Inspection on 19/07/07 for Chestnut Lodge

This inspection was carried out on 19th July 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chestnut Lodge 01/06/09

Chestnut Lodge 10/07/08

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ Lead Inspector Brenda O`Neill Key Unannounced Inspection 19th July 2007 09:15 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.V338135.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.V338135.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.V338135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th July 2006 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 fees range from £314 to £332 per week. Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this key unannounced inspection over one day in July 2007. During the course of the inspection a tour of the premises was carried out, the files for three staff and three of the people living in the home were sampled as well as other care and health and safety documentation. The inspector spoke with the manager, one member of staff and six of the people living in the home. Prior to the inspection the manager had completed and returned to the Commission an Annual Quality Assurance Assessment (AQAA) that gave additional information about the home. The inspector sent out questionnaires to some of the people living in the home and their relatives and the majority of these were returned. The majority of the comments received were favourable and many are included in this report. No complaints had been logged at the home since the last inspection. A district nurse had raised one concern with the Commission. This involved a staff member dressing a wound in appropriately. The manager had investigated this and acted appropriately. What the service does well: The home was comfortable and homely with a friendly atmosphere. The people living in the home and their relatives were generally quite happy with the staff team and the service being received. Comments received included: ‘The residents all appear to well cared for and happy in their environment.’ ‘The staff are very helpful.’ ‘Staff listen and act on what you say.’ ‘The home is very nice and I’m happy here.’ ‘On the whole the level of care is good.’ Generally there was good evidence of health care needs being identified, followed up and monitored. Comments received from the people living in the home included: ‘I certainly receive medical support.’ ‘Our doctor visits, sometimes the surgery nurse.’ 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 some activities available for people wishing to take part. The people living in the home that were spoken with were happy with the meals being served in the home. Comments received about the food included: ‘I choose what I want, not a lover of meat.’ Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 6 ‘We have more than we need to eat.’ ‘Very good meals.’ ‘Good food.’ Staffing levels were appropriate for the needs of the people living in the home at the time. There were friendly relationships evident between the staff and the people living in the home. The individuals spoken with and the comments received prior to the inspection were very positive in relation to the staff team. These included: ‘The residents all appear to be well cared for and happy in their environment.’ ‘Seem to keep people safe, well fed and looked after.’ ‘Look after mom especially well.’ ‘There is a pleasant atmosphere.’ Staff received training in all the topics necessary to ensure they could care for the people living in the home. The manager was very experienced and ensured the home ran smoothly. What has improved since the last inspection? What they could do better: To ensure the people living in the home received person centred care they needed to have comprehensive care plans that detailed all their needs and how these were to be met by staff. The processes in place for risk assessments needed to be improved to ensure any identified risks for the people living in the home were minimised. There needed to be a system in place to ensure the manager was alerted if any of the people living in the home had any significant weight loss or gain. This will ensure people are not put at risk. Some improvements were needed to the medication administration system to ensure it was entirely safe for the people living in the home. Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 7 To evidence that the nutritional needs of the people living in the home were met there needed to be records that indicated what was eaten by individuals and of any medical or cultural diets being catered for. To enhance the safety of the people living in the home staff needed to ensure that footrests were used on wheelchairs, risk assessments were in place for the use of bed rails and that the call system was accessible from all toilets. To ensure there was a system in place to continually improve the service offered to the people living there the quality assurance system in the home needed to be progressed. 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.V338135.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.V338135.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): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wanting to live in the home were able to visit prior to admission to assess the facilities available. People moving into the home were not being issued with a contract or statement of the terms and conditions of residence at the point of moving into the home. EVIDENCE: There had been no new admissions to the home since the last inspection therefore it was not possible to assess the key standard in relation to pre admission assessment. The requirement made following the last inspection in relation to this standard has been carried forward to this report. Two of the completed questionnaires returned to the Commission did evidence that people had been able to visit the home prior to admission to assess the facilities. Comments were: ‘I visited before coming to live here.’ Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 10 ‘I spent the day here from the hospital.’ There was no evidence on the two files sampled that the people living in the home were issued with contracts or statements of the terms and conditions of residence at the point of moving into the home. Chestnut Lodge DS0000016897.V338135.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 and risk assessments for the people living in the home did not detail how all needs were to be met or any risks minimised. Generally the health care needs of the people living in the home were met. Some minor improvements were needed to the medication system to ensure it was entirely safe. EVIDENCE: The files for three of the people living in the home were sampled and the care they were receiving was tracked. Staff were completing booklets entitled Assessment for Good Care Planning for the people living in the home. These documents were very good for helping the home to carry out assessments of the individuals’ needs and prompt for monthly and six monthly reviews of the people living in the home. They also gave some past history about the individuals and their family contact. There was a section for Care/Action Plans however the detail recorded in these did Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 12 not enable a new member of staff to be able to pick up the care plan and identify all the needs of the people living in the home and how they were to be met. For example, one of the people living in the home was seen having some treatment applied to their hair and this was necessary due to their culture but this was not detailed. For another person the booklet stated she wore a hearing aid but there was no mention of which ear it should go in or whether she took care of it herself. The booklets did include some detailed information about the social needs of the people living in the home. When discussing this with the manager she stated all the people living in the home did have specific care plans and went to find them. The care plans were in the back of the care files with what was generally old paper work. The care plans in the home needed to be clearly visible to staff and should be used as working documents at all times. One was looked at but this included statements such as ‘assist with personal care’ but there were no details of what type of assistance. The care plans needed to be further developed to include all the needs of the people living in the home that were detailed in the assessment booklets and how these needs were to be met by staff. There also needed to be some detail of what people were able to do for themselves and what their likes, dislikes and preferences were. The manager stated the staff had completed sheets detailing the preferred daily routines of the people living in the home but these could not be found for the people whose care was being tracked. Several risk assessments were carried out including general risk assessments, nutrition and pressure area care when the booklets were being completed. Not all these were fully completed and did not include all the relevant information. For example, one of the people living in the home was seen using a feeder cup and the manager stated that at times she had to be fed. None of this was detailed on the nutritional assessment. Bed rails were in place on two of the beds in the home. There were no risk assessments in place for these. One of the assessments stated ‘needs help walking to the toilet and the dining room’ but it did not detail what help. It was evident from one of the files sampled that one of the people living in the home had a mental health need, there was no information as to how staff would recognise a relapse in the individual’s mental health or what they should do to manage any presenting behaviours, some of which were quite challenging. 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 terminology being used in the daily records was not always appropriate, for example, ‘noisy and demanding’ and ‘still causing a problem’. These statements are not appropriate, as they do not tell the reader exactly what was happening are very undignified and could have been interpreted differently by different staff. Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 13 Generally there was good evidence of health care needs being identified, followed up and monitored. Comments received from the people living in the home included: ‘I certainly receive medical support.’ ‘Our doctor visits, sometimes the surgery nurse.’ Records were kept of visits to the home by health care professionals, although at times staff were not recording them on the appropriate sheet and they were only on daily records. There was evidence of people attending diabetic clinics, hospital appointments, seeing the audiologist, CPN, psychogeriatricians and chiropodist. The weights of the people living in the home were being recorded on a monthly basis where possible however there did not seem to be a system in place to alert the manager of any significant weight loss or gain. According to the records some people had lost weight but there was no evidence of any follow up to this. This was discussed with the manager she stated it had been very difficult to accurately weigh most of the people in the home due to the type of scales being used. However the home had just purchased a pair of sit on scales which would be more accurate. Medication continued to be administered via a 28 day monitored dosage system. The system was generally well managed. The manager stated that all staff that were administering medication had undertaken accredited training. There were no people living in the home that were self administering their medication at the time of the inspection and no controlled medication was being administered. Only one minor requirement was made in relation to medication following the last inspection and this had been addressed. Some issues were raised during the audit undertaken by the inspector. Some medication was recorded on the MAR (medication administration record) chart to be given ‘as directed by the prescriber’ administration details needed to be precise so that staff were aware of exactly what medication was to be administered. Some prescriptions were not being seen, checked and copied prior to them going to the pharmacist therefore any errors would not be noticed until medication was delivered. One tablet that was being administered could have been increased from one half tablet to one whole tablet if necessary but there was no guidance for staff to tell them when this might be. It was also recommended that the medication cupboard was cleaned out of anything that did not relate to medication as there were lots of bits and pieces in there. Privacy was generally well catered for in the home. 