Inspection on 23/07/08 for Chestnut Court Rest Home

This inspection was carried out on 23rd July 2008.

CSCI found this care home to be providing an Adequate 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

Chestnut Court Rest Home 07/08/06

Chestnut Court Rest Home 04/10/05

Chestnut Court Rest Home 13/04/05

Chestnut Court Rest Home 08/11/04

Chestnut Court Rest Home 27/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Chestnut Court Rest Home 9 Copse Road New Milton Hampshire BH25 6ES Lead Inspector Joy Bingham Unannounced Inspection 23/07/08 09:00 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 Rest Home DS0000011777.V367382.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 Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Court Rest Home Address 9 Copse Road New Milton Hampshire BH25 6ES 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) 01425 620000 01425 627707 chestnutcourt-care@yahoo.co.uk www.chestnutcourtcarehome.co.uk Goldenpride Limited Mrs Patricia Harrison Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: Chestnut Court is set in a residential area close to local amenities and New Milton town centre and only 10 minutes drive from the coast. It provides residential care for up to 25 elderly residents, some of whom may have dementia. The home is on the ground and first floors and there is a wheelchair adapted passenger lift between these. Chestnut Court is a ‘no lifting’ home but there are a variety of aids and adaptations to allow residents to move about independently. Twenty three of the bedrooms are single with en-suite facilities. One is a double room. There are two communal toilets on the ground floor and a bathroom on the first floor. There is a garden with seating to the rear of the property. Fees vary according to the room chosen, facilities available in the room and individual care needs, and are in the range of £425 to £550. This includes personal laundry and entertainments/activities. The providers gave this information during the inspection on 23/07/08. Chestnut Court Rest Home DS0000011777.V367382.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 1 star. This means the people who use this service experience adequate quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included the Annual Quality Assurance Assessment (AQAA) completed by the home, and survey comments from residents, and staff. An unannounced visit to the home was carried out on 23 July, lasting a total of 8 hours and 45 minutes. During this time we were able to have a partial tour of the premises, including five ground floor bedrooms and a number on the first floor, the two dining areas and lounge, laundry, kitchen, bathroom and toilets. We had discussions with the manager, deputy manager and two staff, 4 visitors, and contact with a number of the residents of the home. Comments were obtained from professional stakeholders. We sampled staff and care records, and policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection (CSCI). What the service does well: What has improved since the last inspection? Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 6 No requirements were made at the conclusion of the last inspection. The home has replaced a number of the en-suite baths with showers that have proved more usable to the residents. Some bedrooms have been redecorated and re-carpeted. The provision of an alternative quiet lounge/dining room has helped the residents to move away from noise and challenging interactions. 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 Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 7 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 Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 8 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): 3 ,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ are confident their needs can be met by the process of preadmission assessments conducted by the home and by information they are given that welcomes them to the home and tells them about the service they can expect. EVIDENCE: The home informed us that all potential residents are given a brochure and access to a welcome pack and a service user guide. They or their representative are invited to visit the home prior to admission. One family member said she was taken on a tour of the premises and was impressed that she was even shown into the kitchen. She had been able to download the previous inspection report from the internet and had researched for herself but noted that the home had been open and transparent with the information given to her. She said ‘the manager was businesslike but kind’. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 9 Four other people told us that they received adequate information from the home before they moved in. We noted from the written contract and what we were told by the staff that every resident is given one month’s trial residence. Three missing elements in the service user guide that are required by law were pointed out to the deputy manager. These were a standard form of contract for the provision of services and facilities, the range of fees and method of payment, and a copy of the last inspection report. The deputy manager agreed to incorporate these items. We also commented that the staff had said during the inspection that Chestnut Court is a no lifting home and should anyone require regular lifting they would have to move elsewhere. This needs to be clearly stated in the written information people receive before they move in. It also states that the majority of our staff are trained nurses which is incorrect and misleading to the public. We sampled four preadmission assessments that had been conducted recently. They had been completed either by the manager or the deputy manager. In most cases they had been undertaken where the resident lived. One had been taken down over the telephone from staff caring for someone in hospital. This had been followed up with further hospital records. However the information did not impart an accurate profile of the person and as a result establishing a care plan from this simple assessment had proved more complex. Records had been made of assessments. They were signed but not always dated. They were available for inspection. The home is usually full and does not make specific provision for intermediate care. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal support is not always offered in a way that promotes the residents’ choice and dignity and does not always provide good protection through risk assessment and thorough care planning. The systems for the administration of medication are good, but regular monitoring of practice is needed to ensure the residents’ medication needs are always met. EVIDENCE: On arrival at 9 am we saw that some residents were already in the lounge and others were in process of arriving there. One lady was in her night attire and dressing gown and one gentleman was in his pyjamas. Staff treated them kindly and politely. We observed interactions during the day, staff helping people into and out of the lounge and assisting them with their meals. It was evident that some residents had an advanced level of dementia. There were a number of occasions when their inability to express themselves or be understood, could have spilled over into episodes of frustration, e.g. wanting to Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 11 leave the building, wandering with intent but unable to describe the reason. The staff responded kindly by using reassurance and distraction. We saw that people who chose to stay in their rooms and come down to the dining room for coffee and meals were enabled to do so, and those who chose to stay in their rooms all day could also do so. Care files for four residents were inspected and found to be in a well-ordered modular layout. They contained preadmission details, including contact information, a very basic care plan, limited risk assessments, a medical report section, a coded activities and personal care record. The ones sampled had been completed by the residents’ key worker and although the provider could identify who had completed them, they were mostly undated and unsigned. Day and night reports were kept separately and then incorporated into the residents’ files periodically. An ABC form (antecedent behaviour chart) was available. There were a number of aspects of the care planning process that we raised and discussed with the deputy manager. • We could not see any evidence that the care plans had been agreed with the residents or, where they are not capable, with their representatives. When asked, one family visitor who was very involved in the residents’ care said she was unaware that there was a written care plan established by the home or that she could contribute to one. • Assumptions were made by the staff about the residents’ acceptance of cross gender care. One male carer had been recently employed and the manager and deputy both stated that residents are free to say if they do not wish to be supported with personal care by a male member of staff. One senior member of staff said she had never thought about it as an issue before. The male member of staff told us that the day before the inspection a lady with dementia had requested a female carer. He said “she said ‘no’ but I convinced her”. He had responded to her refusal by saying that he was a carer and there to help her, and she said ‘Oh, Ok then’. When we subsequently asked the resident in private an open question about preference she said, ‘I’d prefer a woman. I’m not with men doing it. I’ve not liked the way they touch or pull. It makes me shudder.’ A family member who was present at the time said, ‘Mum really would not like a man at all to help her with her personal care’. • Very few written risk assessments were available when we would have expected them to be there e.g. people at risk of falling, some made vulnerable by their dementia, a very elderly resident with food controlled diabetes who was managing her own nutrition/consumption. • The written records lacked a pen picture of the person and any helpful, detailed information about life history, personal tendencies, social and psychological likes and dislikes, significant life experiences. • Given the level of dementia there were few recorded strategies to manage behaviour. The ABC had not been put into use when it could have proved a useful document e.g. a lady wishing to get out of the Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 12 • • • home all the time, another constantly annoying others with loud and sometimes abusive comments. The care plan for at least one resident was very out-of-date. One resident who we were told had been bedfast for a month and was now in receipt of terminal care with no food and limited drinks had a care plan describing her independence and mobility. The above resident had flow charts recording the times at which they had been given water and were turned in bed. During the night this had been done every hour or hour and a half. Since 6:15am there was no record made until past 11am. This was raised with the manager immediately. A member of staff said she had attended to the resident at about 10am but had forgotten to record this. (The district nursing service subsequently confirmed that the home has been managing this adequately as the resident has no pressure areas that are breaking down from lack of turning). From the records we learned that one resident had a sore area requiring