Inspection on 25/07/06 for Chestnut House

This inspection was carried out on 25th July 2006.

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 House 14/12/05

Chestnut House 18/07/05

Chestnut House 25/02/05

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 Chestnut House 62 High Street Marton Lincolnshire DN21 5AW Lead Inspector Sue Hayward Key Unannounced Inspection 25th July 2006 13:15 Chestnut House DS0000061665.V305208.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 DS0000061665.V305208.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 DS0000061665.V305208.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut House Address 62 High Street Marton Lincolnshire DN21 5AW 01427 718272 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) Prime Life Ltd Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: Prime Life Care Limited owns Chestnut House. It is a detached adapted property set in an extensive plot of land, which is registered to provide care and accommodation for up to nineteen clients with mental health needs. The home is situated in the village of Marton, approximately five miles from Gainsborough town and ten miles north west of the city of Lincoln. The village has a pub and two Churches. Other facilities are available both in Gainsborough and Lincoln. There is a public bus service that stops on the main high street near to Chestnut House. The home has the shared use of a minibus with another home within the area to take clients to day care services, trips or appointments. Bedrooms are located on both floors, with a smoking lounge/dining area, a non-smoking lounge and kitchen being on the ground floor. The providers since they acquired the home have done extensive refurbishment that has involved consultation with clients living in the home. The main lounge/dining area has been made into a bistro type cafe bar. The home does not have a lift and access to the first floor is via stairs. The home has a large parking area to the side of the house and garden to the rear. There is a courtyard, which includes a conservatory, which clients can use for leisure activities such as playing pool. Information provided at the time of the site visit indicated that the current weekly fees are £348. Chiropody is charged additionally to the fees. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken by one inspector and formed part of a key inspection. It started at 13:15 and lasted 5 ½ hours. Information already held on file was used to plan the visit and produce this report. This included, records of any incidents that had been notified to the CSCI since the last inspection and correspondence with the company. “Have your say questionnaires” had been returned to the CSCI from five clients prior to the inspection and information from these are also included in the report. The site visit focussed on key standards and checking whether the issues raised at the previous inspection had been addressed. The main method used for this was “case tracking” a sample of three residents with a range of needs via their records, observation, and discussion with the two of the clients and their key-worker. Two clients also agreed to the inspector visiting their bedrooms. Three residents were spoken to on a more general basis. The manager was present throughout and general feedback was given at the end of the visit. What the service does well: This home provides a comfortable, clean and homely environment, where clients are supported and cared for by a committed group of staff. A good rapport was noted between clients and staff. Staff had a good knowledge of the care and support needs of clients to enable them to be as independent as possible and have regular training opportunities to ensure they have the necessary skills to provide appropriate care. Comments from clients were very positive about the care provided indicating they had choices and were involved in decisions about the operation of the home. Visiting professionals were complimentary about the service indicating that there was good communication to ensure that clients received appropriate care. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chestnut House DS0000061665.V305208.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 DS0000061665.V305208.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 at least once during a 12 month period. 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 the service. There is a satisfactory assessment procedure in place, which involves clients and ensures that care needs are identified prior to admission. EVIDENCE: Information about the home is readily available in the entrance hall of the home for anyone to refer to should they wish. Comments from clients, the questionnaires received and the record checked of a client who had recently been admitted to the home showed that there was a thorough assessment process in place to identify clients needs. Clients comments and questionnaires verified that there are opportunities to visit the home and have trial stays of a day, overnight and/or weekends to help clients come to a decision about whether they wish to stay. Clients felt they were given sufficient information about the home and one comment made was, “I really like it here at Chestnut House. Its one of the best homes I’ve lived in. I’m happy here”. Records demonstrated that assessments covered a whole range of needs such as social and leisure interests, dietary requirements and health. Discussion Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 9 with a visiting professional and records confirmed that there is also consultation with other care professionals as to the needs of clients. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Care planning in this home is good, providing detailed information on how the health and social care needs of clients are met. They are consulted and involved in all aspects of their care and are able to make decisions and choices as to how they lead their lives at this home. EVIDENCE: All three care plans checked contained clear information for staff relating to the care needs of clients and demonstrated that clients were involved in the development of them. There is evidence of regular reviews including annual multi-agency reviews, some which were taking place on the day of the visit. Clients’ comments confirmed they are able to make decisions about their lives. Clients undertake a number of activities, which promote their independence and skills. Risk assessments are in place in relation to activities identified as a potential risk. Since the last site visit some risk assessments have been Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 11 reviewed although the manager agreed to develop them further in some instances to show more fully matters that had been considered in determining levels of risk to clients. Staff spoken to had a good knowledge of the care and support needs of the clients being “case tracked”. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Clients are able to pursue a wide range of activities and leisure interests both within the home and community, which are based on their individual needs and preferences. Visitors are made welcome at the home. The meals provided are well balanced and cater for clients’ individual preferences and specific dietary needs. EVIDENCE: Comments, observations made and records checked provided information; indicating clients can participate in work, educational and training opportunities. Information provided at the time of the visit confirmed there is also a range of recreational and leisure interests which clients can chose whether or not to participate in, for example a client said how much she had Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 13 enjoyed a recent trip out to Blackpool. Another commented that they had been involved in making up hanging baskets and tubs, which were on display in the patio area. Clients’ independence is promoted in various ways according to individual needs and there are opportunities to develop independent living skills such as housekeeping, laundry and preparing meals. The pre-inspection questionnaire noted a range of leisure interests available both at the home and in the local community. Notices were also on display advertising specific events. Clients have the use of a minibus, which is shared with another home in the area for which they are charged. Comments from clients and visiting professionals confirmed that visitors are made to feel welcome. Several clients keep in contact with friends and relatives and some were out visiting them on the day. A visiting professional made a comment, which indicated that clients are supported appropriately with personal relationships and information provided at the time of the visit confirmed there are policies and procedures in place about this. Discussion, information obtained from questionnaires and records checked indicated that clients are encouraged to be as independent as possible and their privacy and dignity is respected. For example, all clients have keys to their rooms. Staff were attentive to the clients needs, knocked on bedroom doors before entering and spoke to clients in a respectful manner. Clients said that the meals provided were good and catered for their individual preferences and specific dietary requirements. Records are kept which demonstrate varied and well-balanced meals. Clients have opportunities to prepare their own drinks and meals as they have the use of a kitchenette. The home has been awarded a 4 star food business rating from West Lindsey District Council, which is a quality award. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Clients receive the support and care they need to be as independent as possible and to promote their physical and emotional wellbeing. There are satisfactory systems in place for the storage and administration of medication in the home, which help keep clients safe. EVIDENCE: Comments from clients were complimentary about the care and support they received such as “I really like it here, it’s one of the best homes I’ve lived in. I’m happy here”. Staff gave assistance to clients when needed and clients commented that they are able to make choices and decisions about their lives. The CSCI has been receiving information in the form of notifications such as when clients attend hospital for treatment demonstrating that health care is promoted in the home. Clients’ records included information about health needs and staff comments indicated they were aware of these. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 15 A client said she is responsible for her own medication and has been provided with a safe place to keep it. This enables her to be as independent as possible. Records checked demonstrated that this had been risk assessed to ensure as far as possible her safety. For those clients who do not look after their own medication there are satisfactory systems in place to ensure that medication is stored and administered safely. The manager said that 4 staff had had safe handling of medication training this year and further training is to be arranged for other staff. She also confirmed that she is looking to arrange a visit from a local pharmacist to offer advice about the current systems in place Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Clients are protected by the procedures in place for handling complaints and allegations of abuse and are encouraged to raise any issues. EVIDENCE: Information from clients’ surveys indicated that they knew who was in charge and how to make a complaint and would feel comfortable to do so. Comments from clients spoken to at the time of the inspection indicated that they felt safe in the home and comfortable to talk over any problems with staff. No one raised any complaints about the service during the visit. There are satisfactory policies and procedures in place for staff to follow to protect and promote the well being of clients. These cover complaints, the company’s own adult protection procedures and Local Authority adult protection procedure (February 2005) the latter which is available on the office notice board. Records indicated there have been no complaints or adult protection issues raised since the last inspection. However records checked demonstrated that the home had received three compliments about the service, which made the following comments, “A great place, friendly and warm”, “Staff are great and caring” and “I like it here”. A visiting professional commented that any issues raised had been satisfactorily dealt with and there was good communication between himself and the manager. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 17 The CSCI has been notified that there was a report of money going missing at the home, although the manager said this was unable to be verified. This was dealt with appropriately by contacting the police and also through discussion at a “clients” meeting. There are satisfactory storage arrangements, records kept and procedures in place to ensure that any money or valuables placed in safekeeping is secure. (See also comments made at staffing standard) Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is clean and tidy and provides a comfortable and safe environment for clients to live in. EVIDENCE: Those areas of the home seen were generally clean, tidy and comfortably furnished. Two clients were happy for their bedrooms to be viewed during the visit and said they found their rooms to be comfortable and had been able to arrange them, as they wanted. One client said she had recently moved rooms, which suited her, needs better. Areas that pose a potential risk to clients such as unguarded radiators have been risk assessed. One client did not wish her room to be visited but confirmed that she was satisfied with it. Questionnaires completed by clients indicated that they were satisfied with the cleanliness of the home. Observations and information provided on the preinspection questionnaire demonstrated that there is an on-going programme of Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 19 redecoration and refurbishment and records are kept of any maintenance issues. Since the last inspection a bathroom has been changed to a shower room, which a staff member said was so that it was more easily accessible for a client. The dining, lounge area and some bedrooms have also been redecorated. Clients have opportunities to assist in some domestic tasks to increase their independence. For example a client said she could do her own laundry if she wished. Staff provide support as needed with such tasks. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff on duty to meet the current needs of clients. Staff have training to ensure they have the skills needed to carry out their roles and are committed to the work they do. The recruitment procedure does not fully protect clients from potential risks. EVIDENCE: There was evidence that the recruitment procedure was based on equal opportunities and robust in all but one instance where discussion with the manager indicated a staff member had attended a supervised induction shift whilst waiting for the appropriate references and Criminal Record bureau checks to be returned to the company before her position was confirmed. The manager agreed that this practice would cease to ensure clients safety. CRB records are held within the company’s central office but there was evidence that disclosures have been obtained on all other staff that work in the home. Staff have copies of the General Social Care Council code of conduct and a company handbook. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 21 Clients’ comments about the care provided were very positive and a good rapport was noted between staff and clients. A visiting professional made the comment that there was a “ good staff team”. Records and discussion with staff indicated that the organisation provide a range of training which is updated at various intervals to ensure staff have the knowledge and skills to care for clients safely. The manager acknowledged and agreed to arrange training for those staff that have not yet participated in adult protection training. Records demonstrated that staff follow an inductiontraining programme and have regular updates on matters such as fire training, first aid and manual handling. Over 50 of staff have either obtained or are working towards achieving a vocational award in care. Examples of some of the training that has occurred in the last twelve months is food hygiene, fire awareness, mental health training, first aid, medication and COSHH (control of substances hazardous to health). Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is being well managed and the health, safety and welfare of clients is promoted EVIDENCE: There have been changes to the management arrangements since the last site visit. The registered manager has moved to another service within the company. The CSCI had been appropriately notified of the change and the current manager confirmed she would be submitting an application to become registered. She has completed a management award and has also obtained a vocational qualification in care at level III and is to commence level IV. She has previously been working in the home as the deputy manager. Comments from clients were positive in relation to her approachability and a visiting professional spoke in very positive terms of her management of the home Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 23 indicating that she worked in a multi-disciplinary way and there was good liaison. The company have a quality audit system in place and the manager confirmed that the date for this was 26/07/06. There are also various other means of quality assessing the service such as regular staff and client meetings. There is a staff supervision and appraisal system in place and records were in place to demonstrate that a representative from the company makes visits to the home on a monthly basis to monitor the quality of the service provided. A development and action plan was available to view about the service. Information given at the time of the visit demonstrated that maintenance of the home and systems are regularly checked to ensure residents live in a safe environment such as weekly checks of the fire alarm system to ensure it is working correctly. There is a range of policies and procedures in place to promote the health and safety of clients and staff. Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 24 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 X 12 3 13 3 14 X 15 3 16 4 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 DS0000061665.V305208.R01.S.doc Version 5.2 Page 25 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. 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 House DS0000061665.V305208.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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. Extracts may not be used or reproduced without the express permission of CSCI Chestnut House DS0000061665.V305208.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!