Inspection on 01/03/07 for Chestnut House

This inspection was carried out on 1st March 2007.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chestnut House 05/02/09

Chestnut House 04/03/08

Chestnut House 25/01/06

Chestnut House 17/06/05

Chestnut House 22/09/04

Chestnut House 05/05/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 Chestnut House 141 Acklam Road Thornaby Stockton-on-Tees TS17 7JT Lead Inspector Jackie Herring Key Unannounced Inspection 1st March 2007 09:30 Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 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 House DS0000000005.V311832.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 Adults 18-65. 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 House DS0000000005.V311832.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut House Address 141 Acklam Road Thornaby Stockton-on-Tees TS17 7JT 01642 670581 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) www.mencap.org.uk Royal Mencap Society Miss Joanna Elizabeth Lowrie Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The number of persons shall not at any one time exceed 6 people with learning disabilities 25th January 2006 Date of last inspection Brief Description of the Service: Chestnut House is registered under the Care Standards Act 2000 with the Commission for Social Care Inspection as a care home providing care and accommodation for up to six adults who have a learning disability. The home is operated by the Mencap Homes Foundation for the Royal Mencap Society and is on the busy Acklam to Thornaby main road. The home is a large detached house retaining many or the original features, and is in keeping with the surrounding area. The building is indistinguishable from other houses in the neighbourhood. The home has six single bedrooms, none have an en-suite, but all service users have access to the communal bath/shower and toilet facilities. The weekly fees at Chestnut House are £550 - £600. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key unannounced inspection and was completed in two inspection days, eight inspection hours in total. As a key inspection, all of the key standards were examined. This was to check that the home meets the standards that the Commission for Social Care Inspection say are the most important for the people who use services, and that it does what the Care Standards regulations say it must. Five of the residents were involved in individual discussions with the inspector to seek their views, as were staff members and the home manager. A number of records were looked at including resident’s assessments and plans of care, staff recruitment records, complaints and maintenance records along with the pre inspection questionnaire. Indirect observations also took place and a number of resident and relative surveys were completed. This was a very positive inspection and residents and staff to Chestnut House warmly welcomed the inspector. What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection including some redecoration and replacement of carpets. Changes have been made to staff recruitment and training records. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 6 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 House DS0000000005.V311832.R01.S.doc Version 5.2 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are fully assessed prior to moving into Chestnut House and the home clearly can meet their needs. EVIDENCE: Three of the six residents records were looked at in detail. All contained a detailed copy of the care management assessment, which informed the home’s own assessment of need. During discussion with one of the residents whose records were looked at, it was confirmed that they had trial visits leading up to their move into Chestnut House, these visits built up over time from staying for tea to an overnight staff. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well aware of their assessed needs and care plans, they are active in decision making, as a result their independence is promoted and care needs are clearly met. EVIDENCE: Very detailed care and risk assessments were in place in the three resident’s files that were looked at. Care plans were well written, were most certainly person centred and individual. Covered within the assessments were twenty areas of need including self-advocacy, behavioural and emotional needs, leisure, domestic skill and relationships. These were supported by good daily care records which clearly detailed support and care given and included daily life events. The documentation contained a very good life history, had clear links to multi agency involvements and clearly demonstrated that individual residents health, emotional and physical health needs were being met. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 10 It was also clear that residents are fully consulted about their assessments and care plans and throughout the individual files there is evidence of this consultation and agreement. There was evidence throughout the documentation that the service users had been consulted and they had signed up to their assessments and care plans. During discussion with residents, they confirmed that their key worker sits with them and discusses their plan of care. They confirmed that the information contained within the assessments and care plans were factual and they were satisfied with it. It was clear from the time spent at the home during this inspection and through indirect observation that the staff at Chestnut House provides a consultative environment in which there was very good communication, with everyone being treated very much as an individuals who were able to express views and opinions. Residents were observed to have free access to the kitchen to make breakfast and lunch, some residents do their own washing and it was confirmed that a range of risk assessment are carried out to ensure safety in these areas. One member of staff said, “Residents are free to make drinks when they want, the emphasis here is home, there are limited restrictions and these are contained within the enablement plans”, “Residents have choice in all aspects of daily life, they determine how they live their lives, most important is support, encouragement, independence and individuality”. During discussion with the manager, it was identified that some of the care records were in need of updating. This was as a result of some staff turnover. It was confirmed that new key workers had been allocated and all records were in the process of being reviewed and updated. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to take part in a wide range of activity in the home and further a field. Resident’s dietary needs and choices are well catered for and relatives and friends are encouraged to maintain contact. EVIDENCE: Five of the six current residents have lived at Chestnut House since it was registered. Residents are involved in different activities depending upon their needs and their interests. Daily life for some residents included attended day facilities where they are involved in cookery and community courses as well as in the past computer courses and gardening. One resident spoke of going out with their support worker and said they enjoyed bowling and going to the local pub. A resident also said that they had Sky satellite facilities in their own room. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 12 Residents said they really enjoyed going to concerts at the local theatres. They were looking forward to attending a ‘Tina Turner’ Tribute Act with a meal and disco to midnight. One staff member said, “There are always a dozen different things to go to and the residents particularly like the theatre”. One of the residents had brochures for Euro Disney said that they were in the process of planning a holiday if they could save enough money. Through discussions it was confirmed that residents are consulted about all of the meals at Chestnut House and every week produce the menu for the week which takes account of individual likes, dislikes and preferences. Residents are also involved in shopping and also in making the meals for each other. One resident said, “The food is nice, you have a choice and we all make a decision about the menu”. It was confirmed through discussion that intimate relationships are able to continue and that friend/family and loved ones are able to visit freely. The kitchen is very pleasant, domestic in nature and fully equipped. The residents have free access and are able to make a snack or a drink when the want to. The dining area is very well laid out and is a very pleasing environment and is also used for group activities. The pre inspection questionnaire stated, “There are no se mealtimes within the home, the times listed are only an appropriate guide according to the service users needs”. During the inspection, flexibility and individuality was observed to be key to live within the home, for example one resident having a very leisurely shower and late breakfast. One staff member said, “all of the residents are involved in the cooking, all pick one meal for the following week, however there is still a choice and alternatives”. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal and health care support appropriate to their needs and preferences, which ensure their privacy and dignity is respected and independence promoted. The medication systems are robust. EVIDENCE: Residents’ records confirmed that there was involvement from the GP, Occupation Therapy, Diabetic Nurse and these records confirmed that physical and other health care needs are being attended to. This was also confirmed through discussion with residents who said that they went to the doctor’s if needed or had hospital appointments, this also included health checks, breast screening and smears. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 14 The medication system was looked at and discussed at length with the manager. The storage was sufficient for the medication in use within the home. Medication records contained the required information and there were no gaps in these records. All staff are trained in the administration of medication through Mencaps training programme. There was some very good supporting information contained within the medication records such as a medication pen picture, what the medication for individual residents was, the side effects and contra indications. A medication assessment and care plan was also in place for those residents whose records were looked at. It was also good to see information about medical conditions and what to look for, for example in the event of “flare up with gout”. Currently information about the medication in use is downloaded from the British National Formulary (BNF) website, it is recommended that an up to date BNF be available on site in the event that there is new medication and no access to the internet. Where items are handwritten onto the Medication Administration Records, two staff are to sign for this. It was recommended that staff responsible for the administration of medication undertake regular competency assessments. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware that if they had any concerns or complaints, these will be dealt with quickly and effectively and robust procedures are in place to protect residents from abuse. EVIDENCE: A complaints procedure is available within Chestnut House and accessible to residents in both a written and cassette tape format. Residents said if they had any concerns they would speak to the manager or staff about it. One resident said, “Jo is a good manager, I can talk to her if there is something wrong”. Staff also confirmed that they would know what to do in the event there was a complaint. The manager said that individual correspondence about the complaints procedure is available within resident’s own rooms. Staff confirmed that they were aware of the topic of abuse and they had received No Secrets training. The pre inspection questionnaire also detailed that No Secrets training takes place for staff and that some staff have also been involved in the Train the Trainer No Secrets course. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a pleasant, clean and generally well-decorated home to suit their needs and lifestyles. EVIDENCE: One of the residents kindly showed the inspector around the home and took pride in doing this and pointing out the fire exits. Chestnut House is a six bedroom detached house, which is indistinguishable from other houses in the area. It is situated on a busy main road within easy access to local transport and a park. The residents who live at Chestnut House each have their own bedrooms, which they have personalised to their own tastes and interests. Chestnut House is a bright, airy and homely place for people to live, which generally is very nicely decorated and very clean. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 17 There is a very pleasant lounge, separate dining room and big family kitchen. Residents have access to all communal areas of the home as well as the laundry area and garden, which really is only suitable for people without mobility problems. Since the last inspection two bedrooms have been redecorated and new carpets laid as well as the lounge and dining room. Ongoing redecoration is included within the refurbishment plan, with the hallway and landing identified as the next area. Work is ongoing in the garden to establish more planting. The bathrooms and shower rooms are starting to look a little tired and in need of freshening up. Some mildew was observed in one of the showers and the flooring was in need of replacement. There was also the need to replace a light shade. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 18 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. Good recruitment practises are in place and the staff team are well trained and well able to meet the needs of the residents. EVIDENCE: Three sets of staff files were looked at during the inspection and the information was a little confusing initially as it was contained within two separate files. There was discussion with the manager regarding confidentiality and data protection and it was agreed that the actual recruitment and selection, terms of engagement and Criminal Records Bureau/ Protection of Vulnerable Adults information be kept together in a secure place. After discussion, it was identified that the required information to demonstrate sound recruitment practices is in place and that good procedures have been established to ensure protection of the residents. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 19 Training of staff was also discussed and training records were looked at. There is a regional training co-ordinator and individual training needs questionnaires are completed on an annual basis and workforce development plans are formulated which also take into account client specific training. Training such as dual diagnosis; protect and respect; respond and respect are completed by all staff. Individual training records are maintained and they also contain copies of all certificates. The pre inspection questionnaire also detailed a range of training included in this was dementia awareness, epilepsy awareness, autism and autistic as well as mandatory training. Induction was discussed and the manager said that Mencap have developed their own induction which meets the requirements of Scills for Care and that staff would then be nominated for the NVQ following completion of this. Currently, Chestnut House does not meet the required number of staff trained to NVQ level 2; this has been due to some staff turnover and is in the process of being addressed. A separate induction has also been developed for relief workers and student nurses. It was good to see that the staffing levels within Chestnut House were flexible depending upon the needs and preferences of residents and staffing levels were altered throughout the day and the week to meet individual needs. One member of staff said, “Chestnut House is always staffed appropriately, they will bring in agency staff if needed”, another said, “The staffing is flexible depending upon the needs of the residents”. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 20 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. . Residents benefit from a well managed home, which provides consistently high standards with sound leadership and support to the staff team ensuring residents needs are met. EVIDENCE: The manager has the required qualification, skill and experience and is highly competent to manage Chestnut House. She is extremely enthusiastic about her role and her commitment to the home was very obvious on the day of the inspection. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 21 The manager confirmed that all staff are up to date with the required mandatory training. A brief examination of maintenance records showed that weekly fire checks; the periodic electrical installation and gas landlord certificate are up to date. Staff said, “Chestnut House is very relaxed, there is a nice atmosphere and good morale, all of the residents are really happy”. The residents personal finance systems was looked at and found to be a well managed, well-recorded and robust system. Personal finance risk assessment was observed to have been completed and financial agreements were in place. A number of records and systems were looked at during the inspection and there was clear evidence of audits by the manager. In addition, minutes of meetings were made available. Quality assurance was also discussed and although views are sought Relative surveys stated, “Chestnut House is definitely the best care home they have every lived in. They are well cared for and we hope she will be staying there as long as possible and the staff are always civil, courteous and dedicated”, “We are very pleased with the care and attention that our loved one receives. It is obvious that they are very happy living at Chestnut House”. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 23 Yes 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. Standard YA24 Regulation 23 Requirement The planned maintenance/repairs and redecoration must be carried out: The stair banister with peeling paintwork must be redecorated. The upstairs shower room must be redecorated. The flooring must be replaced as must the light shade and the bathroom must be redecorated. 2. YA32 18 50 of care staff must be trained to NVQ Level 2. 30/09/07 Timescale for action 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The residents care records should be updated and remain DS0000000005.V311832.R01.S.doc Version 5.2 Page 24 Chestnut House 2. 1. YA20 YA37 current to their needs. It is recommended that regular competency assessment be carried out on all staff responsible for the administration of medicines. The manager should attain qualifications in National Vocational Qualification Level 4, or equivalent, in care. Chestnut House DS0000000005.V311832.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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. 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