washing twice a day and medicated cream applying after cleansing. This instruction from the district nurse was recorded by staff in the day book but a task of care had not been established in the care plan. The day records repeatedly stated ‘all fine’ with no reference to action about this. When asked the deputy said the resident is largely self-caring. It was unclear whether or not staff had been monitoring that this was done. A further repeat requirement from the district nurse who had revisited suggests it had not been followed up. We told the deputy that further thought should be given to all these issues and that strategies were needed to deal positively with some aspects of care and certain behaviours. The home informed us through their AQAA that they have good relationships with other agencies (doctors, district nurses, occupational health therapists and community psychiatric nurses etc.) and they know the correct times to access their support. There was evidence in the files of medical, dental, and opticians’ visits. Contact was made with stakeholders including local General Practices, district nursing service and care managers. The overall view was that the home is providing an adequate service but there is scope for building a greater degree of confidence in the standard of care and communication. Comments included: ‘They’re doing a very good job’ ‘On the whole it’s not too bad’ ‘Some issues have not been altogether their fault’ ‘there’s nothing neglectful but I’m not sure I leave feeling confidant’ ‘they seem to have a high turnover of staff’ ‘the care can be a bit basic at times’. ‘the home could do with a holistic philosophy as a good starting point.’ Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 13 ‘the standard of care that elderly people require does not always seem to be in place.’ From the four residents’ surveys that were completed we were told there is a high degree of satisfaction with the care and support they receive from the home, and also with the means of accessing medical support services. Comments included: • They had got the doctors in to see to Mum without me even asking. • I am happy that she is being cared for. • We were quite impressed really. • Yes. It’s OK. Things seem to go smoothly. The carer on duty explained the process of drug administration from ordering through to return. A list of staff members who are trained in medicine administration is kept with the records and we were told that only trained staff deal with the drugs. The drug trolleys were observed in use during the morning and at lunchtime. An audit trail of medicines was possible from the point when medicine is accepted by the home. A separate small drug refrigerator is provided for medicine that needs low temperature. A monitored dosage system is followed and there are photos of each individual resident on every administration sheet. A copy of the drug procedure was kept in each drug trolley for easy reference by staff when needed. Administration of medicines was observed and the following points were brought to the attention of the deputy: • One lady’s medicine from an earlier shift was presumed given as the blister pack had been popped but the administration record had not been signed. • One record was not signed for on the current shift although the medicine had been given. • It was uncertain whether a second dose of tamoxifen had been administered to one resident or whether the resident had refused it. • One resident was given a number of tablets at 10.10am when the record indicated an 8am administration. (This was also at a time when there was no food being consumed). • Water had been accidentally dripped into the medication cup containing a number of pills which meant one tablet had softened. The resident scraped it out with her finger and in the process tipped the other tablets out of the container onto her knee. • We learnt from an outside agency that in the recent past two residents had been discharged with medication from hospital following surgery for fractures. In one case the resident returned with medication to be injected daily over six weeks. The home assumed that the district nurses would come following receipt of information direct from the hospital. With communication breakdown a short delay ensued. The surgery said a more proactive follow up from the home had been expected. Chestnut Court Rest Home DS0000011777.V367382.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents benefit from an overall flexible approach to routines of daily living, and a variety of meals. There is scope for more individualised opportunity to engage in a wider range of leisure and social activities. EVIDENCE: The general atmosphere of Chestnut Court is homely. There is an absence of regimentation, with people moving around freely inside the home, and choosing between the ground floor lounge and the first floor lounge/dining room, or to remain in their rooms. A security code is necessary to enter and leave the house. Two elderly residents who were wearing badges with their names and ‘Chestnut Court’ on them, told us that they were the only two who could go out of the home without staff support. They told us they need the badge in case they got lost. The limited information in the care plans demonstrated that the residents’ interests/hobbies/preferences had not been individually assessed and recorded. Activities were arranged for the group and we were told that it was up to the resident to choose to join in or opt out of the event. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 15 Once a week art and craft is organised. Once a fortnight a keyboard player visits and another time a lady singer who does karaoke. A church service takes place every month organised by a local independent church. We were told that board games are organised by the staff when time permits, including bingo, dominoes and cards. Two of the residents regularly lay the tables in preparation for the meals. We were told that the staff take some of the residents along to the shops a short walk along the road, and many family members take people out for drives in the car and home visits. The provider said that parties happen every time there is a birthday. Organised trips out are not arranged by the home but the home has occasional events of fundraising. We were told that every day someone visits. We took the opportunity to speak with four visitors on the day of the inspection. They all spoke highly of the home and said they were made welcome and given hospitality. The survey returns indicated that there are ‘usually’ or ‘always’ activities happening. The meals at the home scored 81 satisfaction. A four-week menu plan is displayed on the notice board in the lounge. On the day of the inspection we were told the menu was to be smoked salmon and dill with crackers as a starter, followed by gammon and roast potatoes and mixed vegetables, then profiteroles. When it was served it was pate on toast, followed by chicken casserole, herbed potatoes and mixed vegetables, then trifle and cream. This can be confusing for the residents. However, it was nicely presented and staff assisted the residents where necessary. Comments from the residents included: • The food is good, mainly • What I’ve had has been very good • I love vegetables • Very adequate • I like sweet sandwiches Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are supported by the home’s complaints procedure and protected by a staff team who are trained in awareness of abuse issues and whistle blowing on poor practice. EVIDENCE: The CSCI have not received a complaint about his home since the last inspection. The residents’ survey informed us that if they were not happy about anything in the home they/or their family knew who they could talk to, and they said they knew how to make a complaint. The home has a complaints procedure that forms part of the service user guide and the welcome pack. The contact details of the CSCI are not up-to-date, and the deputy agreed to amend that. We were told by the manager that no formal complaints have been received by her in the last twelve months. However, subsequently we were told that a resident had recently made a complaint about an incident with the night staff. While this was being investigated the resident had forgotten she had expressed any discontent. We were told that the home’s management were still continuing to collect written versions of the incident from the staff concerned. We told the provider that this should have been recorded in the complaints file/log. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 17 We spoke with two of the staff members in private. They expressed appropriate attitudes towards the support and protection of the residents and were aware of the policy of whistle blowing on poor and abusive practice. There was also evidence from the files that training had been provided to the staff team in understanding and detecting abuse and the appropriate procedures to follow. One member of staff had activated the whistle blowing procedure about two years ago and said she would not hesitate to raise any issue of concern. All staff are subject to POVA checks (protection of vulnerable adults register). Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a good quality environment with reasonable furnishings and fittings. The home offers a comfortable and homely place to live. EVIDENCE: Chestnut Court has mainly single rooms with en-suite toilet and shower facilities. All rooms have a staff call system. The house is a large family home that has been extended and adapted. It is located in spacious grounds. A full passenger lift operates between the ground and first floor. There is a lounge/ dining room on the ground floor and an alternative one on the first floor. The residents said they appreciated being able to choose which lounge they wanted to sit in. We noted that a selection of chairs and sofas are provided in the lounges, of various sizes and shapes to suit different tastes. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 19 A new, large, wide-screen television in the ground floor lounge gives a clear well defined picture. The hallway has a colourful, bright fish tank that is appreciated by the residents. A tour of the home confirmed that the home meets the current standards, with opportunity to improve aspects of the environment. • Some of the corridor paintwork is marked and chipped and in need of redecoration. • We were told that the laundry is small and too cramped to work in. It is a narrow room containing both a commercial and domestic washing machine and a tumble dryer. • Ensuite bathrooms are screened from the bedrooms by heavy curtains. Some of the curtains required re-hooking. • The back garden is attractively laid out with mature shrubs and colourful plants. However the exterior presents some hazard to residents due to the uneven paving. In particular the patio door-latch on the floor leading from the lounge presents a clear tripping hazard. • The grab rail along the corridors is grubby. We were told this had been regularly wiped with disinfectant in response to the recent outbreak of D and V. However, we stated that a thorough clean was necessary. • A number of bedrooms have a poor odour. The manager told us that the home is constantly cleaning carpets and they are replaced from time to time. • We noted a number of dressing table drawers that were labelled with their contents. When we asked about this as it can be an institutionalising feature we were told that the residents and/or their families particularly requested this as they got confused and or were of poor eyesight and it helped them remember where things were. The home was given a 94 rating in the survey returns for being clean and fresh. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by a mix of experienced staff and newly appointed, inexperienced staff. Greater focus is needed on securing and maintaining full staff records. The recent period of unsettled staffing has impacted the morale of the team, involving them in additional work and now supporting and training new staff. EVIDENCE: We observed the staff interaction with the residents throughout the day. They were kind and respectful, though not always confident. The leadership of the team was provided by the deputy manager who was ‘hands on’. Only two staff out of the team of fourteen had completed the confidential inspection surveys to indicate their views about how the home was run. The deputy manager provided an up-to-date staff duty roster that informed us that the normal routine is to provide three carers, the deputy manager, a dedicated cook, and a part time cleaner who works 5 hours each day. Shift patterns follow an 8am to 8pm, or 8am to 2pm and 2pm to 8pm and some 5 to 8pm shifts. Two night staff members are awake on duty from 8pm to 8am. The AQAA that was completed in October 2007 informed us that 78 of the staff team had obtained equivalent to Level 2 of the National Vocational Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 21 Qualification (NVQ) in care, including training in dementia. However some change of staffing has occurred and the process of raising the level of training for the staff group is continuing. The entrance hall displayed a large number of certificates for staff training, including understanding of dementia. The manager said the home put a lot of emphasis on training, and the providers readily agree to sponsor staff to attend relevant training events. One staff member said she felt the training was one of the home’s strong points and that she had benefited from accessing training and gaining certificates of competence in the full range of care issues. The residents’ survey confirmed they find the staff always listen and act on what they say, and 92 felt that the staff are always available. Two of the staff, including the deputy, were spoken with in private and they confirmed their confidence in their role and satisfaction with the support they receive working at the home. They told us that training was available and they had benefited from attending relevant courses. They expressed some sound values about care and were aware of the potential of abuse in this setting and what to do if it was ever experienced or witnessed. One of the staff had just started work at the home and they told us about the style of induction that had commenced. We were concerned to note that they had not come from a care background, and their confidence in the use of the English language was limited. Phrases such as ‘making a wash with the residents’, and ‘do you want green or white?’ when offering a choice of cauliflower or broccoli. They had received only 3 day’s induction but we observed were already getting residents up and dressed single handed, and forming part of the essential core staff team. No training had been given in the fire procedure. We were not reassured that this member of staff was competent to fulfil this role and that the residents actually had choice about whether they were willing to receive cross gender personal care. The limited use of English on the part of foreign staff was raised with the manager and she said that she recognised this is an important part of the role when communicating with elderly people. In the past foreign staff have been placed on English courses and she stated this would be processed again if necessary. The staff referred to the pressure they had felt from recent staff changes and being in the holiday period. Visitors said there had been many changes of staff faces, although it seemed better now. A notice from the deputy to the staff referred to her appreciation of their pulling together during an unsettled staff period. We were told that historically the home had not found it necessary to engage agency staff but more recently it had proved necessary in order to maintain a full staff roster. Subsequently the provider has confirmed that only three staff members have left employment since the end of last year, two of which were in June and July, which is a difficult period for recruitment. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 22 Records for staff were sampled. A number of shortcomings were brought to the attention of the deputy manager, including one member of staff with only one character reference, and two new staff with no criminal records bureau checks available. The deputy stated that the personnel service who recruits the staff had obtained the CRB clearances but they had not yet been sent to the home. For one new member of staff a work permit could not be located on the file. One staff file lacked a photograph. We required that the home review the information required by Schedule 2 of the Care Home’s Regulations to ensure the home maintains all that is required, and the deputy agreed to do this. The recruitment application form used by the home makes reference to the rehabilitation of offender’s statement but does not anywhere require the applicant to make a clear yes/no statement. This was brought to the attention of the deputy manager for action and she agreed to ensure this was adjusted for future use. Chestnut Court Rest Home DS0000011777.V367382.