ensure they provide all the information prescribed by the National Minimum Standard, so that prospective residents and their representatives are fully informed. Prospective residents benefit by assessments carried out before their admission, to ensure that the home can meet their needs. EVIDENCE: The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 10 The home has combined its Statement of Purpose, Service User Guide and contract with a number of other documents, within a folder for each resident’s room. Taken in combination, the folder usefully describes a range of facilities, services and service principles. However, this folder will require further attention to provide all the information prescribed by the National Minimum Standard, so that prospective residents or their representatives have all the information they need to reflect on, in order to make an informed decision. These matters were minor, and reported back to the proprietors separately. When asked, residents said that the decision to apply to this home was in practice influenced more by its locality (i.e. close to where they or their relatives lived), and by its reputation, rather than by any public information produced by the home itself. The files selected for case tracking did not evidence the issue of this pack, or whether other languages or formats (e.g. large print or tape etc) were warranted. This is recommended. There was good evidence of the home carrying out preadmission assessments, to ascertain whether the home could meet residents’ needs. The home has always taken into account assessments from other professionals in the health and social care field, where they have been available, but there have been gaps and weaknesses in the information provided, particularly in respect of clinical issues. So this process has benefited by the role played by the proprietors’ daughter, Mrs Plumb, who is a qualified nurse. Mrs Plumb is on site every day with her father, The registered manager, and has assumed much of the day-to-day management of the home (including preadmission assessments) with a view to becoming its registered manager in due course. Prospective residents or their representatives are able to visit the home to judge it for themselves, before admission, though two of the residents spoken to on this occasion had not done so. They said they had felt able to trust the home’s reputation or the hospital or relatives choosing on their behalf. One other said she had visited several homes first with her daughter. Although each resident would ideally have preferred to be able to continue living at home, they said were generally very happy there Each admission is subject to a 4-week trial stay before being confirmed by a contract. The home’s contract was judged largely compliant with the elements of the National Minimum Standard, but will require further attention to provide all the information prescribed. These matters were minor, and were reported back to the proprietors for attention. The files selected for case tracking did not evidence the issue of the contract, or whether other languages or formats (e.g. large print or tape etc) were warranted. This is recommended. On their admission, the home carries out further assessments and sets up a care plan (see next section). See sections on “Environment” and “Health and The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 11 Personal Care” for a description of services provision; and the section on staffing for information on deployment and training. This home does not provide intermediate care. Should the home provide rehabilitation and/or convalescence, all the elements of National Minimum Standard 6 will apply The Chestnuts DS0000024032.V359483.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): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. 7, 8, 9, 10 Residents benefit from the health and personal care they receive at this home, and records reflect the level of care given. Residents can feel confident that the principles of respect, dignity and privacy are put into practice EVIDENCE: Three residents’ files were selected for case tracking on this occasion, to represent the latest admissions (i.e. over the past year) and these were followed through with discussions with residents (where they were able and willing) and staff. The format of the assessments used by this home to inform the residents’ plans of care, properly identify a range of health and personal care needs in the first instance, and these are followed through with detailed staff instruction, daily reports (see below), monitoring charts (e.g. weight, The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 13 medication etc), risk assessments and records of access to a healthcare professionals. This home has adopted a software package which enables staff to use handheld computers (rather than having to write everything down long-hand) to input details about each resident’s condition and level of support required, so that daily fluctuations and emerging trends can be tracked by the manager. This system enables the manager to readily assess the overall effectiveness of each care plan, the objectives set and any unmet needs or changes required. It also readily generates transfer information for hospital admissions and formal reviews with other professionals. All of which is judged exemplary practice. There was also good evidence on record of residents and/or their representatives exercising choice over being involved in care plan reviews, and the inspector was shown one example of a resident requesting the rewording of one element of her