Random inspection report
Care homes for older people
Name: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN zero star poor service 11/01/2010 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Joanne Pasker Date: 1 9 0 3 2 0 1 0 Information about the care home
Name of care home: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN 01202892116 Telephone number: Fax number: Email address: Provider web address: janetravers@chestnutlodgecare.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Jane Travers Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Jane Travers care home 10 Number of places (if applicable): Under 65 Over 65 10 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Chestnut Lodge is situated in a residential area of West Moors, local shops, churches, pubs and a library are available close by following a level walk. It is a detached property with a pleasant front garden and summerhouse. It is registered to provide
Care Homes for Older People Page 2 of 11 1 1 0 1 2 0 1 0 Brief description of the care home residential care only for up to 10 male and female residents over the age of 65yrs.There are 5 bedrooms on the ground floor rooms all of which are single occupancy and most with en suites. On the first floor there are a further 5 bedrooms, 2 of which are double size and communal bathroom facilities.It is privately owned by Mrs Jane Travers, who is also the Registered Manager and manages the home on a day-today basis, together with her son, who is deputy manager. The service aims to provide individualised care to people in a friendly, family atmosphere and tries to encourage residents to continue with the lifestyle and interests they had prior to moving into the home. Care Homes for Older People Page 3 of 11 What we found:
We looked at the care file of one person who had recently moved into the home. It contained a copy of the pre admission assessment however this had not been signed or dated by the person completing the form. Some areas , such as religious needs and social interests, had also been left blank, not giving a full picture of the persons needs. We also looked at the care files and daily notes of two other people living in the home. Records showed that both contained a care plan and risk assessment but that some actions given regarding care were not always followed by staff and that other improvements could be made. The first file looked at had been signed by the individual and the staff member completing it, covered all appropriate areas and was personalised. Regular reviews were also undertaken and recorded. The daily notes made by staff were quite task orientated and comments such as slept well, no problems and good day were frequently written, with little evidence of daily activities, interactions with others or mood. The file also showed that the person, who managed their own medicines, had become muddled using two similar preparations prescribed for them and had administered them incorrectly. This had caused discomfort and although initial first aid was administered by staff and all recorded, advice had not been sought from the GP. It was found that both the care plan and self medication risk assessment had also not been updated to include details of the medicines prescribed and the possible risks involved. The care plan stated that the person should be weighed at least once a month however the last weight recorded was in December 2009. In the second file it showed that regular reviews had taken place however the care plan had not been signed by staff or the individual. The risk assessment for mobility and dexterity stated that staff observe X regularly but there was no indication of how frequently this happened or should be happening. The medication consent form had not been signed by the person of the family. Daily entries again were task orientated and gave little indication of that persons day to day activities or interactions with others. The care plan for weight stated that the person again should be weighed monthly but the last weight seen recorded was in February 2008. The care record stated that Y was unable to safely stand unaided and staff had recorded how they felt there had been no change in Ys weight from just observation of their general size and appearance. When discussed with staff it appeared that the home only had standing scales which were not appropriate for this person and no chair scales. Other peoples care records showed that the home now clearly record when people have
Care Homes for Older People Page 4 of 11 pacemakers fitted, so funeral directors are aware following a persons death. Medication records showed that as required medicines now clearly state the reasons they are prescribed and when staff should administer them. Staff also record this information on the back of the MAR chart. Medicines are now supplied in the correct dosage tablets so staff dont need to break tablets in half. Also the home has an appropriate tablet cutter to use if needed. A self medication risk assessment was seen for one person. It was discussed how this could be improved by stating the specific medications prescribed and any side effects or risks of overdose and their effects, so staff could spot these. One person had recently been prescribed a medicine for pain relief but only took it as and when they needed it. It was recommended that the home request a review from the GP. Hand written entries were not always double signed. Only one member of staff had recently received medication training however the owner of the home booked more training for the rest of the staff in April