Inspection on 10/07/08 for Chestnut Lodge

This inspection was carried out on 10th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Lodge 01/06/09

Chestnut Lodge 19/07/07

Chestnut Lodge 20/07/06

Chestnut Lodge 30/01/06

Chestnut Lodge 14/09/05

Chestnut Lodge 02/11/04

Chestnut Lodge 18/05/04

Chestnut Lodge 29/01/04

Chestnut Lodge 06/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ Lead Inspector Brenda O`Neill Unannounced Inspection 10th July 2008 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Lodge Address 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ 0121 551 3035 F/P 0121 551 3035 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) Mrs Evelyn McIntosh Mrs Catherine McHugh Mrs Evelyn McIntosh Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th July 2007 Brief Description of the Service: Chestnut Lodge is a home providing residential care for up to 15 older people. The premises consist of 2 large houses that are joined, and situated on a busy main road with shops nearby. The home has a well-maintained garden at the rear, with a paved patio area, and furniture for those people living in the home that wish to sit outside in fine weather. There is parking for 2-3 cars at the front of the property. Accommodation is provided on three floors consisting of a mix of single and double rooms. There are ample communal bathing and toilet facilities. The home has two sitting rooms, one at the front of the house and another at the rear overlooking the garden. The atmosphere of the home is very homely. A shaft lift gives access to upstairs rooms. The range of fees were in the service user guide but they were not current at the time of the inspection. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. One inspector carried out this inspection over one day in July 2008. During the course of the inspection a tour of the home was undertaken, we spoke to the manager and five of the people living in the home. We looked at the care being received by two of the people living in the home and the recruitment file for one staff member. Other documents looked at were in relation to health and safety, staff training and complaints. Prior to the inspection the manager had completed and returned to us the Annual Quality Assurance Assessment which provided us with additional information about the home. Satisfaction surveys were sent out to eight of the people living in the home. Seven of these were returned and without exception all the comments about the home were very positive. There had been no adult protection issues or complaints raised with the Commission about the home. No complaints had been logged at the home since the last inspection. What the service does well: People wanting to move into the home could visit before going in to assess the facilities and see if it was suitable for them. The home had a very relaxed atmosphere and the people living there were very happy with the service they received and the staff team. Comments received included: ‘Care always very good always someone to help.’ ‘Staff are always here when you need them.’ ‘Always available when I need them.’ ‘Staff pleasant’ The people living in the home were very satisfied that their health care needs were being met. Comments received included: ‘I receive the care and support that I always need.’ ‘If I am sick or have a problem I tell one of the staff.’ ‘When I am unwell the doctor is called to see me.’ ‘They will always call my doctor when I am feeling unwell Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 6 There was evidence of the people living the home seeing, G.P.s, opticians, chiropodists and district nurses as well as specialised health care professionals such as community psychiatric nurses. There were activities available for the people living in the home for those wishing to take part. The surveys returned prior to the inspection indicated that the people living in the home enjoyed the activities in the home. Comments included: ‘There are activities arranged that I take part in every week.’ ‘Arm chair exercise, games and the church service’ ‘All the activities are gentle and fun.’ Without exception the people spoken with were very satisfied with the food being served in the home and records did show that cultural diets were being catered for. . Comments received included: ‘…. comments that she enjoys all the meals which is provided.’ ‘There is always a choice of food and they are always good.’ (meals) ‘Meals are always good.’ The people living in the home knew how to make a complaint and said that staff listened to them and acted on what they said. There had been little staff turnover at the home which was good for the continuity of care of the people living in the home. Care was being provided in a homely, comfortable environment that was generally well maintained. The manager of the home was very experienced, had a good knowledge of how the people living in the home wanted to be cared for and ensured the home ran smoothly. What has improved since the last inspection? Further risk assessments had been undertaken for the people living in the home and others had been improved enhancing the safety of the people living in the home. Recruitment procedures had been improved by ensuring there were two written references for all new employees and staff completing medical questionnaires. This ensured staff were fit to work with the people living in the home. The unsafe practice of using wheelchairs without foot rests had stopped. There had been further improvements made to the environment enhancing both the comfort and safety of the people living in the home. These included some redecoration, some new furnishings and flooring and the emergency call system was accessible from all toilets. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 7 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 Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information available for people wanting to move into the home needed to be reviewed and updated to ensure it was current. The pre admission assessment procedure ensured the majority of the needs of the individuals were known to staff before admission. People wanting to live in the home were able to visit prior to admission to assess the facilities available. EVIDENCE: The service user guide for the home had not been updated for some time. The fees included in the guide were not the current range of fees charged at the home. It was recommended that the guide was reviewed and updated to ensure people wanting to move into the home had all the current information. The files for two people admitted to the home since the last inspection were sampled. Staff at the home had undertaken the pre admission assessments. The information gathered was quite basic but did indicate what the individuals Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 10 basic needs were, for example, any illnesses, whether they had dementia, some personal and social care needs. It was evident from the files that social workers had been involved in the admission process as there were copies of the care plans drawn up by them. It was strongly recommended that the manager also obtained a copy of the social workers assessment to ensure staff had as much information as possible about the individuals being admitted to the home. One of the files sampled included a brief summary of the pre view visit the individual had made to the home. The other file indicated that the individual had visited with the Community Psychiatric nurse involved in her care. The completed surveys returned prior to the inspection also indicated that people were able to visit the home prior to admission. One person commented: ‘I spent a day in the home and decided I liked it.’ Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans did not reflect the level of assistance being given to the people living in the home. Some of the risk assessments needed to be further developed to ensure the people living in the home were fully safeguarded. Some issue needed to be addressed with the management of medicines to ensure the system in place was entirely safe. EVIDENCE: The care files for two of the people admitted to the home since the last inspection were sampled. Both files included a lot of information about the individuals and their needs but it was not always possible to determine how staff were to meet the identified needs. Both files included a document entitled assessment and daily care plan and both also had new booklets entitled needs assessment and care plan. It was difficult to determine which documents were being used as the day to day care plans. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 12 The assessments included details of some of the needs of the individuals, for example, dietary requirements for one person in relation to their culture and diabetes and some assistance with personal care. The general daily routines for both individuals were detailed and included preferred rising and retiring times, whether they preferred a shower or bath and at what time, and likes and dislikes at meals times. For one individual it was evident that she had had an injury and was unable to lift her arms very high and needed assistance with personal care. However what assistance she required was not detailed. Information throughout the files indicated whether the individuals were mobile or if they had any hearing or sight impairments but not if any needs arose from these. The care plans did not reflect the care observed or that was detailed as being given in the daily records. This was discussed with the manager and it was recommended that all the necessary information be collated into one document and also detail how staff were to meet any identified needs. Any unnecessary documentation needed to be archived to enable easy tracking of information for staff. The files showed that there were monthly reviews with the people living in the home and they were asked about their care. Comments included in the reviews included such things as ‘says there is nothing to worry about because we take good care of her.’ There were also comments made by staff that indicated they knew the needs of the people living in the home, for example, one mentioned the mental health issue of one of the people living in the home. Both files included nutritional, manual handling and tissue viability assessments. Although both individuals were at low risk on all the assessments comments had been made where necessary. For example, for one person it stated ‘keeps to her diet and eats the right food’ this related to the person’s diabetes. The manual handling risk assessments did not identify any handling needs for the two individuals. One of the people living in the home was being hoisted and this was detailed on the manual handling risk assessment however the size of the sling to be used was not included. It was also noted that this person was being bed bathed but there were no details of how staff were to do this or what equipment was to be used in the assessment. This was addressed after the inspection and a copy of the new risk assessment was sent to us. All the people living in the home, whether at risk or not, were having their skin integrity checked on a regular basis and staff were keeping records of the checks. There were also other risk assessments in