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): 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are supported by a manager and deputy manager who have years of experience within the care services. Management and administration systems are in place to underpin their leadership and to ensure that the health and wellbeing of service users are promoted. However, the residents would benefit from an increased level of the manager’s focus on monitoring the quality and effectiveness of the individual care planning; of the need and application of risk assessments; and effectively communicating their content to the whole of the staff team. EVIDENCE: The manager was unavailable the week before and during the inspection but called in during the day for a short period to be as helpful as possible. Assistance was given throughout the day by the deputy manager. Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 24 The manager has many years of experience in care, mainly in the field of learning disability. This is her first home managing care for the elderly. She is qualified to NVQ level 4 and she has obtained the Registered Manager’s Award. She has attended the Alzheimer’s Society training in dementia. She expresses a high commitment to training. This is demonstrated by the number of courses the staff are encouraged to attend. The visitors on the day indicated their satisfaction with the home, telling us that it has improved a lot, with ‘more regular and better staff.’ One said the manager was ‘business like and kind’. The manager told us about the positive and supportive relationship the home enjoys with the owner and the internal verifier who conducts the monthly assessment visits. We sampled the monthly reports that are produced and noted the recommendations made for on-going improvements. The home has a comprehensive file of policy and procedures covering aspects of employment and care management. It is available for staff reference in the first floor office. The AQAA informed us that it is reviewed annually. We saw that fire training for staff takes place twice a year and food handling and hygiene, manual handling training is done annually. Certificates of servicing for equipment were available and up-to-date. Reference is made in the health and wellbeing section of this report that indicates a greater focus must be placed by the manager on monitoring of the staff performance and attention to the home’s policies and procedures including drug administration, care planning and the identification of significant risks to individuals. There is also need to identify in writing risks within the home such as the door latch at ground level in the lounge that is a tripping hazard and the stone surface of the patio. The recurring incidence of scabies and recent outbreak of sickness and diarrhoea was noted. Safety procedures were posted in key places. The provider completes a monthly visit, review and reports on the conduct of the home. The home keeps the CSCI informed of any incidents or circumstances requiring notification. The accident book was inspected and details noted. We recommended that the manager should counter sign each entry regularly to ensure she is aware and taking any remedial action that is necessary. The deputy described the home’s procedure for assisting people with personal monies when requested to do so. Records are computerised. Cash is held in personalised wallets, in a locked cabinet, in a locked office. Receipts are kept. Where personal allowances are processed on behalf of residents these are Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 25 signed for and records kept. Two were sampled and found to be well ordered and in balance. The manager and deputy told us that the views of the residents and their families are constantly sought in an informal way and an annual audit of views takes place each year. Planned meetings to encourage comments and suggestions from family and friends have been held in the past but we were told that for some reason they were poorly attended. The home keeps records of compliments and letters of thanks provided by residents and their families. Chestnut Court Rest Home DS0000011777.V367382.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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Timescale for action Care plans must cover the social, 01/10/08 psychological and emotional needs of each resident to ensure they receive holistic care. The manager must supervise the implementation and maintenance of the care plans on a day-today basis to ensure all of the assessed needs are met. The manager must ensure that 01/10/08 medication is administered safely as prescribed and regularly monitor and keep under review the staff’s adherence to the recording and storage and handling of medication, to ensure there is no mishandling. 01/10/08 The manager must ensure risks are identified and assessments completed by a competent person for each resident at risk of falling, at risk from other residents, and those risks presented by the environment to ensure the residents are protected from harm. The manager must ensure that 01/10/08 the home obtains staff information and documents DS0000011777.V367382.R01.S.doc Version 5.2 Page 28 Requirement 2 OP9 13 (2) 3 OP19 13 (4) (a) 4 OP29 19(4) (b) Chestnut Court Rest Home required by law to ensure those employed to care for the residents are fit to do so. These must be available at the home for inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnut Court Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 29 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 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 Rest Home DS0000011777.V367382.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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