during the visit. A tour of the premises and introductions to people living at the home was taken with staff. Interactions were seen to be polite, caring and appropriate when speaking to different people, including those with dementia who may not have been as aware as others of what was happening. All staff have received safeguarding training since the last key inspection with the exception of three staff who are booked on 4 day course by the local county council. A tour of home showed that many actions have been taken to address the requirements made in the last report relating to health and safety. These included: The first floor bathroom now has bars (as window restrictor unable to be fitted) on window, a lock on the door to restrict access and is being refurbished. All rooms in use by residents have window restrictors fitted. Some rooms seen currently empty, did not have restrictors fitted and it was discussed that these should. However all empty rooms were locked and unaccessible to residents or visitors also. The bathroom on the first floor and en suites have temperature valves now fitted and water temperatures are taken for the downstairs bathroom each time it is used and a record kept. Radiator covers have also been fitted in all current residents rooms and any at risk communal areas. An adequate risk assessment was in place regarding a requirement made in the last report about a lack of radiator cover in one persons room. Two people who did not have access to their call bells both had risk assessments regarding the reasons why. It was recommended that all people who do not have access to a call bell for a reason ie. severe dementia, must have a risk assessment identifying why not. All fabric hand towels and flannels have now been removed from communal bathrooms and people have their own individual ones in their rooms. Disposable paper towels and soap were available in all communal bathrooms and toilets. Waste bins seen were to be lidded and foot operated. Care Homes for Older People Page 5 of 11 The staff rota was seen and found not adequate as it did not have daily dates or staff surnames on it. The home use one continuous rota for each week, writing any changes (ie sickness) in a diary book. Advised that there must be individual rotas for each week regardless of whether the same staff members work the same days each week. It also must identify who is the most senior person on duty in charge. The training matrix showed that the majority of staff have received training in first aid, moving and handling and safeguarding recently and certificates were seen in staff files to evidence some of this. The home were still waiting for certificates from the most recent training to be available. It was recommended that the matrix be improved as currently only states the date that training will be out of date, not when it was received. What the care home does well: What they could do better: 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 2.
Care Homes for Older People Page 6 of 11 Care Homes for Older People Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 18 18 The registered manager must ensure that all staff undertake Safeguarding Adult training To ensure that staff have the knowledge to respond to safeguarding concerns and thus protect those who live at the home. 30/04/2010 2 30 18 The manager must ensure that all staff have undertaken the statutory training required. to ensure people are not placed at risk of poor practice caused by untrained staff. 14/05/2010 3 37 17 The registered manager must ensure that they develop a system which illustrates who and when staff have been on duty. To ensure that the home can demonstrate that sufficient staff are on duty. 30/04/2010 Care Homes for Older People Page 8 of 11 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, 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 1 7 17 Care and support monitoring 21/05/2010 records, namely weight charts, must be completed and regularly reviewed. Action must be taken when changes occur in peoples health needs and records and equipment reviewed and amended accordingly. This is to make sure that peoples health and well being is monitored and they receive the care and support they need. 2 8 13 Other healthcare professional 30/04/2010 advice and treatment must be sought where necessary. Action must be taken when changes occur in peoples health needs. This is to make sure that all peoples health and welfare is monitored and they receive the care and support they need. Care Homes for Older People Page 9 of 11 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 3 All pre admission assessments should be fully completed, gathering information from as many different sources as possible. This will ensure that the home has a full picture of the needs of anyone they are considering admitting to the home. Staff should record how people have been spending their time. This is to ensure that records give a more accurate reflection of peoples day to day lives and not just the care and support provided to them. It is good practice that medication self administration risk assessments include details of individual medicines prescribed and any possible side effects or overdose effects. This is so staff are fully aware of all areas of a persons medication self administration. Regular reviews should be sought from GPs when there are any changes in how a person takes their medication from what is prescribed. This is to ensure that peoples medications needs are appropriately assessed. 2 7 3 10 4 10 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