care plan. The software system readily accommodates this. The residents spoken to on the day of the inspection showed a range of understanding of care plans as a concept; but they each confirmed having been asked about their needs and preferences as part of the admission process, and on a daily basis thereon. In the home’s last feedback exercise (February 2008) the 12 residents who had responded so far were virtually unanimous in rating their care as satisfactory, and 80 of the 19 relatives who had responded so far, rated it as “excellent”. No one rated the level of care given as lower than “good”. Observed interactions between staff and residents were judged appropriately familiar and respectful, and residents confirmed this was representative. See section on “Daily Life and Social Activities” for findings in respect of social care needs. All the bedrooms are currently being used for single occupancy (though one is registered for use as a double) and, with just two exceptions, they all have ensuite facilities, so that personal care and medical interventions can be assured of some privacy. All bedroom doors are lockable and each bedroom has lockable facilities (unless residents are using their own furniture), so that residents would be able to safe-keep medication and items of value, as required. The home has a medication trolley, which is kept properly secured to a wall, and access to it is restricted to staff, to keep people safe. The home also has a cabinet for controlled drugs, though the home currently only manages patches for residents. It does not have a fridge for medication (e.g. for eye drops) but one is planned. The home’s record keeping appeared satisfactory – there were The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 14 no apparent gaps (other than the recording of allergies) or anomalies. The home keeps a directory of medication for reference, though this was due for updating, and also keeps a copy of the Royal Pharmaceutical Society Guidance, to ensure practice complies with best practice standards. The home’s medication arrangements are subject to six-weekly reviews with the local GP practice and there are also periodic informal inspections twice a year by a local pharmacist, which is judged good practice, though neither generates reports. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 12, 13, 14, 15 Residents benefit from a life style of their choosing, and are provided with occasional social activities. Residents are supported to keep in contact with family and friends. Residents benefit from a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Although some reference is made in initial assessments to social interests, hobbies and religion, there was an overwhelming health and personal care bias in the care planning documentation seen thereon. There needs to be a better balance between documentation and anecdotal information, to evidence how holistic the care planning is in practice. If the same level of sophistication already applicable to personal and health care could be applied to other aspects of care (such as activities, stimulation and fulfilment), this could obtain an “excellent” quality rating for this aspect of the The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 16 home’s operation, particularly in the light of resources being planned (see below). The residents and staff spoken to on this occasion were able to give some examples of activities at this home, which include individuals coming in from the local community to run reminiscence sessions, games, quizzes, exercises to music, Bingo, poetry, sing along sessions, and card games. One resident with dementia is given one-to-one sessions to look at photographs, to carry out light tasks, listen to music or dance. The local library provides large-print books for residents with visual impairment. On the day of this site visit, one member of staff had brought in her own electronic keyboard for one resident to try. There is an activities programme but there isn’t currently an overall coordinator as such (one is planned) – this responsibility is shared. Residents said that they were generally very content with their lifestyles in this home. But the latest feedback exercise indicated that residents might benefit by more stimulation, and weekends are said to be in particular need of attention. Feedback and suggestions for improvement included “More quizzes and games of Whist etc. I know it can be difficult to encourage participation but whenever we visit **** the majority of residents are asleep!”; “I still wonder if they can’t go out on fine days around the country as I am sure they are finding life boring”; “As much mental stimulation as you are able to give. Suggestion:- Is there anywhere you could show the date and which day of the week it is?” One member of staff told the inspector how she was making arrangements for one resident’s request to attend their preferred church services. The proprietors told the inspector that they plan to introduce an on site nonprofit shop and to introduce an electric buggy so that residents can access community resources for themselves. They also plan to introduce a computer for the residents’ use, and to improve access within the garden and to create a sensory garden. All of which is judged very promising. The daily routines are as flexible as healthcare needs will allow. There is a good choice of communal areas. Some of the residents clearly preferred their own company and would read, listen to the radio rather than join in with any group activities, and their choice is respected. The home has open visiting arrangements, though visitors are asked to avoid meal times if possible can be provided for visitors. There isn’t a communal landline telephone but there is a cordless handset, which can be taken into bedrooms for residents’ use in privacy, and the plan is to introduce an amplified handset to meet some residents’ identified needs. Residents can also arrange to have their own lines installed at their own expense and many bedrooms already have fixed cabling to anticipate this. