Inspection on 03/04/08 for Chestnut Court Care Home

This inspection was carried out on 3rd April 2008.

CSCI found this care home to be providing an Good service.

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

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chestnut Court Care Home Frizlands Lane Dagenham Essex RM10 7YD Lead Inspector Ms Gwen Lording Unannounced Inspection 3rd April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnut Court Care Home DS0000071133.V361292.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. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Court Care Home Address Frizlands Lane Dagenham Essex RM10 7YD 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 596 9249 0208 984 9643 Carebase (Dagenham) Ltd vacant post Care Home 62 Category(ies) of Dementia (48), Old age, not falling within any registration, with number other category (14) of places Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 2. Dementia - Code DE (maximum number of places: 48) The maximum number of service users who can be accommodated is: 62 First inspection of newly registered service Date of last inspection Brief Description of the Service: 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 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 well-maintained 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. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. At this first key inspection services that have registered with us for the first time cannot receive an excellent rating because they must demonstrate a proven track record of providing excellent quality care over a sustained period of time. This was the home’s first key inspection since being registered in December 2007, and was an announced inspection. It started at 09:30am and took place over five and a half hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The organisations Business Services Manager was available throughout the visit to aid the inspection process. Discussion took place with the Business Service Manager; Care Service Manager; activity co-ordinator; domestic, kitchen, maintenance, laundry staff; and the home’s administrator. The inspectors spoke to a number of residents and relatives; and where possible residents were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including laundry and main kitchen was undertaken. The files of several residents on each unit were case tracked, together with the examination of other staff and home records. This included medication administration, staff training and recruitment procedures and files, maintenance records and complaints. Information was also taken from an Annual Quality Assurance Assessment (AQAA), which was completed and returned prior to the inspection. This is a self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from Regulation 26 monitoring reports and Regulation 37, notification of events. Surveys were sent out to the home prior to the inspection for completion by staff, residents and relatives. As part of the inspection process the views of funding authorities that place residents in the home were sought and are commented on in this report. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 6 The people living in the home were asked how they wished to be referred to during the inspection and in the report. The majority expressed a wish to be referred to as ‘resident’. This is reflected accordingly in the report. The inspectors would like to thank the residents and staff for their input during the inspection. What the service does well: If the service continues to provide the quality evidenced during the inspection, and develops the service as detailed in the AQAA then they should be able to achieve a excellent rating at the next key inspection. There was a good response from surveys and all commented positively about the quality of care being provided in the home. Comments included: “Dad has settled in so well and he is happy when we leave him. This has made such a difference to us as a family as we know that our father is safe at all times”. “Staff are very committed to the residents. They treat us as individuals”. In spite of several management changes since registration, the service is well organised and managed to the benefit of residents. This was supported in discussion with residents, staff and relatives. Staff are to be commended for their continued commitment to the care of the residents in spite of recent difficulties. Good staff interaction was observed with all of the residents and this resulted in a high level of motivation for people in the home. All staff are very aware that Chestnut Court is the home of the residents and try to make this as pleasant as possible. The nutritional needs of residents are well considered so that food and mealtimes are seen as being important for all residents. Staff are permitted to eat with residents and staff reported that this helps encourage those residents with poorer appetites. As part of the inspection, contact was made by phone with two funding authorities. They commented positively on their involvement with the home; expressed no concerns about the care being provided; and that any issues raised were well received and actioned accordingly The standard of the décor, furnishings and fittings are maintained to a high standard and provide people living in the home with a pleasant and comfortable environment. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 7 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 be made available in other formats on request. Chestnut Court Care Home DS0000071133.V361292.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 Chestnut Court Care Home DS0000071133.V361292.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): Standards 1, 3, 4 & 5 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined on each floor of the home. All records inspected have assessment information recorded and the information has been used to continue assessment following admission to the home, and develop written care plans. The records showed that residents where possible, and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also included. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 10 Prospective residents and their families have the opportunity to visit the home, talk to staff and assess the home’s facilities. One relative commented: “We received enough information prior to my father moving into Chestnut Court. We were shown around and asked all our questions on our first visit. This was extremely helpful as we did not make an appointment, but just turned up”. Chestnut Court Care Home DS0000071133.V361292.R01.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): Standards 7, 8, 9, 10 & 11. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents’ needs. There are clear medication policies and procedures for staff to follow, so as to ensure that residents are safeguarded with regard to medication. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: Individual care plans were available for each resident and a total of files of ten residents were case tracked, across the three floors, and their care plans and related documentation inspected. This included two residents who are the Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 12 subject of a complaint currently being addressed by the organisation. It was evident from the care plans seen and talking to the residents that their health care needs were being met. Care plans showed evidence that nutritional screening is being undertaken on admission and that a record is maintained of nutrition, including weight gain or loss. Where concerns are indicated there is evidence that appropriate action is taken, with an initial referral to the GP and then to a dietician or nutritionist. One resident told the inspector: “ I like the food and have put on weight since living here”. The documentation/ health records relating to wound management; management of diabetes; and residents with a diagnosis of dementia were examined. Care plans showed that residents are able to access GP, dental care, chiropody services, optician and other specialist medical services as necessary. One resident regularly attends the local Warfarin clinic. A recent review undertaken by the funding authority indicated that it was “happy with the current care, and that a referral had been made to the Tissue Viability Nurse because of a high Waterlow score”. Where a resident requires dentures, hearing aid or spectacles, these are discreetly marked with the name of the resident. A resident with diabetes, had a detailed care plan around the management of the condition, and blood sugar monitoring was being undertaken in accordance with the care plan. Records also showed that staff had received training in the procedures for blood monitoring. Where necessary risk assessments were in place, and in discussions with staff members they demonstrated a good understanding of the residents’ needs and also of the identified risks associated with each individual, such as at risk of falling, or indicators which may lead to exhibiting behaviours which challenged. Accidents sustained by residents are being recorded on their files, together with any action which had been taken. Risk assessments are being reviewed and updated accordingly. Some files showed evidence of end of life care needs and wishes. However, these should be transferred into the actual care plan to ensure that such important information does not become lost. Some care plans had a specific ‘night’ care plan, but some files seen did not have such a plan. Whilst care plans were being reviewed on a monthly basis, the manager must ensure that reviews are undertaken in a meaningful way and do not become a routine exercise with “no change” being routinely recorded. This, together with the further development of specific night and end of life care plans, was discussed with the Business Services Manager who was present during the inspection and feedback. A further point of discussion was that staff need to ensure that daily recordings are more in line with outcomes identified in the Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 13 care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. Equality and diversity issues are addressed by the staff, and there was evidence of this in care plans seen. For example, there is a resident who is of Eastern European origin, and although he speaks English, sometimes prefers to speak in his native tongue. There is a member of staff who is fluent in this language and is allocated planned time to sit and talk to him. Religious preferences are clearly recorded and residents are enabled to participate in Church and other religious activities as desired. From observations, and discussions with residents and staff, it was evident that the privacy and dignity of residents was respected. Staff were heard to call residents by a preferred name, some residents were referred to as Mr. or Mrs X, and others by a first name. An audit was undertaken for the handling and recording of medicines within the home, and a sample of Medication Administration Record (MAR) charts were examined. Discussions with staff and the review of medication records show that nursing and senior care staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. The organisation has recently changed the supplier of the monitored dosage system used in the home. From discussions with staff and from letters received by the home, it was evident that residents are assured that at the time of their death, both they and their families would be treated with care, sensitivity and respect. Staff routinely send sympathy cards and floral tributes and staff are supported to attend residents funerals. One family had written: “Thank you for your kind thoughts, flowers and all your support and help over the past months”. Another card read: “All the nurses (my angels) and care staff who helped take care of my father. Your care went above the call of duty and we will always be grateful for your help. You will always have a very special place in our hearts”. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The lifestyle within the home matches the expectations and preferences of residents with regard to their social, cultural, religious and recreational interests and needs. The attitude and practice of the service and that of the staff, promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. The nutritional needs of residents are well considered so that food and mealtimes are seen as being important for all residents. EVIDENCE: The home has a full time activity co-ordinator and she is viewed as a valued member of the staff team. There is a planned general programme of activities for all residents and the activity co-ordinator has given a great deal of consideration and time in planning and undertaking activities in the home. All residents have an activity assessment completed and this provides guidance on the appropriate level of activity for the individual. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 15 From talking to residents, relatives and staff and from observations on the day, it was evident that the routines of daily living and activities are flexible and varied to suit the preferences and capabilities of the residents. During the inspection a bingo session was being enjoyed by many of the residents, and this was apparent from the laughter that was overheard. Activities also include both large group, small group and individual activities with residents. In conversation with a relative we were informed that: “Since coming into this home my sister is much more alert because of the activities, and is also eating so much better than when in a previous home. This has been a really good move for her and also for me”. We observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their daily lives. All staff are very aware that Chestnut Court is the home of the residents and try to make this as pleasant as possible. One resident was able to bring his pet budgerigar when he moved into the home and cares for it in his own room. The home does have a visiting hairdresser and in discussions it was evident that she has a good understanding of the needs of the residents. From discussions with the hairdresser and the maintenance person it is evident that they are also