place. Both the people whose care was being tracked had mental health needs and these had been clearly detailed in risk assessments drawn up by the community psychiatric nurses involved in their care. These detailed how to recognise any relapse and what to do. At the time of the last inspection an issue was raised about the use of bed rails without a risk assessment. This had been addressed but the assessment was not adequately detailed in relation to how entrapment was avoided. At the time of writing this report the risk assessment had been reviewed and more Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 13 detail included. The manager had also put a risk assessment in place for one of the people living in the home in relation to their diabetes. This needed to be further developed to include how staff would recognise if the diabetes were unstable and what they should do. The people living in the home were very satisfied that their health care needs were being met and that they were receiving a good service. Comments received included: ‘I receive the care and support that I always need.’ ‘If I am sick or have a problem I tell one of the staff.’ ‘When I am unwell the doctor is called to see me.’ ‘They will always call my doctor when I am feeling unwell.’ ‘Care always very good always someone to help.’ Staff were not using the appropriate sheets to document health care visits but were putting this information in the daily records. It was recommended that the appropriate sheets were used as with the build up of daily records the information will be very difficult to track. There was evidence of people seeing, G.P.s, opticians, chiropodists and district nurses as well as specialised health care professionals such as community psychiatric nurses. Staff were not always recording the reason for a visit or the outcome, for example, one record stated ‘CPN visited’ but it did not say why or what the outcome was. This information was needed to ensure there were no implications for the care of the individual. The daily records for the people living in the home gave some detail of the well being of the individuals and of their personal care needs being met. The issue raised at the last inspection about the use of inappropriate terminology had been addressed. Medication continued to be administered via a 28 day monitored system for most of the medication. The issues raised at the last inspection in relation to all prescriptions being seen and checked prior to going to the pharmacist and ensuring specific administration details were included on the MAR (medication administration record) charts had been addressed. We were told only trained staff administered medication. Copies of the most recent prescriptions were being kept with the MAR charts and all medication was being acknowledged when received into the home. In general medication was being signed for as administered however it was noted that the MAR chart had been signed for the administration of medication to one of the people living in the home two evenings and the medication was still in the blister pack. Some of the boxed medication was audited and several discrepancies were noted with the painkilling medication. The amounts left in the home did not correspond with what had been detailed as received and what had been administered. The manager stated this was because the balances from the previous month had not been brought forward to the current MAR chart. The audits on other boxed Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 14 medication was correct. Eye drops and eye ointment were being dated on opening and used within the specified time. No issues were raised by the people living in the home about their privacy and dignity. Staff addressed them appropriately and assistance with personal care was offered discreetly. There were privacy screens in shared bedrooms, toilets and bathrooms had appropriate locks on the doors and there was a lockable piece of furniture in almost all the bedrooms. The bedroom doors did not have appropriate locks fitted as they were the lever type generally used in bathrooms. There were two bedrooms with a fire exit route through them which meant that the occupant of one room could access another person’s bedroom. However this had been a long standing arrangement in the home. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were no rigid rules or routines in the home and the people living in the home were able to spend their time as they chose. There were activities available for those people living in the home who wished to take part. The people living in the home were satisfied with the catering arrangements. EVIDENCE: The home was very relaxed throughout the course of the inspection. People were seen sitting in both lounges. Some chatting, some watching television others sitting quietly on their own. Staff facilitated an activity during the afternoon and those who took part appeared to enjoy this. The home is quite small and staff were able to spend a considerable amount of time with the people living in the home interacting with them. There were activity records in the home but they had lapsed on 16/06/08. Up to this point there was an activity facilitated by staff virtually every day. These included music, bingo, quizzes, old movies, skittles, listening to the radio and exercise. Staff were also generally recording when the people living in the home declined to join in with an activity. There were occasional outside Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 16 entertainers who visited the home. There was also some evidence that the people living in the home were taken out on occasions. The minutes for the meetings with the people living in the home indicated visitors from the church had taken them out. Places visited included the Botanical Gardens, Sandwell Valley Country Park and the local park. The surveys returned prior to the inspection indicated that the people living in the home enjoyed the activities in the home. Comments included: ‘There are activities arranged that I take part in every week.’ ‘Arm chair exercise, games and the church service’ ‘All the activities are gentle and fun.’ The care files for the people living in the home included some information about their social needs, likes and preferences. One of the people whose care was being followed liked going to church and her family arranged to take her, she also enjoyed chatting with staff and singing. It was evident from the activity records and daily records that these activities were taking place. For another person it was clear she liked sitting on her own, listening to opera and watching specific television programmes. She was spoken with and was sitting on her own as this is what she preferred but there was no evidence to suggest that her other social needs were being met. The daily records indicated relatives and friends visited the home at various times throughout the day. Some of the people living in the home went out with their relatives. There were regular visits to the home by people from the local churches. The people living in the home were able to exercise some control over their lives. Those people spoken with were satisfied that they were able to choose how they spent their time and if they declined to take part in an activity staff respected this. They were able to choose when to go to bed and get up, what they ate what they wore and so on a daily basis. All the people spoken with and the surveys returned to us prior to the inspection indicated that the people living in the home were very satisfied with the service they were receiving. There was a menu book at the home and this indicated that the meals were varied and nutritious. Staff were only recording what people were having for lunch and this was being done in the daily records. It was recommended that the records of food eaten by the people living in the home were recorded separately from the daily records. The records needed to include details of all the meals eaten by the people living in the home so it could be determined they were receiving a varied and nutritious diet. The records did show that cultural diets were being catered for. Without exception the people spoken with were very satisfied with the food being served in the home. Comments received included: ‘…. comments that she enjoys all the meals which is provided.’ ‘There is always a choice of food and they are always good.’ (meals) ‘Meals are always good.’ Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were listened to and their views acted on. All staff needed to have training in adult protection issues to ensure the people living in the home were fully safeguarded. EVIDENCE: There was a complaints procedure in the home. The completed surveys returned to us and the comments received from the people living in the home showed that they knew how to make a complaint and that staff listen to them. Comments included: ‘They listen when I talk or ask questions.’ ‘If I am not happy I speak to one of the staff or the manager.’ ‘All the staff listen to what I say and act on it.’ ‘I speak to the manager or carers.’ (complaints) I can always talk to the staff.’ The home had not any complaints raised with them and none had been lodged with us. It was recommended that the manager sets up a system for recording minor issues or ‘grumbles’ that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. There were adult protection procedures on site. These were not viewed during this inspection as they had been seen previously. No adult protection issues Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 18 had been raised with us since the last inspection. It was difficult to determine how many staff had received training in adult protection issues as there was no training matrix for the home. Four staff files were sampled only two of these indicated that the staff had received this training. However all the staff were qualified to NVQ level 2 and this training includes information on adult protection. The manager had arranged for adult protection training to take place in the home during August and September of this year. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care was being provided in a homely, comfortable environment that was generally well maintained. EVIDENCE: There had been further improvements made at the home including redecoration, new carpets to stairs and hall, additional lighting in some areas and some new furnishings. The home is quite small and provides the people living there with a homely environment. There was no doubt that the people living in the home were very comfortable. The home had ample communal space with two lounges, a dining area and a large entrance hall. Some new chairs had been purchased since the last inspection and there had been some redecoration of the communal areas. It was noted that although the dining room carpet is cleaned regularly it was still Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 20 stained. This should be replaced as soon as funds allow. There was a well maintained garden to the rear of the home with seating available for the people living in the home. There were bathing and toilet facilities on all floors. Some of the facilities were quite basic but all were useable. The aids and adaptations throughout the home appeared to meet the