CARE HOMES FOR OLDER PEOPLE
Chestnut Grove Rest Home St Catherines Way Todd Lane South Lostock Hall, Preston Lancashire PR5 5XE Lead Inspector
Mrs Felicity Lacey Unannounced Inspection 22nd February 2007 10:00 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 Grove Rest Home DS0000005876.V322521.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 Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Chestnut Grove Rest Home Address St Catherines Way Todd Lane South Lostock Hall, Preston Lancashire PR5 5XE 01772 337061 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) kneen3@aol.com Ms Doris Mary Kneen Ms Doris Mary Kneen Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home is registered for a maximum of 11 service users in the category of OP (Old Age, not falling within any other category). Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 8th December 2005 Date of last inspection Brief Description of the Service: Chestnut Grove is a care home that has eleven beds for service users of either sex over the age of sixty-five years. The home is set in its own grounds in a quiet residential area in Lostock Hall, Preston. Chestnut Grove is close to motorway links and main bus routes. Accommodation is provided on two floors. The first floor is accessed by a stair lift, however there are three steps from the stair lift to the bedrooms. Accordingly service users with mobility problems are accommodated on the ground floor. The home has a large lounge and separate dining area. There is ramped access to the grounds which are safe and well maintained, outdoor seating is provided so service users are able to enjoy the garden. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. As part of this inspection an unannounced visit was made to Chestnut Grove. The inspector spoke with residents, a relative, staff and the owner of Chestnut Grove during the visit. At the visit documents and care records were looked at. Before the visit 7 comment cards were received from residents and 7 from relatives, 3 GPs also completed comment cards. The owner provided information about the home in a Pre Inspection Questionnaire. What the service does well:
All the comment cards and views expressed about Chestnut Grove were very positive. The home provides a service for up to 11 people, and this allows for close personal relationships to develop between residents, staff and relatives. The staff team are stable and the owner, who is also the manager of the home, is held in high regard by everyone who has contact with the home. Comments received from residents included: ‘Chestnut Grove Rest Home is comfortable, friendly, caring, and staff who make it feel like home’ ‘I could see as soon as I opened the door, this place was the one for me. It was so fresh and clean. The owner sat and talked with me…I could see her heart is in her job, also the staff, her words to me were “make this your home”. I could not wish for anything better.’ ‘Staff are very helpful and always listen respectfully, nothing ever seems to be too much trouble for them.’ Comments from relatives included: ‘I have been going to Chestnut Grove for 6 years…this is not just a rest home for the residents, it is also a home.’ ‘Since moving to Chestnut Grove Mother has put on weight, colour improved …we feel she gets excellent personal care.’ ‘Chestnut Grove is a homely welcoming rest home, and I have no worries about the care my mother receives which is excellent.’ ‘There is always a friendly, homely atmosphere at Chestnut Grove. The staff always show care and concerns for the residents.’ Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 6 ‘My mum has been at Chestnut Grove for 7 years. We cannot fault the home in any way-we have always found it to be a very clean, efficient, caring, friendly and a happy “Home form Home”’. The GP comment cards received confirmed that the staff of the home communicate clearly with the surgery, and demonstrate a clear understanding of the health needs of the residents. Staff who work at the home feel well supported and valued by the owner and the residents. Relatives consider the staff to be dedicated and supportive. The owner is committed to making sure that everyone is included in planning their own care and that everyone feels able to express their views. What has improved since the last inspection? What they could do better:
There were no areas for improvement identified during this inspection. The owner, staff team, residents and relatives are all involved in ensuring the home provides an excellent service and continues to improve. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 7 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 Grove Rest Home DS0000005876.V322521.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 Grove Rest Home DS0000005876.V322521.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All prospective residents are visited prior to admission to ensure that their needs are understood and that they can be met at Chestnut Grove. EVIDENCE: All comment cards received indicated that contracts were in place and that the home had provided enough information to enable an informed decision to be made, when moving to the home. All prospective residents have been encouraged to visit the home prior to deciding to move in. A resident spoken with explained that she had been very reluctant to move to a care home, but the owner and staff had spent time with her and she has settled at the home and has now decided that she wishes to stay permanently. The case files seen showed that a through assessment is completed and this is supported, where appropriate with a social work or health assessment. Chestnut Grove Rest Home DS0000005876.V322521.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 excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are understood and this means the support provided promotes their welfare. EVIDENCE: The care plans seen were detailed and contained information relating to the health, personal care and social care needs of the individual. Care plans were signed and reviewed regularly. The care plans were supported by relevant risk assessments, which ensured that the balance between independence and safety was maintained. The health care needs of the residents were documented. The GP comment cards received indicated that staff made appropriate referrals and followed advice given. Residents spoken with had confidence in the home, and were sure that any health concern they may have would be dealt with promptly. There were excellent examples of detailed health records being maintained which provided a clear picture of the changing health needs of residents. These notes are complied when a change is observed and then form the basis of a report to whichever consultant may be involved. The owner prepares clear and
Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 11 relevant reports that are then shared with the consultant by the staff or relatives. This helps ensure that appropriate health care can be given. The home maintains records of visiting professionals, including the Community Psychiatric Nurse, District Nurse and Chiropodist. All residents attend specialist services as needed. Residents with particular needs, such as sight difficulties are supported by the provision of aids and adaptations, for example one resident has a phone with large numbers, and received regular talking newspapers and books. Medication is stored and administered in a safe way. All senior staff have received training in the safe use of medication. Residents are able to self medicate if they wish and it is safe to do so. The records kept of medication administered were completed correctly. All residents and relatives who expressed a view thought that the staff of the home ensured that privacy and dignity were respected at all times. GP comment cards indicated that consultations took place in private. Staff knock at doors before entering and ensured that when helping a residents they took the time to explain what they were going to do. Some service users have their own telephone and maintain regular contact with their family members and friends. The home does have a double room, but currently respects the wishes of the resident who prefers it as a single room. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The social and spiritual needs of residents are respected at Chestnut House. Social activities are well managed and give residents and relatives the opportunity to enjoy their time together. EVIDENCE: Residents at Chestnut Grove enjoy an active social life, with regular events held through the year. Birthdays are celebrated and resident and relative were very pleased with the efforts made by the staff to make occasions special. There are three yearly events held at the home to which all are invited. Relatives are involved in helping at the annual barbecue and firework display. A relative spoken with had attended many events at the home. Residents spoken with enjoyed a variety of activities and had the choice whether to spend time alone or in company. A diversion therapist visits every fortnight and recent activities have included, Indian Head Massage and reminiscence sessions. Activities are geared to the interests of residents. There are arrangements in place for regular contact with local churches. A service is held every Sunday morning, and all who wish can attend. The local Roman Catholic priest visits weekly, and the Church of England vicar keeps regular contact.
Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 13 Residents can entertain visitors in the privacy of their own rooms, or in one of the communal areas. Relatives and friends are always made to feel welcome. The owner is keen to ensure that relatives and friends remain very much involved in the care and support of the people who live at Chestnut Grove. Residents retain control over their financial affairs or appoint an agent. Residents can bring their own furniture and possessions to personalise their own room. Staff prepare the meals at the home. Residents can choose where to have their meals. Residents thought the meals were very good, and said that they could have what ever they fancied. Meals are unhurried. Comments included: ‘It is all home cooked, and the food which we are used too. Good variety of everything.’ ‘Meals are fresh and cooked daily. Residents can have any type of food they request’ (relative) ‘(The home) caters well for individual likes and dislikes.’ Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 14 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 home has policies in place which safeguard the welfare of the residents. EVIDENCE: Residents and relatives were aware of the homes complaints procedure, however they had no reason to raise any complaints. They felt that the owner was readily available and any issues that arose would be sorted out. The staff are aware of the procedures for the safeguarding of adults. The policies and procedures of the home protect the rights and welfare of residents. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 15 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 home is clean and well furnished, providing a safe and attractive place for the people who live there. EVIDENCE: The owner has continually improved the standard of furnishing and decoration at the home. The home is well maintained both internally and externally. There is a lovely garden area to the rear of the home which is well used in good weather. The home has a lounge and separate dining area. The home was very clean and looked well cared for. Comments included: ‘I could not wish for anything better.’ (resident) ‘Very impressed with the cleanliness and no unpleasant smells’ (relative) Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 16 The home has one shared bedroom, however this is currently used as a single bedroom. The residents spoken with were pleased with their bedrooms and liked the way in which the home was furnished and decorated. The owner has applied to the Local Authority for a grant to improve facilities by refurbishing the bathrooms and providing a shower facility. The home has satisfactory laundry facilities. The owner has checked that the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The policies for recruitment at the home are robust and safeguard the welfare of residents. Staff are encouraged to undertake regular training and this ensures that they are competent to carry out their job. EVIDENCE: The home has a stable staff group who have worked at the home for many years. Residents and relatives indicated that staff were always readily available and were held in high regard. Comments included: ‘The owner and all the staff are always there.’ ‘Nothing ever seems to be too much trouble for them.’ ‘The home is always an open and friendly place, staff are always willing to help.’ Recruitment procedures ensure that all required checks are completed. The owner has recently amended job contracts to reflect the new age discrimination legislation. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 18 The staff feel well supported in their roles and are encouraged to undertake regular training. 70 of staff have achieved a National Vocational Qualification at level 2 or above, this exceeds the recommended minimum standard. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 19 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, 32, 33, 35, 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed in an inclusive and open way which encourages residents and relatives express their opinions. The health and welfare of residents are promoted by the safe working practices of the home. EVIDENCE: The owner is the manager of the home she has many years experience. She is a qualified nurse and she maintains her registration. She is held in high regard by residents, relatives and staff. She is committed to continually improving the service offered at the home and to ensure the home operates in an inclusive way. Residents and relatives felt that their opinions were sought over matters arising at the home and their views taken into consideration. The home has a number of Quality Assurance and monitoring systems in place. The home has recently renewed its Investors in People Award. The owner has arranged two
Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 20 weekends away with relatives to discuss the home and to gain their views. Relatives and residents felt that the owner was committed to providing a quality service. The pre-inspection questionnaire provided details of recent health and safety audits, and required checks. The owner is active in ensuring that safe working practices are promoted at Chestnut Grove. Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 21 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 X X 3 Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnut Grove Rest Home DS0000005876.V322521.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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
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