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 17 Catering needs and preferences are properly established in the first instance as part of the admission process, and amended or updated thereon. Feedback confirmed that the menu (generally, traditional English fare) is varied and alternative options are available. Some special needs are catered for. The residents spoken to on this occasion said they were generally very satisfied with the meals. A lunch was sampled and judged well cooked and presented. Since the last inspection, the dining area had been moved to another room, and was judged a congenial setting. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 16,18 The processes are in place to enable complaints to be taken seriously and investigated, to benefit residents. Residents need to know that there are independent agencies they can call upon to protect their rights. EVIDENCE: This home has a complaints procedure, which is detailed in several places within the residents’ information file in each room. The proprietors will need to remove its reference to the CSCI as the lead agency, once the new arrangements are publicised. Information supplied in the home’s AQAA indicated that no complaints had been registered over the past twelve months. This is not usually judged a realistic reflection of communal living, but for the high level of satisfaction expressed by residents on the day of this visit and in the home’s latest feedback exercise. The proprietors said that no independent advocacy services are being to support the residents. Residents would need to rely on relatives or staff to represent their interests, where they are not able to do this for themselves. A directory of local advocacy services would be judged good practice. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 19 Previous inspections have established that the home has policies governing the protection of the residents, including whistle-blowing. And the home has access to a copy of the local multi-agency protocols, to ensure a timely and coordinated approach, should an incident arise. In discussions with the inspector, staff confirmed their commitment to report any instances of adult abuse. One incident, involving an allegation of abuse was properly referred to this process, and investigated by the police and resolved without repercussions for the home or its staff. There was evidence (anecdotal and on record) of training for staff on safeguarding adults. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 19, 20, 21, 22, 23, 24, 25, 26 Residents benefit from living in this well-maintained and comfortable environment. The physical design and layout of the home enable residents to live in safety. EVIDENCE: This is a handsome, imposing building set back from the busy Wrotham Road. The front of the site is dominated by a forecourt, and there is overall parking space on site for up to 11 vehicles. There are good bus and train links within walking distance of the site - linking the home to Sevenoaks, Tunbridge Wells, London and Dover. See section on Daily Life and Social Activities for details on telephones and contact with families and friends. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 21 Meopham village is close by, with all the transport and community resources that implies. The home is served by the local library services and individuals from the local community come into the home to run activities. The proprietors also plan an electric buggy so that residents can be supported by staff to access community resources. There is a pleasantly landscaped garden at the back, which provides seating and attractive focal points. Raised garden beds are planned, and one resident is reported to have been involved in their planning. All areas of the home inspected were found to be comfortable, clean, adequately lit and maintained at comfortable temperatures. The furniture tends to be domestic in style, which is judged good practice until needs change, and there were homely touches throughout. All the bedrooms, communal bathrooms and WCs seen had accessible call bells. Accommodation is arranged over two of the three floors (the top floor is currently reserved for administration). A shaft lift provides access to the first floor, and there is also a Stannah lift, if required. The home has a range of equipment and adaptations, and residents would have access to their own wheelchairs, Zimmer frames and other mobility equipment. When asked, one of the proprietors said there was a Loop system for use with hearing aids, but it was not currently working. Residents have a good choice of communal areas. There are three lounge areas (including a room, which is scheduled to have a computer for residents’ use) and two dining areas (the formal dining room and another area at one end of the main lounge). The bedrooms in this home vary in size but are all reported to be compliant with the National Minimum spatial standards. One bedroom is registered for use as a potential double room, though they are all effectively being used as single occupancy. Eleven bedrooms were inspected during this site visit, and were judged well maintained and personalised. They did not all have all the furniture prescribed by the National Minimum Standards. Non-provision must be justified in each case by properly documented consultation or risk assessment. Some bedroom doors and mattresses have been fitted with sensors, where residents have been assessed as likely to wander, to keep them safe. Some residents carry life-line pendants. With two exceptions, all the bedrooms in this home are en-suite, so that access and privacy can usually be assured. And there are communal WC and bathroom facilities within reasonable access to the bedrooms and communal areas. Two or three residents have, however, said they would like to have more than their allocated one bath a week. The plan is to introduce shower facilities, to give residents more choice. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 22 The home out-sources the laundry of its bed linen. It has two washing machines and one of these has a sluice cycle. Continence appears to be managed adequately at this home. There were no unpleasant odours. All maintenance records seen were up to date and in good order. See schedule of recommended action for matters requiring attention or consideration. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 27, 28, 29, 30 Residents benefit from a stable core group of staff who care for, understand and anticipate their needs and wishes. Residents are well protected by the systems within the home for staff recruitment and training. EVIDENCE: This home has an unusually complex staffing arrangement, which involves a succession of shifts over a 15-hour working/waking day. • • • • • • • From 7am till 1pm one carer comes in to assist residents to get up, bath, and to do the laundry From 7.30am till 2pm a second carer comes in to assist with bathing and general care From 8am till 4pm there is a senior carer and a third carer From 8am till 6pm there are two team leaders From 9am till 1.00pm there are two cleaners, who are also available as carers From 4pm till 8pm there is one carer to give general care From 6pm till 10pm there are two other carers DS0000024032.V359483.R01.S.doc Version 5.2 Page 24 The Chestnuts • From 10pm till 8am there are two waking staff, who carry out 2-hourly checks and clean the communal areas. There are clear lines of reporting, in the event of any emergency. The complexity of the day-to-day rotas owes much to the balance being drawn between the fluctuating demands in the home and staff availability, and can involve even further adjustments to the statement shown above, to suit requirements. Care staff are, for example, expected to be able to work in different capacities e.g. catering, cleaning – and training reflects this. This home plans its staffing rotas 12 weeks in advance, so that staff can organise their personal lives and commitments with some confidence. Absence and sickness levels are, as a result, reported to be minimal, and the home has not had to resort to using agency staff, so residents can benefit by continuity of care. Residents and their relatives have expressed a sound level of satisfaction with the care given. As one relative said “We are more than satisfied with the way **** is taken care of. The staff are friendly and caring”. An audit of three personnel files, selected to represent recruitment during 2007, confirmed that each had been subject to satisfactory police checks with the Criminal Record Bureau (CRB) and POVA first checks (which enable staff to start employment and work under direct supervision until the CRB is received). There was good evidence of other recruitment checks (identity, references), and interview assessments and all records were systematically arranged. A policy on renewing CRB checks is recommended, to keep people safe. In terms of equal opportunities and diversity, all the current residents are white British and, with two exceptions, female. The staff group is largely reflective i.e. currently all female (though male workers have featured in the past), predominantly white British, though 25 are more ethnically diverse. All working ages are represented in the staff group. Residents are able to express a preference, and this is recorded. Each new member of staff is given a copy of the General Social Care Council Code of Practice, to ensure their understanding of best practice principles. And each is required to work through an induction workbook and is subject to formal appraisals during their first six months, and training thereon (including NVQ Level 2). Records confirmed a range of mandatory training, designed to keep people safe: Food hygiene, health and safety, safeguarding adults, medication, infection control, moving and handling. Staff are also given training in MRSA, dementia care and mental capacity, to meet any emerging needs of the residents. The overall level of NVQ accreditation (level 2 or higher) is currently reported to be slightly below the national target of 50 of the workforce, because of The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 25 some staff having left. But new staff are reported to have been enrolled for NVQ training to redress this shortfall. Records confirm that staff competency is being usefully assessed in practical observational “supervision” sessions e.g. bed-making, personal care, toileting, answering the call bell, cleaning, serving meals etc. This is judged sound practice. However, see section on “management and Administration” for findings in respect of “supervision” as defined by the National Minimum Standards. The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 