needs of the people living in the home. These included assisted bathing and toilet facilities, emergency call system, shaft lift and freestanding hoist. At the last inspection it was noted that the emergency call system was not accessible from all the toilets. This had been addressed. Some of the bedrooms had been fitted with new emergency call points meaning the home were operating two systems however this did not appear to be causing any difficulties. The practice of using wheelchairs without footrests had stopped since the last inspection. Several bedrooms were seen during the tour of the home. These varied in size and were a mixture of singles and doubles. The rooms were comfortable and it was evident that the occupants were encouraged to personalise their rooms to their choosing. As mentioned previously bedrooms did not have the appropriate locks fitted. The home was generally clean and odour free. The kitchen was clean, tidy and well organised. The laundry was appropriately located and although quite small was equipped with a sluice washing machine and a tumble drier. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels and a well trained staff group were able to meet the needs of the people living in the home. There were robust recruitment procedures in place ensuring the right people were employed and that the people living in the home were safeguarded. EVIDENCE: There had been little staff turnover since the last inspection which was good for the continuity of care of the people living in the home. Good relationships between the staff and the people living in the home were evident throughout the inspection. As the home was quite small the staff had a considerable amount of contact with the people living in the home. We received some very positive comments about the staff team these included: ‘Care always very good always someone to help.’ ‘I can always pull the alarm in the toilet, or call carers when I need them.’ ‘Staff are always here when you need them.’ ‘Always available when I need them.’ ‘Staff pleasant’ The rotas in the home indicated the manager was working 12 hours a day seven days a week. This was discussed and she indicated she did have a day off. This needed to be shown on the rota. The rotas showed that there were Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 22 generally two staff on duty throughout the day and night with the managers hours being supernumery to the care rota. There were three staff on duty the day of the inspection but one of these was cooking as the cook was not on duty. The rota also showed that between 7 and 8 pm most evenings there was only one person on duty. Again the manager stated this was not the case the other partner in the business worked in the home during these times. The manager needed to ensure the rota was a true reflection of what hours staff were actually working. There had been only one new employee since the last inspection. The recruitments records for this individual were sampled. All the required checks had been carried out prior to the person starting work at the home including two written references being obtained, POVA first and CRB checks and the applicant had completed a medical questionnaire. The issues raised at the last inspection in relation to references being on file and pre employment medical checks had been addressed. Information received on the AQAA prior to the inspection indicated that all staff had NVQ level 2 and one was undertaking level 4. The manager confirmed this and also stated that three staff were undertaking NVQ level 3. It was not possible to determine what training all the staff had undertaken as there was no training matrix for the home. Four staff files were sampled and they had undertaken a range of training including, manual handling, infection control, medicine management, dementia care, falls awareness, fire safety, food hygiene and first aid. The manager had adult protection and fire safety training booked for the near future. It was strongly recommended that the manager developed a training matrix for the whole home that detailed what training staff had undertaken and when. This will enable easy tracking of when staff are due to take any updates. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager ensured the smooth running of the home in a competent manner. The quality monitoring system needed to be progressed to ensure there was a system in place for continuous improvement based on seeking the views of the people living in the home. EVIDENCE: There had been no changes in the management of the home since the last inspection. The manager had been in post for a considerable amount of time. She had completed her Registered Manager’s Award since the last inspection. She had a very good knowledge of the needs of the people in her care and she clearly had good relationships with the people living in the home and the staff. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 24 As at the last inspection there was no doubt that overall the home offered a good level of service to the people living there but the recording let them down in some areas, for example, care plans. Unfortunately this could lead to some individuals not having their needs met as they would like particularly if any new staff started working in the home. A quality assurance system had been purchased for the home. The system is intended to audit the home against the National Minimum Standards but this had not been started. Meetings were held with the people living in the home and these continued to be facilitated by a visitor from the church. The minutes for one of were these seen and topics discussed included general care, food and entertainment. There were also regular staff meetings at the home. We were told that the home did not handle any money on behalf of the people living there. If anyone needed anything it was purchased by the manager and relatives, Social Care and Health or solicitors then reimbursed the money. The manager was satisfied that all the people living in the home had access to money if they needed it. Health and safety in the home were generally well managed. Staff received training in safe working practices and protective clothing was available for their use. The servicing of the equipment in the home was up to date and all the in house checks on the fire system were being carried out at the required frequency. The only issue raised at this inspection was the need to highlight in the fire book when fire drills had taken place and which of the staff were on duty at the time. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 2 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(5) Requirement Where the use of a hoist is detailed in a manual handling risk assessment the size of the sling to be used must be detailed. This will ensure the people living in the home and the staff are not put at risk. Risk assessments in place for diabetes must include detail of how staff will recognise if the condition is unstable and what they are to do in these circumstances. This will ensure the people living in the home are not exposed to any unnecessary risks. Medication must only be signed for if it has been administered. There must be a complete audit trail for all medication received into the home. This will ensure the people living in the home receive the correct medication at the right times. Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 27 Timescale for action 25/08/08 2. OP8 13(4)(c) 25/08/08 3. OP9 13(2) 25/08/08 4. OP18 13(6) All staff working in the home must undertake training in adult protection issues. This will ensure the people living in the home are safeguarded. There must be evidence on site that fire drills are carried out every six months. This will ensure the people living in the home are not put at risk. 30/09/08 5. OP38 23(4)(e) 25/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP2 Good Practice Recommendations The service user guide for the home should be reviewed and updated to ensure it includes all the necessary information for anyone thinking of moving into the home. People living in the home should be issued with a contract/terms and conditions of residence at the point of moving into the home. This will ensure they are aware of the terms of their stay. Not assessed for progress at this inspection. It is recommended that the home obtains a copy of the social work assessment prior to the admission of people into the home. This will ensure staff have enough information to enable them to make an informed judgement as to whether they can meet the needs of the individual. Care plans should be further developed to detail all the needs of the people living in the home and how these needs are to be met by staff. They should reflect the care being given by the staff in the home. This will enable any new staff in the home to be able to offer care appropriately to the people living in the home. It is strongly recommended that care files used on a daily basis are reorganised so that only the relevant documents and information are held on them. This will ensure staff are able to find all the necessary information. DS0000016897.V367902.R01.S.doc Version 5.2 Page 28 3. OP3 4. OP7 5. OP7 Chestnut Lodge 6. 7. OP8 OP10 8. OP12 9. 10. OP15 OP16 11. 12. OP20 OP27 13. 14. OP30 OP30 To ensure health care visits to the people living in the home are easy to track staff should ensure they record the information on the appropriate sheet. To further improve the privacy of the people living in the home consideration should be given to having suited locks fitted to the bedroom doors and all rooms should have a lockable facility. To evidence the social needs of the people living in the home are being met staff should: - Ensure they complete the activity records on an ongoing basis. - Enable the people living in the home to pursue their preferred leisure activities. Staff should keep a record of all the foods served to the people living in the home so that it can be determined that they are receiving a varied and nutritious diet. It is recommended that the manager sets up a system for recording minor issues or ‘grumbles’ that are raised by the people living in the home to further evidence that they are listened to and their comments acted on. It recommended that the dining room carpet is replaced. This will ensure the home is kept to an acceptable standard for the people living there. The staffing rota must be a true reflection of which staff are working on each shift and the hours worked. This will evidence there are adequate numbers of staff on duty to care for the people living in the home. There should be evidence on site of what induction training staff are undertaking. Not assessed at this inspection as no new care staff had been employed. It is strongly recommended that the manager develops a training matrix for the whole home that details what training staff had undertaken and when. The quality assurance system in the home should be progressed. This will ensure there is a system in place to continually improve the service offered to the people living there. 15. OP33 Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Chestnut Lodge DS0000016897.V367902.R01.S.doc Version 5.2 Page 30 - 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. 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