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 the bedrooms. The bedroom doors did not have appropriate locks on as they were the lever type generally used in bathrooms. Not all the bedrooms had a lockable facility for personal possessions. There were two bedrooms with a fire exit route through them which meant that another person living in the home could access their bedrooms. One of the completed questionnaires received prior to the inspection did comment the home ‘could do with a better room where people Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 14 could meet their relatives.’ Although there were no very private areas in the home there were some quiet areas which could be utilised by visitors. The home did not have the scope to have a dedicated visitors lounge. Chestnut Lodge DS0000016897.V338135.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 some activities available for people wishing to take part but it could not be evidenced that these met the needs of all the people living in the home. The people living in the home were satisfied with the catering arrangements. EVIDENCE: There did not appear to be any rigid rules or routines in the home. The people living in the home were seen to wander freely around the home and spend time in their rooms if they wished. Staff were seen to spend a considerable amount of time with the people living in the home chatting to them and relationships were very friendly. The daily records for the people being case tracked detailed some of the activities that they were involved in during the day. For example, reading, listening to tapes, going to church, exercises celebrating birthdays and going to the park. The manager stated that she had recently purchased some board games and musical instruments for the use of the people living in the home. There was no evidence to suggest these had been utilised. The manager said that the staff did facilitate some activities Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 16 however they were not recording when these were taking place. Staff needed to ensure they recorded how the people living in the home were spending their days to evidence their social needs were being met. Comments received on the completed questionnaires from the people living in the home and their relatives included: ‘I only join in some’ (activities) ‘I like to join in activities.’ ‘Somebody rings ring and ride and arranges for my mother to go to church if she is well enough.’ ‘Could provide more activities and entertainment.’ It was evident from the daily records and comments received from relatives that there were no restrictions on visitors to the home. Some of the people living in the home were taken out by relatives and friends. There were regular visits to the home by people from the local churches and some of the people living in the home were taken out to church. The people living in the home that were spoken with were happy with the meals being served in the home. There was no rolling menu in place. The menu for the day was put in the diary it was varied and nutritious however it was not possible to identify what each person had eaten that day or whether any diets had been catered for. There needed to be evidence that medical and cultural diets had been catered for. It was recommended that a rolling programme of menus was put in place, after consultation with the people living in the home that also identified choices for any specific diets. Comments received about the food included: ‘I choose what I want, not a lover of meat.’ ‘We have more than we need to eat.’ ‘Very good meals.’ ‘Good food.’ The people living in the home appeared to enjoy their lunch on the day of the inspection and staff were on hand to offer assistance where needed. Chestnut Lodge DS0000016897.V338135.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 good. 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. The policies and procedures on site and the training staff had received ensured the people living in the home were safeguarded. EVIDENCE: The home had a complaints procedure. At the time of the last inspection a minor amendment was needed as it stated all complaints must be raised with the Commission. The information received prior to the inspection stated this amendment had been made when in fact it had not. The manager was reminded to ensure this was undertaken. No complaints had been logged at the home since the last inspection. A district nurse had raised one concern with the Commission. This involved a staff member dressing a wound in appropriately. The manager had investigated this and acted appropriately. The people living in the home were comfortable in the presence of the manager and staff which would have given them the confidence to raise any issues. Comments received from the people living in the home and their relatives included: ‘No complaints or concerns have arisen.’ ‘Staff listen and act on what you say.’ Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 18 ‘Not had to raise any concerns.’ There were adult protection procedures on site. These were not viewed during this inspection as they had been seen previously. Staff had received training in adult protection issues. The recruitment procedures in the home raised no concerns about the protection of the people living there. Chestnut Lodge DS0000016897.V338135.