very important members of the home’s staff team. The maintenance person told the inspector: “I enjoy sitting and talking to the residents and also play cards with some, but I must make sure that my own jobs are always up to date”. Relatives and friends are encouraged to visit, and are able to use the small servery kitchens to make drinks. Also visitors can choose to have a meal with their relative, and certainly there was evidence that a visitor does this on a regular basis. The inspector was able to observe the lunchtime meal being served on the ground floor. Prior to lunch residents are offered a selection of pre-lunch drinks, both alcoholic and non-alcoholic. This helps to stimulate the appetite of residents and is seen as being important in considering the nutritional needs of residents and the overall dining and social experience. Staff were seen to offer assistance and encouragement where necessary and this was done discreetly and individually. On all floors tables were routinely laid with tablecloths, napkins, cutlery, glasses and condiments. The settings were very congenial and there was a nice relaxed atmosphere throughout the meal. Staff are permitted to eat with residents and staff reported that this helps encourage those residents with poorer appetites. Prior to the meal the chef or a member of kitchen staff visits each resident and asks what they would like to eat from the day’s menu. One visiting relative confirmed that this happened each day and that all meals served were appealing and well presented. We were informed that the home is in the process of developing pictorial menus to further encourage and assist residents in making a choice at meal times. The Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 16 home has recently changed their menu planning following advice and training from a company of nutritional consultants. A visit was made to the main kitchen and the inspector was able to meet the chef and discuss the storage and preparation of food and menus. He was able to demonstrate a good knowledge and understanding of the importance of well balanced and well presented meals. Fresh fruit is provided daily and is available on request. There is little reliance on tinned, processed or frozen foods. Chestnut Court Care Home DS0000071133.V361292.R01.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): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The organisation and staff team make every effort to sort out any problems and concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to, taken seriously and acted upon. All staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints or concerns made to them. The complaints record was inspected, and it was evident that complaints are addressed in line with the home’s complaints procedure. The Commission has received one complaint since the home opened and this is currently being addressed by the organisation to effect a satisfactory outcome for the complainant. Those residents spoken to were aware of how to make a complaint if they needed to, and one resident told us “I would speak to the manager, but the staff are so good that I have nothing to moan about”. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 18 The home has a suggestion box in the reception area for the use of visitors and residents, and there is also a book in which they are encouraged to make comments. In discussions with the Business Services Manager it was evident that complaints and comments are used to inform improvements to the service, and in the quality assurance process. All of the current staff have undertaken training in safeguarding vulnerable adults and this is included in induction training for all newly recruited staff. This was evidenced on staff files and the training schedule. Those staff spoken to were able to demonstrate a good understanding of the organisation’s policy and procedures in this area and were conversant with the action to be taken if they had concerns about the safety and welfare of residents, or if they witnessed any suspected abuse. Chestnut Court Care Home DS0000071133.V361292.R01.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): Standards 19, 20, 23, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Chestnut Court provides a very homely and attractive living environment, which is appropriate to the specific needs and particular lifestyle of people living there. The high standard of cleanliness, comfort, facilities and maintenance adds considerably to their quality of life. EVIDENCE: The building was toured by the inspectors, accompanied by the Business Service Manager, at the start of the visit and all areas were visited again later during the day. Some bedrooms were seen either by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were very personalised and reflective of the occupant’s interests. All Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 20 bedrooms are provided with flat screen colour TV’s and have telephone points. All rooms have en suite facilities. We were told that all residents have flowers and chocolates placed in their bedrooms routinely on admission as a welcome to the home. There were no offensive odours and the home was very clean and tidy. The décor, furnishings and fittings are to a high standard. The external grounds and attractive rear garden are equally to a high standard. There is a full time maintenance person and there is an effective system in place for staff to report items requiring repair or attention. The signage and décor on the dementia unit could be developed further to aid orientation and provided objects, pictures and items of interest for people living with dementia. The laundry area was visited and this was found to be well equipped and clean, with soiled articles, clothing and foul linen being stored appropriately, pending washing. The laundry person is aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, goggles, masks and gloves were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. The home is fully accessible to people with physical disabilities. There are adaptations and equipment in situ which are capable of meeting the needs of all residents. Chestnut Court Care Home DS0000071133.V361292.R01.