31, 32, 33, 36, 37, 38 Residents benefit from the management and administration of the home, which is based on openness and respect. The home can demonstrate that there are effective business and quality assurance systems in place, which can demonstrate how residents and their representatives can influence the way services are delivered. EVIDENCE: This home has been a family business for the past 25 years. Both proprietors have had an active involvement in all aspects of its organisation throughout, and Mr Banks has been able to demonstrate that he has the necessary The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 27 qualifications in care and care management that are required to be registered by the Commission as the Registered Manager. The home has responded positively to matters raised at inspections, and (with one exception) has not scored less than 2 (i.e. minor shortfall) on any standard inspected by the CSCI since it assumed regulatory control in 2004. There are clear lines of accountability within the home. Team working and flexibility appear to be key strengths in this staff group. More recently, their daughter, Mrs Plumb, has been assuming more control over the day to day operation of the home, to good effect (e.g. over care planning initiatives), and is working towards obtaining NVQ Level 4 (Registered Managers’ Award) accreditation, with a view to becoming the home’s registered manager in due course. The last quality assurance initiative carried out by this home for itself (twice yearly) was in February 2008. Feedback from that exercise and during this site visit indicates a sound level of satisfaction with the care given by staff. There was good evidence of monthly group meetings with residents and of them exercising choices and control over their own daily routines. The home had submitted an Annual Quality Assurance Assessment (AQAA) by its due date, and in good time for this site visit. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. This document was judged a comprehensive account of the issues raised, and reflected provision fairly. The home was also able to produce its latest annual financial statement and a current Business Development Plan. There were conspicuously links to be drawn to the home’s quality assurance system, which showed that the views of all stakeholders do influence the way services are provided. There were risk assessments in place in respect of each individual, their activities or the environment), to ensure their health and safety are being properly safeguarded. However, although there was good evidence of staff competency being assessed in what the home refers to as “supervision” records, this does not accord with “supervision” as defined by the provisions of the National Minimum Standard. Staff supervision should be subject to individual contracts, which spell out the rights and responsibilities of both parties – including the frequency of meetings. And records of staff supervision should routinely cover: all aspects of practices; the philosophy of care in the homes; and career development needs The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 3 3 3 2 3 3 2 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 3 3 X X 2 X 3 The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The home could usefully include in its admission procedure a checklist to certify the issue of a Statement of Purpose, Service User Guide and contract; and whether other languages or formats were warranted. The home’s Information folder for residents should be checked for compliance with all the elements of the National Minimum Standard that apply to the Statement of Purpose. The home’s contract should be checked for compliance with all the elements of the National Minimum Standard. The same level of sophistication already applicable to personal and health care should be applied to other aspects of care such as activities, stimulation and fulfilment DS0000024032.V359483.R01.S.doc Version 5.2 Page 30 2 OP1 3 4 OP2 OP12 The Chestnuts 5 OP16 Complaints procedure. The home will need to remove its reference to the CSCI as the lead agency, once the new arrangements are publicised. A directory of local advocacy services would be judged good practice. Property. The following matters are raised for attention / consideration: • Does the side entrance require comparable security to front door? • Loop system needs repair, replacement or removal • Does the area housing the medication trolley (chained to wall), a milk vending machine and hot water dispenser require risk assessment / secure provision against unauthorised access by residents with confusion? • Does WC used by occupant 19/20 require call bell • Bins in WCs should be lidded • Bathroom doors should have handles rather than knobs • Bedrooms. The furniture and fittings in bedrooms should be checked against the provisions of the National Minimum Standard and non provision should justified in each case by documented risk assessment/consultation. The home should consider having a policy of periodically renewing CRB checks. Staff supervision should be subject to individual contracts, which spell out the rights and responsibilities of both parties – including the frequency of meetings. And records of staff supervision should routinely cover: • All aspects of practices • Philosophy of care in the homes • Career development needs 6 7 OP17 OP19 8 9 OP29 OP36 The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 The Chestnuts DS0000024032.V359483.R01.S.doc Version 5.2 Page 32 - 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!