Inspection on 05/02/09 for Chestnut House

This inspection was carried out on 5th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chestnut House 04/03/08

Chestnut House 01/03/07

Chestnut House 25/01/06

Chestnut House 17/06/05

Chestnut House 22/09/04

Chestnut House 05/05/04

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Craigmore House

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Chestnut House 141 Acklam Road Thornaby Stockton-on-Tees TS17 7JT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jacqueline Herring     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Chestnut House 141 Acklam Road Thornaby Stockton-on-Tees TS17 7JT 01642670581 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): val.bowman@mencap.org.uk Royal Mencap Society Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 6 The number of persons shall not at any one time exceed 6 people with learning disabilities Date of last inspection Brief description of the care home 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 ensuite, but all service users have access to the communal bath/shower and toilet facilities. The weekly fees at Chestnut House could not be determined at the inspection. Care Homes for Adults (18-65 years) Page 4 of 29 Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection 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 the services, and that it does what the Care Standards regulations say it must. This inspection was conducted in two inspection days. During the inspection, a number of records were looked at, including records of people who use the service, along with staff recruitment and training records. The medication systems was also looked at and discussed at length. Discussion also took place with the people living at Chestnut House, the manager and staff. Care Homes for Adults (18-65 years) Page 6 of 29 The manager has completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting standards. This was received prior to the inspection and some of information has been reflected within the report to support the judgements made. The AQAA was extremely well completed. We have reviewed our practise when making requirement to improve national consistency. Some regulations from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: It is commendable that of the National Minimum Standards examined so little has been identified as in need of improvement. A small number of recommendations have been made. The manager needs to register with CSCI. The flooring to bathrooms needs to be replaced. The temperate of the room in which medication is stored should be monitored. Care Homes for Adults (18-65 years) Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs fully assessed prior to be admitted to the service ensuring that they can be met. Evidence: The AQAA states about the admission process, We receive an assessment document from Social Services Department as part of the initial referral process. We then carry out our own assessment, to ensure we can met the needs of the service user. There had not been any admissions to the home since the last inspection, however care plans looked at demonstrated that in-depth assessments had taken place prior to each admission. The records contained up to date assessment information as well as other supporting documentation, such as care management and review information. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes assessment and care planning process ensures peoples needs are identified and met. People are consulted about all aspects of their life and were supported to be as independent as possible. Evidence: Mencap continues to have comprehensive assessment and care documentation, which lead to very detailed support plans for people living within their services. All of the people who live at Chestnut House had a range of information in place for them, this includes assessments of twenty areas of need including self-advocacy, behavioural and emotional needs, leisure, domestic skill and relationships. The AQAA details, All service users have individual care and support plans. All care plans are person centred and are a true reflection. The care files looked at during this inspection contained detailed and up to date information about the individual people living at the home. This information clearly had Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: the individual person at the centre of it. Care plans were well organised and it was clear that considerable effort had been made to make the planning process and format understandable to the individual person and there was clear evidence of their involvement in this. Detailed risk assessments are in place and appropriate risk management strategies developed. All information was cross referenced. Monitoring and regular reviews take place to ensure that changing needs are identified and appropriate action taken. People living at Chestnut House were fully aware of who their keyworkers were and the support that they give. During the second inspection day, staff were supporting a person who had a specific support plan for an aspect of their care. This was observed to be professionally managed, with respect and courtesy. Throughout there were clear explanations given and reassurances. It was clear through examination of records and observations that the relationships with people living at the home and staff are very open and enabling, with people being encouraged to make their own decisions and choices within a risk assessed framework. People are fully involved in the assessment and person centred planning process and have signed and agreed their individual plans. People knew who their keyworkers were and confirmed that they met with them regularly. People living at the home said, The staff are brilliant, they are there when you need them, support you when you need it. They are respectful, but you can have a laugh and a joke. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with respect and their lifestyles are very much individualised and underpinned by appropriate social and recreational activities as well as the opportunities for personal development. People benefit from maintaining personal relationships and have their right respected. Meals are provided to a good standard within a suitable environment. Evidence: Within the individual plans looked at, there was clear information about promotion of independence, risk taking and maintaining relationships. The plans also showed how people were being supported and encouraged to lead fulfilling lives, to develop their skills and to lead as independent lives as possible. An example of this included, one person who wanted to be supported to obtain a job. Steps were in place to support the person with the wish and they were about to embark on a twelve week training Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: programme. People are also involved in groups within the organisation such as, Share Group, which is a forum in which to share ideas and discuss developments waiting Mencap. One person said of this group, We learn from each other and make things better. Other people living at the home go out with their individual support workers to community based activities of their choice. On the first day of inspection one person was going shopping, whilst on the second day, one person was looking forward to going to the pictures. People also attend local day services where they are involved in a variety of sessions such as literacy class, healthy eating, fitness, pottery and cooking. In discussion with the manager it was clear that they and the staff team were working with people to identify opportunities to enable them, where appropriate, to take more control of their lives and for the independence to be further promoted. One person spoken to said, I have more indepenance now, more than I did this time last year and I am getting out more. People clearly see Chestnut House as their home. They talked of being happy and settled there. They answer the front door and the telephone. One person said, I make my own decisions, this is my own home, staff are there to support you as and when needed. A member of staff said, Residents are fully involved in all aspects of live within the home, everyone is treated as individuals. Another member of staff said, It is important to promote independence. It is their home, we support them and empower them to make safe decisions. It is about enabling, not doing for. People are able to maintain relationships with their families and friends and to have other fulfilling relationships. One person spoke of the time they spend with their girlfriend, while another talked about visiting their relative at home. Observation throughout the inspection identified that interactions between people living at the home and staff was good, people were being encouraged to make choices and supported to make daily live decisions. The meal provision at Chestnut House continues to be planned in a consultative way, with menu planning meeting taking place and everyone able to influence this. They continue to be involved in putting the shopping list together, helping with the shopping and the cooking. One person said, We do the menu together, we pick what we want. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples healthcare and personal care needs are met by staff who provide support in a sensitive and flexible manner in accordance with the wishes of the individual. Appropriate healthcare professionals provide advice and additional support. The systems for managing medication are good. Evidence: People living at Chestnut House confirmed that there health needs are met. It was confirmed that people would visit the GP if necessary and also other health professionals such as their psychiatrists. People where necessary had involvement from their care managers/community psychiatric nurses. A separate health/medical file is kept for each individual person living at the home, which detail the involvement of GP, Consultant Psychiatrists and all health related matters. It is clear that the home works well with external professionals and specialists support such community psychiatric nurses, to support the people. The medication system was looked at and discussed with the manager of the service. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: This has been improved significantly since the last inspection. The medication records were clear and well written with no gaps. The correct balances were in place. Stock monitoring is taking place. It was also good to see pen picture and supporting information within the medication files for staff. Storage facilities had improved since last inspection and appropriate facilities were available if items needed to kept in the fridge. Currently none of the people who live at Chestnut House self medicate but the manager is aware that this is an area that could, when appropriate be developed with people. Good systems are in place for the ordering and receipt of medication, which involves the individual people who live at Chestnut House. Appropriate systems are also in place for the return of unused medication. It is recommended that the temperature of the room in which medication is stored is monitored. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have access to the complaints procedure. Complaints are dealt with appropriately. Staff have had training around safeguarding adults to ensure protection of people who live at the home. Evidence: The AQAA detailed that there had been one complaint since the last inspection. It also contained the following information, There is a complaints procedure in the service accessible to everyone which includes the stages and time scales. Service users are aware of who to complaint to. Service users are listened to. Service users have access to an advocate if they wish. The folder containing complaints information was looked at. One complaint was fully recorded. There was also information about the investigation process and outcome of the complaint, which was fedback to the complainant. Staff spoken to said they were aware of the topic of abuse and protection of vulnerable adults. They were clear about the procedure to follow in the event that they had any concerns of this nature. People who live at the home confirmed that they felt safe and had no concerns. They said that they could speak with any member of staff and the manager if they had any worries or concerns. One