Inspection on 06/05/05 for Chestnut Grange Care Home

This inspection was carried out on 6th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Chestnut Grange Care Home 26/07/06

Chestnut Grange Care Home 24/01/06

Chestnut Grange Care Home 29/11/04

Chestnut Grange Care Home 07/04/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Chestnut Grange Care Home Main Street Weston Nottinghamshire NG23 6ST Lead Inspector Jayne Hilton Unannounced 6 May 2005 10:00 am th 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Chestnut Grange Care Home Address Main Street Weston Nottinghamshire NG23 6ST 01636 821438 01636 822 642 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Voyage Limited Ms Brenda Rolph Care Home (CRH) 10 Category(ies) of Learning Disability (LD), x 10 registration, with number of places Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users shall be within the category LD Date of last inspection 29/11/04 Brief Description of the Service: Chestnut Grange is a large detached property in a very rural area. It is home for 10 service users with a learning disability and additional specific needs.There is an enclosed garden to the rear and a smaller garden to the front of the property, there is also ample parking to the front of the property.The home provides transport for the service users. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by examining three service users personal records, observing practices, undertaking a tour of the building, looking at service users rooms, speaking with four staff and the manager, examining records and speaking/communicating with five service users. The inspection time was eight and half hours. The Inspector wishes to thank the service users for their helpful comments and in allowing her to have such insight into their specialist needs. What the service does well: Service users individual needs and aspirations are assessed and prospective service users know that the home will meet their needs and aspirations. Multi disciplinary involvement and support contributes to the specialised development plans. Service users at Chestnut Grange know their assessed and changing needs, personal goals and responsible risk taking, are reflected in their individual plan, they are consulted and encouraged to participate and make decisions about their lives with assistance as needed. Service users are encouraged to strive for personal goals and service users have made significant progress and achievement despite having complex needs. Service users lifestyle’s are well balanced with personal development, education, leisure and daily living responsibilities and routines, which promote community links and inclusion. The management of the complex needs of service users is balanced with good promotion of individual rights. A service user commented, “Chestnut Grange is a good place to live because the staff cares a lot about the residents”. “Nothing here needs to change,” when asked if really sure the service user stated adamantly, “I’m positive” Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 6 A staff member commented that Chestnut Grange is successful as the staff are consistent in approach and support each other, the work can be stressful at times, we can talk to each other and we are open. Brenda the manager is approachable and very good. She is helpful to staff regarding personal issues etc. Brenda encourages staff to develop and provided good supervision and appraisal. A service user commented that he liked living at the home, stating he gets on well with the staff, he gets a bit upset and down and the staff help him to get through it. There are good systems in place for staff support and a good level of training provision. Service users live in a homely, clean, comfortable and safe environment. Personal and communal space meets the needs of individuals residing in the home. What has improved since the last inspection? What they could do better: Some terms of address used by staff to service users, may be not appropriate and this requires sensitive review. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 7 The systems in place for ensuring the healthcare needs of service users are met require improvement. The systems in place for the management of medication in the home overall, require evaluation and review to improve practice. Further training and input is required to ensure that staff can discuss and challenge practices in an open and professional way. Service users finances require robust checking and auditing to protect, both service users, manager and staff. There are identified issues around surface temperatures of radiators, water temperatures and use of rugs, which must be addressed to ensure the safety of service users. 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. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,5 Service users individual needs and aspirations are assessed and prospective service users know that the home will meet their needs and aspirations. Multi disciplinary involvement and support contributes to the specialised development plans. Service users had an individual written statement of terms and conditions. EVIDENCE: Three care/development plans were examined, each contained a detailed assessment, which included clear information about any specific or specialised needs. Terms and conditions of residence were seen and signed by the individual or their representatives. The document contains a furniture list of what the home provides in service users rooms. The National Minimum Standards ST 26.6 includes a table and this was not included in the homes list. The organisation should look at this. The service users at Chestnut Grange have various specialist needs, including Prada Willis Syndrome and Pica syndrome. Development plans were well detailed and informed staff of how service users needs will be met. There was evidence that development plans are supported Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 10 by, psychiatrists, psychologists, social workers etc. A review for one service user was held on the day of the inspection. A service user had written a statement of his needs within the development plans. Development plans include short and long term objectives. The achievements of service users were very clear and a service user praised the manager and staff for supporting him to achieve his particular goals. Pictures and symbols were observed within development plans and around the home. Staff were observed to communicate in various methods, including the use of makaton. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9, Service users at Chestnut Grange know their assessed and changing needs, personal goals and responsible risk taking, are reflected in their individual plan, they are consulted and encouraged to participate and make decisions about their lives with assistance as needed. EVIDENCE: Three development plans were inspected, all were detailed and provided clear guidance for staff and are designed to identify service users needs and to establish and monitor service users short and long term needs. Weekly programmes for activities are included. Key values are incorporated within the package with aims and the philosophy of care to increase the level of independence for service users. The service users have accompanying challenging behaviours and therefore development plans are structured with the oversight of other specialist professionals in order for staff to assist the service users to manage these behaviours. Development plans covered the holistic needs of service users. The participation of service users, was evidenced by, personal statements or signatures. Resident meetings are held and there is a key worker system. A service user thanked the staff for working with him and he informed the inspector that is weight loss is making him more comfortable and he is happier Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 12 in himself. The service user discussed all aspects of his development plan, his syndrome and his healthcare needs. He was very knowledgeable about his condition and very aware of why his programmes and development plan is structured. Risk assessments were evident and deemed appropriate by the inspector. All were reviewed on a six monthly basis. Within the necessary structures of the development plans service users are offered choice and encouraged to make decisions within any limitations set. Contracts for behaviour plans are used and those service users spoken with were aware of what these were. Staff members were observed reminding service users and interacting in a professional but non oppressive approach. Contracts for behaviour programmes, are signed by the individual service user. A buzzer alarm is set up within the office, which indicates when a service users bedroom door is accessed. The reasons for this are documented and the inspector is satisfied that this is in place in the best interests of service users and is consistent with the purpose of the service and the homes duties and responsibilities. Two service users confirmed that they go to bed and get up when they please, but go to bed reasonably early as they get tired and get up for medication. Otherwise they have the freedom to stay in bed as they wish. Service users were observed to communicate freely and were smiling. Where service users develop increasing frailty or reach 65 years, development plans should address this to ensure that the holistic needs of the service users are maintained and met. Service users records are stored securely, in the managers office, Staff were observed gaining access as required. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13,14, 16, 17 Service users are encouraged to strive for personal goals and service users have made significant progress and achievement despite having complex needs. Service users lifestyle’s, are well balanced with personal development, education, leisure and daily living responsibilities and routines, which promote community links and inclusion. The management of the complex needs of service users is balanced with good promotion of individual rights. Some terms of address used by staff to service users, may be not appropriate and this requires sensitive review. EVIDENCE: Service users spoken with informed the inspector about their daytime occupations and activities which ranged from college placements, birds of prey Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 14 centre, independent living skills support and training, money management, numercy and leisure pursuits. A service user went shopping with a member of staff to the local town on the day of the inspection and another informed the inspector she travels to Clipstone to an educational project, called Rumbles. A trip to Alton Towers had taken place the day before, one service user told the inspector he had made a decision not to go for personal reasons. The home has its own minibus, and service users may use public transport if able. Service users reported that holidays are arranged and that birthdays are celebrated with parties and buffets. According to the service users spoken with, there is always plenty to do and that they go out and about on trips. Service users spoken with confirmed that staff knock on their bedroom doors before entering, give mail unopened and respect their privacy. Service users who are able have keys to their rooms, a service user was observed using a key to gain access, other service users have access to their key with supervision. The service users preferred term of address was noted in the development plan, however the inspector observed a service user being addressed by a staff member that may be deemed to be inappropriate or misunderstood by a lay person. The manager needs to address this and ensure that service users are only addressed by a term of their choice, is age appropriate and respectful. A Charter of Rights Statement was observed in the development plans examined. There was lots of staff/service users interaction observed throughout the day of the inspection. Senior staff particularly demonstrated skill and knowledge of the individual’s needs and programme. There were some new members of staff that were observing and learning the specialised techniques of communication. Service users spoken with informed the inspector that they have responsibilities for housekeeping tasks, which was supported by evidence in development plans and individual contracts. Food is stored away from the main building as part of the structure for assisting service users to manage their eating disorders. A service user discussed his diet in detail and informed the inspector that service users need about 1, 200 calories a day. The service user explained that the menu is displayed in the kitchen, and each resident, chooses, what they want for tea from the menu. When parties and buffets are arranged service user are supported to enjoy the occasion within the limitations of their disorder and have a selection of buffet items plated up within their choice options. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 15 A mealtime was observed, staff eat with service users and support a relaxed and unrushed atmosphere. Food stocks were observed to be ample. Service users were observed to be moving freely in the home and gardens, within the limitation of the buzzer/alarm already discussed in the report. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21 Service users are provided with flexible personal support to maximise privacy, dignity, independence and control over their lives. The systems in place for ensuring the healthcare needs of service users are met require improvement. There are examples of good practice within the area of medication, however, the systems in place for the management of medication in the home overall, require evaluation and review to improve practice. The wishes of service users at the end of life are obtained. EVIDENCE: The development plans contained clear information about the personal support and specific healthcare needs of service users and a service user spoken with explained about his personal circumstances in detail. Service users informed the inspector that they choose their own clothes when getting up in a morning and confirmed staff support for personal care as identified within the personal development plan. Service users were observed, to be dressed in varying styles, which reflected their personality. The bedrooms inspected were also personalised. Support from specialist professionals is documented in the development plan. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 17 Where service users present challenging behaviour this is covered within development plans and charts. Chiropody check records are kept in a separate folder. It is recommended that the system for documenting routine healthcare checks including annual well person checks, smear tests is reviewed and that all information pertaining to the individual is kept within their individual file, unless there is a justified reason for not doing so. A service user explained to the inspector what his medication was for and how and when this was taken. A staff informed the inspector, that those, staff who administer medication undertake ‘distance learning’ training in medicines management. There was no evidence of competency assessments being carried out by the manager to ensure that practices are followed and this should be introduced. The keys for the medicine storage room were kept with other house keys and although these are handed over between senior staff, the drug keys should be separate. A spot check on boxed medication showed that a dosage of Diazepam did not correspond with the Medication Record Chart, which highlighted that the checking in procedures are not effective or being followed. Photographs are used on medication charts. A medication round was not observed but when a staff member relayed the procedure practiced, it appears that medication is signed for before the staff member has visibly observed the service user take the medication which is not appropriate practice. Blood sugar monitoring records were seen. The policy for drug errors informing staff of contact numbers and procedures needs to be visible and remind staff to report any incidents of drug errors to CSCI, as required by regulation 37. The Inspector was informed there were no service users who were self medicating currently. Development plans included detailed information about medication and should be developed to contain medication profiles of service users, which details any medication reviews and changes in medication. Where suitable, service users may wish to work towards a goal of achieving independence in managing their own medication and this should be part of the medication profile also Where service users are prescribed ‘as required’ medication [PRN] for challenging behaviours, this is only administered after authorisation from a senior manager in the organisation, this system of good practice ensures that PRN medication is only dispensed to service users as a last resort in managing behaviour or at the service users request. The British National Formulary was in date. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 18 The Inspector gave the manager details of the Royal Pharmaceutical Society guidance on medicine administration in care homes in order for policies in medicines management policies and procedures to be further developed. The wishes of service users at the end of their life are documented within development plans. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 There is an effective complaints procedure which service users are clear about. Service users are protected from abuse, neglect and self harm, however further training and input is required to ensure that staff can discuss and challenge practices in an open and professional way. Service users finances require robust checking and auditing to protect, both, service users, manager and staff. EVIDENCE: A service user explained how to make a complaint should they have one. Five complaints have been received from service users [various issues] and a neighbour [about parking] since the last inspection in November 2004 CSCI have not received any complaints about the home. A copy of the complaints procedure had been issued to those service users whose personal files were examined. The policy states that all complaints will be responded to within 5 days. Some staff interviewed did not appear to be fully aware of the complaints policy or whistleblowing policies should there be a reason to express concerns or challenge about other staff members practice. This was discussed with the manager, who agreed to address this area, in order to encourage staff to discuss good practice and not so good practice in an open and blame free culture. [see standard 31 and 38] Staff confirmed that they had undertaken adult protection training. Service users spoken with said they felt safe. A service user commented that the manager does listen to what he has to say. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 20 Policies are in place for dealing with verbal and physical aggression and all incidents were fully documented. A sample of service users cash records, were examined, one small discrepancy was noted on one record and one withdrawal did not correspond with records kept in the home. The manager should check the records monthly and sign that they have been checked and a representative from Voyage should audit the financial records periodically. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27 28,30 Service users live in a homely, clean, comfortable and safe environment. Personal and communal space meets the needs of individuals residing in the home. EVIDENCE: Chestnut Grange is a large detached property, which is in keeping with the local community. A tour of the building was undertaken at the inspection. Furnishings and fittings were in good order and were domestic and homely. There is provision for the staff of a suitable sleep-in room and the manager with a large office. The kitchen was large and the equipment appeared adequate. The activity room, dining area and large lounge are nicely decorated and are equipped with suitable furniture, The activity area provides a very pleasant environment and an alternative room to be used if relatives want to meet with service users in a room other than their bedroom. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 22 There are large enclosed gardens. Three service users showed the inspector their rooms. All bedrooms examined were furnished and equipped appropriately and personalised by the individual, one service users room is in need of redecoration as he has stripped the paper off stating it was not his choice. The service user informed me that he had chosen some new paper and was working towards having this decorated. Toilet and bathroom facilities were sufficient, all were clean, had privacy locks and adequate ventilation. The laundry area was inspected and appeared to meet the standard. The home was very clean and free from offensive odours on the day of the inspection. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33,34, 35, 36. There are good systems in place for staff support and a good level of training provision. Overall staff members are clearly skilled and confident in the work they perform, but there are some areas of disparity, which the manager must address. Service users are supported and protected by the homes recruitment policies and practices. Service users needs are met, by competent, confident and skilled staff. EVIDENCE: Four staff were spoken with at the inspection and the manager and assistant manager and although copies of the General Social Care Council code of conduct booklets were clearly available in the home there was some disparity in knowledge of the main aims and values of the home, their understanding and implementation of policies and procedures and how their own work and that of others staff including keyworkers, promote the main aims of the home. The main issues were around the implementation of structured development/care plans, consistency of approach and team dynamics. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 24 The issues have been identified with the manager and this is to be addressed. It is recommended that the National Minimum Standards 22, 23, 31 and 38, are explored within team meetings and individual supervision topics. Induction of new staff comprises of skills for work, mentoring and records of this was seen. One fairly new staff member had unfortunately not fully completed their induction due to a breakdown in the IT system. The manager reported this was being dealt with. Staff reported that they had undertaken safe handling, First aid, Strategies for Crisis Intervention and Prevention [SCIP], Health and safety, food hygiene, COSHH[Control of substances hazardous to helath], Abuse awareness, autism training, safe handling of medicines, fire training, better management of challenging behaviours, infection control, The role of the keyworker, crisis intervention, petty cash LDAF [Learning disability award framework] and NVQ’S [National Vocational Qualifications]. Staff personal records supported this. Staff meetings are held and minutes of these were seen. A sample rota was selected and to cover the needs of service users who require 1:1 or 2:1 staffing, 6/7 staff is rostered for each daytime shift. The manager and assistant manager are extra to this but will cover carer/support shifts as required. The manager explained that 2 staff cover, waking nights as general practice, however there may be occasions that 1 waking and 1 sleep in is used where staff shortages occur. There is always 1 male and 1 female on night shift. The home is supported by, two regular bank staff, which with staff overtime keeps staff cover and continuity for the service users. A domestic works 20 hours a week and a handy man provides 32 hours support. Supervision records for three staff were examined and found to be appropriate and frequent. A sample of staff personal files was examined and found to be in order. The manager confirmed robust recruitment practices, however there was no CRB for the visiting hairdresser and this must be rectified urgently. Observations of staff on the day of the inspection demonstrated a skilled, calm and respectful approach to service users. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38, 41, 42 Service users benefit from a well run home that generally promotes and protects their health and safety. There are identified issues around surface temperatures of radiators, water temperatures and use of rugs, which must be addressed to ensure the safety of service users. EVIDENCE: The acting manager has recently attended a fit person interview to be registered and is awaiting the outcome. She is currently undertaking the Registered Managers award When asked what the nicest thing was about Chestnut Grange, a service user stated, “Brenda the Manager, when the inspector asked why, the service user went on to say that before Brenda came there were three other managers, Brenda lifted everything, the house is much better, she brings in flowers, Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 26 makes the house brilliant she treats us very well and knows how to help us properly”. “Brenda does listen to what I have to say and tries to sort things out” The assistant manager echoed everything the service user said, adding that Brenda is very committed to Chestnut Grange and the service users who live there. A service user commented, “Chestnut Grange is a good place to live because the staff cares a lot about the residents”. “Nothing here needs to change,” when asked if really sure the service user stated adamantly, “I’m positive” A staff member commented that Chestnut Grange is successful as the staff are consistent in approach and support each other, the work can be stressful at times, we can talk to each other and we are open. Brenda the manager is approachable and very good. She is helpful to staff regarding personal issues etc. Brenda encourages staff to develop and provided good supervision and appraisal. A service user commented that he liked living at the home, stating he gets on well with the staff, he gets a bit upset and down and the staff help him to get through it. A sample of records were examined including service users information, accident records, rotas, training records staff personal records, fire safety records, water outlet temperature checks, service users financial records and complaints. Most have been covered in the context of other standards, however the water temperature records paperwork should be reviewed to include a column for comments where the temperature exceeds 43 degrees, the action taken and a retest record. Health and safety practices in the home appear to be well managed, evidence was in records of kitchen records, evidence of gloves and liquid soaps, a service user confirmed that staff, wear protective clothing when attending to personal care and that he feels safety is protected. The health and safety poster and policies were satisfactory. Window restrictors are fitted throughout, however radiators were not covered and there was no evidence of risk assessments regarding this. Radiators felt hot and a service user was witnessed to be standing close to the radiator in the lounge until a staff member guided him away. The surface temperatures of radiators present a significant risk to service users, particularly those with complex needs and epilepsy and must be risk assessed and covers provided in priority areas. Where service users prefer rugs in their bedrooms, risk assessments must be included in their personal files. Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 4 3 3 3 x 2 3 Standard No 31 32 33 34 35 36 Score 2 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chestnut Grange Care Home Score 3 2 2 3 Standard No 37 38 39 40 41 42 43 Score 4 3 x x 3 2 x C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 28 NO Are there any outstanding requirements from the last inspection? 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. 2. Standard 19 20 Regulation 12, 13, 14,15 Requirement Timescale for action 6/8/05 6/8/05 3. 4. 20 20 5. 20 6. 23 7. 8. 34 42 Ensure the healthcare needs of service users are fully detailed within their development plans Medicines Ensure that all medicines Act, 13 received into the home are appropriatley checked and documented Medicines Ensure that all medication Act, 13 records are accurate and in accordance with the prescription. Medicines Ensure that staff only sign the Act, 13 medication record chart when they have visibly observed the medicines taken 12,13,18, Ensure all staff are fully aware of the policies and practices in relation to whistleblowing and protection 12, 13, The manager must address the 14, 15, 18 issues identified in Standards 22, 23, 31 and 38 and report the outcome to the CSCI 7.9,19 Ensure that an up to date CRB disclosure is kept on file regarding the hairdresser 12, 13, 16 Ensure that the surface temperatures of radiators are risk assessed and covers fitted to priority areas. 6/8/05 6/8/05 6/8/05 6/08/05 6/8/05 6/8/05 Chestnut Grange Care Home C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 2 7 16 Good Practice Recommendations Amend the terms and conditions document to include a table Implement a care plan for the service user who is 65years regarding ageing and increasing frailty, particularly in relation to arthritic knees and mobility. Ensure that the service users prefered terms of address are documented within the care plan and staff use this term of address. Sensitivity is required to ensure age appropriate terms are used. Service users should be encouraged to have an annual well person check Development plans should have a running record sheet for healthcare sheets, ie Chiropody, GP, dentist, optician etc A copy of the drug error policy should be posted on the drug cupboard door, and /or in medication record folder for easy access and should prompt staff to report under the regulations to CSCI Each service user should have a medication profile which contains a history of medication, medication reviews and any changes Service users should be offered the opportunity to self medicate or work towards this as part of their development plan Competency assessments should be carried out by the manager for staff who have undertaken medicines training and on an ad hoc basis. The assessment needs to be documented. The drug keys should be kept seperate to the other house keys The manager should check service users financial records monthly and sign that this has been completed. The records should also be audited by the responsible individual. Where water outlet temperatures exceed 43 degrees, an action comment should be recorded and the result of a retest. Where service users wish to have rugs in their rooms, a risk assessment should be undertaken C53 C03 S8754 Chestnut Grange V225184 060505 Stage 4.doc Version 1.30 Page 30 4. 5. 6. 19 19 20 7. 8. 9. 20 20 20 10. 11. 20 23 12. 13. 42 42 Chestnut Grange Care Home Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 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. 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