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 no changes to the layout of the home since the last inspection and it was comfortable, homely and generally well maintained. The majority of the requirements made following the last inspection had been addressed. These included a lot of redecoration, a new thermostatic valve had been fitted to the shower, the emergency call system had been altered so that it could be heard throughout the home and the manager had attempted to address the excessively high temperatures in two bedrooms where the boilers were sited. Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 20 The home had ample communal space with two lounges, a dining room and a large sitting area in the entrance hall. The entrance hall and corridors had been redecorated and some new chairs were on order for the lounge. It was noted that the dining room carpet was stained and in need of cleaning. There was a well maintained garden to the rear of the home with seating available for the people living in the home. A ramp had been installed up to the lawned area of the garden. There were bathing and toilet facilities on all floors. The shower in the bathroom on the first floor had had a new thermostatic valve fitted to ensure the people living in the home could not be scalded. Some of the toilets were in need of redecoration and the ground floor toilet needed the flooring replaced. 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. It was noted that the emergency call system was not accessible from all the toilets. There were wheelchairs available for those people that needed them. It was noted that staff were using the wheelchairs without footrests which is very dangerous practice and can lead to the people using them being injured. 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. Some of the bedrooms were in need of redecorating and not all had a lockable facility for personal possessions. The home was generally clean and odour free. The issues raised at the last inspection in relation to infection control had been addressed. The kitchen was clean and tidy and all the required temperature checks on the fridges, freezers and food were being undertaken. The laundry had had new flooring and was appropriately located and equipped. Chestnut Lodge DS0000016897.V338135.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): 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: Discussions with the manager and the information received prior to the inspection confirmed there had been some staff turnover at the home. Three new staff had been employed and the manager was advertising for a cook, as this post was vacant. At the time of the inspection there were four staff on duty in addition to the manager. The staffing levels appeared to meet the needs of the people living in the home. There were friendly relationships evident between the staff and the people living in the home. The individuals spoken with and the comments received prior to the inspection were very positive in relation to the staff team and the service they provide at the home. Some of the comments received included: ‘The residents all appear to be well cared for and happy in their environment.’ ‘The staff are very helpful.’ ‘Seem to keep people safe, well fed and looked after.’ ‘Look after mom especially well.’ Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 22 ‘There is a pleasant atmosphere.’ ‘The home is very nice and I am happy here.’ The recruitment files for three staff employed since the last inspection were sampled. Generally these evidenced that all the required checks were undertaken prior to new staff commencing their employment including POVA first checks and eligibility to work in this country. It was noted that one file had no references and another only had one. This was discussed with the manager who stated she had received them and could not understand why they were not on file. Only one of the files sampled included a completed medical questionnaire determining the employee was fit to undertake her role. The information received prior to the inspection detailed that ninety percent of the staff were qualified to NVQ level 2 which is well above the required fifty percent. The manager stated that the three new employees were all undertaking the Skills for Care induction training but they kept their own books therefore it could not be determined how much of this had been covered. Staff had individual training records and a variety of training had been undertaken including adult protection, risk assessment, death and dying, food hygiene, infection control and pressure area care. Training updates for manual handling and fire procedures were booked. 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.V338135.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: The manager had been a nurse and had managed the home for several years and had a very good knowledge of the needs of the people living in the home and the running of a residential home. She had commenced the Registered Managers Award. Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 24 Relationships between the manager, the people living in the home and the staff were very good. 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 with new staff in the home. The manager had purchased a quality assurance system but little progress had been made on implementing this since the last inspection. The inspector was informed that meetings were held with the people living in the home and a visitor from the church facilitated these. The minutes for these meetings were not on site at the time of the visit. Staff meetings were also held but again the minutes for these were not on site. The inspector was told that the home did not handle any monies on behalf of the people living there. Any items purchased for them were then claimed back by the home by invoicing the appropriate authority. One of the people living in the home continued to manage all her own financial affairs. 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 most recent report by the Environmental Health Officer could not be found but the manager stated she had done what was required and this involved her going on a course and putting new documentation in place in the kitchen. The documentation was seen. Issues raised at this inspection included risk assessments for bedrails and using wheelchairs without footrests. Chestnut Lodge DS0000016897.V338135.