person said, I can speak to Angela (the manager), she is approachable, but I would tell any of the staff if I was unhappy. Care Homes for Adults (18-65 years) Page 19 of 29 Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Chestnut House benefit from a warm, homely and well maintained environment. Evidence: Since the last inspection a number of improvements had been made to the home environment. This included redecoration of bathrooms, shower and toilets. The problem with damp in the ground floor bedroom had been addressed and this had also be redecorated. New carpet had been laid to the entrance, stairs, landing and throughout the ground floor. A wall unit in the dining room had been repaired. The key pad lock on the front door had been removed and the one on the garage door was not in use. People living at Chestnut House had been involved in choosing the new carpet and decor. On both of the inspection days, work was taking place to fully redecorate the hallway, landing and stairs. The flooring in the upstairs bathrooms would benefit from being replaced as some of the seals were exposed. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: Significant work had taken place to remove archived information from the home. The home generally looked more organised and less cluttered in areas. On both inspection days, the home was clean, fresh and very homely. People are able to personalise their bedrooms and they said that they were very comfortable in the home. People had keys to their own bedrooms. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are met by well trained staff and there are sufficient staff available. Staff are competent to do their jobs and people are protected and supported through the home’s recruitment procedures Evidence: On both of the inspection days there were sufficient staff on duty to meet the needs of people living there. Discussion with the manager, staff and people who live at the home confirmed that there was always sufficient staff on duty and that there was also flexibility of staffing. A member of staff spoken to said of the staffing levels, There is sufficient staff to go out with people and for others who want to stay in. There are three staff at the weekend and sometimes four depending on what is happening. Two staff files were looked at, both contained the information needed to show that good recruitment systems are in place and that the appropriate checks are carried out prior to commencing employment. This includes appropriate references and Criminal Bureau Checks. Two care support roles are vacant and recruitment is underway, again, people living at the home were aware of this. One person had been actively involved in the recent Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: interviews that had taken place. An agency member of staff was spoken to. They confirmed that they had received a full induction with their own agency but that health and safety and orientation induction was completed within the home. They said that they had worked in a shadowing capacity for the first few shifts and that they had worked at the home for a couple of weeks before delivery personal care, due to the need and importance of developing relationships. They also confirmed that they were doing regular agency shift, ensuring consistency and continuity of care. The AQAA detailed that 100 of care staff have achieved NVQ Level 2 in care. Other training takes place on a regular basis. A regional training matrix was looked at, which clearly identifies individuals and their ongoing training. It was also confirmed that specialist, client specific training also takes place and that this would be arranged through Mencap when it has been identified. One person said of the staff, They definitely treat you kindly and with respect. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager provides very strong leadership to the staff team and continuously strives to improve standards within the home ensuring that resident’s needs are well met. There is a good range of quality assurance systems. Good service and maintenance arrangements are in place and in good order ensuring health and safety is promoted. Evidence: A new manager has been appointed following the last inspection. They are not currently registered with CSCI. The manager had completed the AQAA, which was extremely well completed, with detailed information about the service. The manager was clearly extremely enthusiastic about their role, the staff team and most importantly that the service was run in the best interest of people living there. Significant improvement had been made to a number of areas since the last inspections and all of the requirements made had been fully addressed. People spoken to were very positive about their lives in the home. They did say that Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: there had been some difficult times last year as they were unclear about the future of the service and this brought about some anxieties. Work is still ongoing in regard to the service but people living there have been given some reassurances about the future. When asked what was good about Chestnut House, one person said, It is the atmosphere, the staff and the other residents. Staff said, I enjoy working here very much, it is a good team and n excellent value base. They made me very welcome, felt part of the team from day one, it is a well run, well organised home. Angela (the manager) is great, she is approachable and you can ask anything. Regulation 26 visits are taking place. There are regular meeting both for the people living at the home and the staff. Minutes of the meetings were made available. For the people living at the home, there were pictorial images. Annual service reviews also take place. The AQAA detailed that appropriate and up to date servicing and maintenance of equipment is in place. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 20 24 37 The temperature of the room in which medication is stored should be monitored. The flooring to the upstairs bathrooms should be replaced. The manager should complete the registration process with CSCI. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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