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): Standards 27, 28, 29 & 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual assessed needs of the residents. Residents benefit from a committed staff team who have the skills and training to meet their needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff rotas were inspected and the staffing levels and skill mix of qualified and nurses and care staff, on all units of the home, was sufficient to meet the assessed nursing and personal care needs of the residents. The home has only been operational for a few months and is not up to full occupancy. However, from discussions with the Business Service Manager it was evident that there are clear plans in place to increase staffing levels in line with an increase in admissions to the home and based on individuals assessed care needs. The home employs a Care Services Manager, whose role is that of deputy manager and she currently works forty hours per week on a supernumerary basis, across all floors of the home. Care workers were being effectively deployed to ensure that residents choosing, or needing to remain in their Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 22 bedrooms were being cared for appropriately. Effective team working was observed throughout the inspection, and staff interacted well, both with each other and the residents. The training records were inspected and current staff have received training in moving and handling, health and safety, medication, safeguarding vulnerable adults, dementia, dying/ bereavement and fire safety awareness. Several staff have received training in first aid and care planning, and the Mental Capacity Act 2005, and its implications on the delivery of care to vulnerable people. There is a well-planned and comprehensive induction training programme for all staff. One member of staff told the inspector that at the beginning of her employment she underwent two weeks intensive induction training and covered the six broad values of rights, choice, privacy, dignity, independence and accomplishing goals. Ongoing training is available for all staff including National Vocational Qualifications, and it is apparent that training is given a high profile by the organisation. The files of three staff were inspected and these were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. The AQAA informed us that as part of the staff recruitment procedure, candidates are routinely invited to the home to meet with the staff team and residents. Carebase Limited; as an organisation, employs a workforce from diverse cultures and backgrounds. It was apparent at the time of the inspection that generally the ethnicity of the staff team matched that of the people currently living in the home. In discussion with staff they were able to demonstrate an awareness of the importance of understanding and appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. It is important that this awareness continues to be reinforced through staff training and supervision. This will ensure that the spiritual, dietary, cultural, sexual and any other diverse need of residents at Chestnut Court is met through meaningful ‘person centred’ care. The organisation is able to demonstrate that they operate a proactive recruitment procedure in line with equality and diversity. The maintenance person told the inspector that when he applied for the position he was really happy with the recruitment process and that the fact that his age had no bearing on the appointment. It was not even a discussion point during the interview. Chestnut Court Care Home DS0000071133.V361292.R01.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): Standards 31, 32, 33, 35, 36 & 38 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. There is currently no registered manager in post. However, the registered providers have replaced the vacant position with a well qualified and experienced temporary appointed person. In addition there is regular input from the Business Services Manager. Active attempts are being made by the organisation to appoint a new person into the manager’s role. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service being provided in the home. Staff are appropriately supervised and the health, safety and welfare of residents and staff are promoted and protected. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Commission were informed the day prior to the inspection that the home manager had not successfully completed his probationary period of employment and that his position as manager had not been made permanent. The organisation’s Business Services Manager was present throughout the inspection the following day. She informed us of the interim arrangements that had been put in place to support and manage the home whilst a new person was being appointed to the manager’s position. The organisation has a peripatetic home manager who is an experienced and well qualified person. She will manage the home on a full time basis, with regular support from the Business Services Manager during this interim period. Active attempts are being made by the organisation to appoint a new person into the manager’s role. In discussion with nurses, care staff and ancillary staff it was evident that they felt well supported by the organisation in the absence of a registered manager. They demonstrated a commitment to ensure that they continued to work as a team for the benefit of the residents and to provide a high standard of care. From viewing staff records and talking to staff it was evident that there is a formal supervision process and staff receive regular supervision. This could include observational and peer supervision as well as 1:1 supervision sessions. The home benefits from the quality assurance procedures of the registered organisation, Carebase. A representative of the organisation undertakes monthly Regulation 26 monitoring visits to monitor and report on the quality of the service being provided. A copy of the report is sent to the Commission. Currently the organisation does not act as an appointed agent for any resident. Residents’ financial affairs are managed by the individual resident, or their relatives/ representatives. There is a computerised financial system in place, which is managed by the home’s administrator. Through discussion with the administrator and records inspected, there was evidence to show that resident’s financial interests are safeguarded. Secure facilities are provided for the safekeeping of any valuables held on behalf of residents. The home employs a full time maintenance person who is responsible for general maintenance around the home, and ensures that routine checks are undertaken on water temperatures, emergency lighting, fire alarm testing, smoke alarms, pressure mattresses and pressure cushions. He also regularly checks wheel chairs to ensure that they are kept in good order. All staff, including any agency or temporary staff, are trained in fire safety and the action to be taken in the event of a fire. A fire risk assessment has been Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 25 undertaken in line with new fire regulations. Records were in place to evidence that the lift; nurse call system, electrics and gas are regularly serviced. Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 X X 3 3 X 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Good Practice Recommendations Staff need to ensure that daily recordings are more in line with outcomes identified in the care plans, and also that the implications of the Mental Capacity Act are routinely taken into account in both care planning and daily recordings. The signage and décor on the dementia unit could be developed further to aid orientation and provided objects, pictures and items of interest for people living with dementia. 2 OP19 Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 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 Chestnut Court Care Home DS0000071133.V361292.R01.S.doc Version 5.2 Page 29 - 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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