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 X 2 X 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 3 2 2 2 2 X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 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.V338135.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation Requirement Timescale for action 31/08/07 14(1)(a,b) The home must receive a comprehensive assessment carried out by the placing authority before the any individual is admitted to the home. (Not assessed at this inspection as no new admissions had been made.) 2. OP7 15(1) This will ensure the needs of the people being admitted to the home are known to staff before admission. All the people living in the home 31/08/07 must have visible care plans that include details of how staff are to care for them and manage all areas of need including any risks. (This has been outstanding since 31/10/05) This will ensure the people living in the home receive person centred care. There must be risk assessments in place that give details of how staff will recognise any relapse and what they should do about it for any people living in the home who have a mental health need. DS0000016897.V338135.R01.S.doc 3. OP7 13(4) 31/08/07 Chestnut Lodge Version 5.2 Page 27 4. OP8 13(5) This will ensure people are safe guarded. Any specific moving and handling 31/08/07 methods must be detailed in the manual handling risk assessments. This will ensure the people living in the home and the staff are not put at risk. Risk assessments in place must 31/08/07 be accompanied by management strategies that include details of how any risks identified are to be minimised: - Nutrition. - Pressure care. - Challenging behaviours. (Previous time scale of 21/08/06 not met.) This will ensure the people living in the home are not exposed to any unnecessary risks 5. OP8 13(4)(c) 6. OP8 13(4)(c) A system must be put in place to ensure the manager is made aware of any significant weight loss or gain of the people living in the home. This will ensure people are not put at risk. There must be specific administration details on the MAR charts for all medicines in the home. All prescriptions must be seen and checked prior to them going to the pharmacist. Where medication can be increased ‘when required’ there must be guidance for staff as to when this might be. 14/08/07 7. OP9 13(2) 14/08/07 Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 28 8. OP15 17(2) Sch 4(13) This will ensure the people living in the home receive the correct medication at the right times. Individual food records must indicate what is eaten by each of the people living in the home. The records must indicate where special diets have been met e.g. diabetic and culturally sensitive diets. (Previous time scale of 21/08/06 not met.) 31/08/07 9. OP19 23(2)(b) This will evidence that the nutritional needs of the people living in the home are being met. Areas of the home highlighted 31/08/07 during the inspection must be redecorated. The dining room carpet must be cleaned. This will ensure the home is kept to an acceptable standard for the people living there. The emergency call system must 31/08/07 be accessible form all toilets. This will ensure the people living gin the home can summon help when needed. Footrests must be used on wheelchairs at all times unless otherwise is specifically detailed in an individual’s care plan. This will ensure that the people living in the home are not put at risk of injury. There must be evidence on site: -That two written references have been obtained for staff prior to them commencing their employment. - That staff are physically and DS0000016897.V338135.R01.S.doc Version 5.2 Page 29 10. OP21 13(4)(c) 11. OP22 13(4)(c) 14/08/07 12. OP29 19(1) schedule 2(5)(6) 31/08/07 Chestnut Lodge mentally fit to undertake their role. This will ensure that the people living in the home are fully safeguarded. 24(1)(a,b) The quality assurance system in the home must be progressed. (Outstanding since February 2005) 20. OP33 30/09/07 21. OP38 13(4)(c) This will ensure there is a system in place to continually improve the service offered to the people living there. Risk assessments for the use of 14/08/07 bed rails must be in place for each resident using them. (Previous time scale of 14/08/06 not met.) This will ensure the people living in the home are not put at risk. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations 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. Staff should ensure that what they record about the people living in the home is appropriate and cannot be misinterpreted by other staff. 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. It is strongly recommended that the medicines cupboard is cleared out of anything that does not relate to the medication system. DS0000016897.V338135.R01.S.doc Version 5.2 Page 30 2. 3. 4. OP8 OP8 OP9 Chestnut Lodge 5. OP10 6. OP12 7. 8. OP15 OP16 9. 10. 11. OP30 OP30 OP36 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 record how they are spending their days and include any activities they have taken part in. Consultation should take place with the people living in the home about having a programme of rolling menus that incorporates their likes and preferences. The complaints procedure should make clear that the home will attempt to resolve concerns locally and the arrangements for making the concerns known with timescales, but that concerns can be raised with the CSCI by the complainant at any time. There should be evidence on site of what induction training staff are undertaking. It is strongly recommended that the manager develops a training matrix for the whole home that details what training staff had undertaken and when. Formal documented supervision should be provided for every member of the care staff at least 6 times a year. (Previous requirement that was not assessed at this inspection.) Chestnut Lodge DS0000016897.V338135.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V338135.R01.S.doc Version 5.2 Page 32 - 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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