Inspection on 20/11/08 for Chestnut Lodge

This inspection was carried out on 20th November 2008.

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

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

Other inspections for this house

Chestnut Lodge 19/03/10

Chestnut Lodge 11/01/10

Chestnut Lodge 21/05/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

CARE HOMES FOR OLDER PEOPLE Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN Lead Inspector John Clarke Unannounced Inspection 20th November 2008 10:00 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 DS0000070886.V373129.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 DS0000070886.V373129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Lodge Address 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN 01202 892116 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) janetravers@chestnutlodgecare.com Mrs Jane Travers Mrs Jane Travers Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 10. 21st May 2008 Date of last inspection Brief Description of the Service: 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 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-to-day 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. At the time of this inspection, fees ranged from £450-£600. Additional charges are made for hairdressing, chiropody, newspapers and personal shopping. See the following website for further guidance on fees and contracts www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Chestnut Lodge DS0000070886.V373129.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 the people who use this service experience adequate quality outcomes. This was an unannounced visit to the home as part of an inspection. We looked at a number of documents including pre-admission assessments, care plans, staff records (recruitment and training) and those relating to health and safety practice in the home. We also looked at the arrangements for the management and administering of medication. There was an opportunity to talk with individuals who live and work in the home. What the service does well: The home provides a welcoming and friendly, homely environment with continued improvement where necessary. There is real sense of staff having a commitment to providing quality care and having an understanding of the needs of individuals who live in the home. The manager and owner is clearly very committed to making the improvements that are needed to bring the service they provide to the required standard and has made significant progress in addressing the shortfalls identified from the last inspection. Comments from individuals who live in the home reflect the quality of care provided in the home: “Couldn’t wish for anything better” “Feel like you are at home, this is home you have a place in it” “Very fortunate to be here” A relative said, “you couldn’t find a more suitable place”. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Despite the recognised improvements and positive response to the requirements made at the last inspection there remain a number of areas which require further improvement to meet the required standard. Care planning must be more rigorous in responding to identified risks through daily care practices and record keeping to evidence that care is being provided at the required level to respond to individuals health and welfare needs. Medication records must illustrate and evidence safeguards are in place to protect individuals through the appropriate use of medication. The training of staff whilst improving particularly NVQ qualification of staff remains an area where there are shortfalls. Safeguarding and Moving and Handling is essential training to protect individuals and staff. The home must have arrangements in place where there is adequate staff on duty at all times who have first aid training. This is particularly important at night where as in this instance there is only one member of staff on duty and therefore all night staff must have this training. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 7 The home must ensure the environment is as safe as possible and alleviate or address identified risks. This relates to uncovered radiators in communal and individual’s accommodation. The completion of risk assessments must be undertaken to identify where action (such as covering) should be undertaken to respond to potential risk. 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 DS0000070886.V373129.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 DS0000070886.V373129.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose fails to reflect the service that individuals can expect to receive when living in the home and is not available to perspective individuals who move to live in the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. EVIDENCE: The Statement of Purpose was not specific to the home and did not have the information needed such as staffing arrangements, facilities, information about the manager regarding qualifications and experience. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 10 We looked at pre-admission assessments completed by the home they provided good information about the care needs of the individual including medical conditions, physical and mental health. Copies of local authority assessments are obtained providing social information and care needs. Chestnut Lodge DS0000070886.V373129.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are adequate providing staff with the necessary information so that the health and social care needs of residents are met. However there are significant shortfalls in providing the information needed to make sure the health and welfare of individuals who live in the home are fully protected. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at 4 care plans for individuals living in the home. Information about the individuals needs were clearly outline including personal hygiene, mobility, Daily routines were included and there was personal information about the likes and dislikes of the individual. Where individual was known to the local Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 12 authority there were care reviews being undertaken. Risk assessments had been completed and reviewed as part of the care plan review. Two individuals had bed rails but no evidence of assessment or consent for their use. Moving and handling assessments had not been completed for all those care plans seen. Waterlow risk assessments had been completed. One individual had pressure sore and district nurse visiting twice weekly however there was no moving/turning chart or fluid chart. The district nurse had advised to move “hourly”. There was evidence form records seen of individuals receiving health services such as chiropody and other health services. The home has regular contact with community nurses for those individuals who need “nursing” care. Medication administering records were looked at and showed good recording of medication. Any changes are recorded and signed by two staff members and signature of all medication received in the home. Where medication is given “as required” there was not always written guidance for circumstances to be given though in one instance this was recorded in doctors visits record. Controlled where used are recorded in controlled drug register with two signatures of staff and stored in separate secure storage. Storage arrangements for other medication was satisfactory. Individual’s allergies recorded. We spoke to a number of individuals about the approach of staff particularly about whether they felt treated with respect. All individuals said they felt staff did so and that “all very friendly” “staff helpful and kind”. Staff was observed throughout the visit interacting in a respectful and supportive way. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 13 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): 12,1,3,14,1,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: The home offers a range of activities including piano entertainment, bingo and exercise classes. Outing arranged particularly in the summer months. Individuals we spoke with said they felt “there’s enough to do” “I enjoy what they do for us”. One individual said that staff “sit and have a chat”. Individuals said they were able to receive visitors “whenever we want” and said that the home was “very welcoming”. We spoke with relatives who said they were “always made welcome”. One relative described staff as “really friendly and helpful” and “staff take time to talk with residents”. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 14 Individuals we spoke with said they “always” were able to choose how they spent their time and had choice about getting up and going to bed. One individual said she was her “own agent, free to do what you like”. We asked individuals who live in the home about the meals provided all spoke very positively “its all very good” “I always enjoy the food here” “they will always give me what I like and find out if you like anything or not”. Menus showed a good variety of meals being provided in the home. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 15 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: We spoke to individuals who live in the home about what they would do if they were unhappy about anything. One individual said she “would speak to the boss” “tell the staff they would do something”. All said they had never had to make a complaint “but know I can if I need to”. A relative said they had spoken to the manager about a concern and it had been “dealt with very promptly”. The home had not received any complaints since our last inspection. A complaints log is kept in the home. The home has a Safeguarding policy and procedure in place however there was no reference to local authority guidance and procedure in relation to responding to any allegations of abuse. Some staff have received training in Safeguarding. We spoke to staff about their understanding of what constitutes abuse they were able to give some good examples and also were clear about how they would respond if an individual made an allegation of abuse. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 16 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, well-maintained, hygienic environment for those that live and work in the home. EVIDENCE: It was evident from walking around the home that there was a good standard of decoration and maintenance. Individuals we spoke with said the home was “always” clean and “well kept”. On the day of our visit the home was clean and free of offensive odours. Staff have received infection control training and there was protective clothing available for staff. The home has an Infection Control policy in place. There have been a number of improvements to the environment of the home since the last inspection including re-decoration of rooms (5), re-furbishment of lounge, hall and dining room. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 17 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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way. Training of staff is generally good however there are significant gaps in training that potentially places individuals who live in the home at risk. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: Staff rotas were looked at and showed that there were satisfactory levels of staff available. At the time of our visit there were two staff on duty with 3 pm and 2 evening in addition to the manager. Individuals we spoke with said that staff “do anything for you” “always come ever so quick” “certainly get all the help you need”. The manager advised that 3 care staff have completed NVQ professional qualification and 4 are due to start in December. We looked the recruitment records for 3 members of staff. The required checks had taken place: Criminal Record Bureau, two references. In one instance there was no previous employer information on application form other applications gave full and detailed information including employment history. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 18 Training records were looked at however there was no training records for a number of staff or evidence that they had completed moving and handling, Safeguarding. One staff member had record which showed they had completed moving and handling, health and safety, first aid. Certificates were displayed in hall of home for staff that had completed “mandatory” training. Records for night staff showed that not all had completed first aid training. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 19 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): 31,33,37,37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager Mrs Travers is a registered nurse and has 30 years experience of working in the care sector. She is hoping to complete her Registered Managers Award shortly. Individuals we spoke with including staff all spoke of her as someone who “we can talk to” “is firm but fair” “approachable”. Relatives Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 20 spoke of her as being “very approachable” and “if we say anything will listen and respect what we say”. Mrs Travers takes an active part in running the home in that she undertakes care shifts and illustrated to the inspector a good understanding of the needs of those in her care. The inspector was advised that quality questionnaires are given to individuals who live in the home and relatives. However we were not able to see any results of these questionnaires. The manager has undertaken full audits of policies and procedure and put in place audits and new procedures where needed. Essential guidance is available to staff in relation Infection Control, Safeguarding, Whistle blowing, and COSHH. There was no direct evidence that staff had received copy of this guidance as part of their employment “pack” or read the guidance. The home has installed new fire alarm system and fire alarm board. Records showed that fire alarms are tested weekly. Staff have undertaken fire drills and training relating to the fire alarm system and evacuation. Equipment is serviced regularly: stair lift 17/07/08, hoists 09/05/08 and electrical test 09/05/08. Fire assessment is being completed. It was noted that there are a number of unprotected radiators in the home. There were no risk assessments in place. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 21 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 1 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X 3 2 Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 12 (1) Requirement The manager shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of individuals living the home. This refers to making sure care staff undertake the required care tasks to protect individuals i.e. through the keeping of fluid and/or turning charts in response to identified risks or maintaining the health of the individual. It also relates to making sure that where bed rails are used there is evidence of an assessment for their use and consent from the individual or if unable to give informed consent a medical practitioner. The manager must make arrangements for the recording, safe handling, safekeeping, safe administration and disposal of medicines received including: Medication prescribed ‘as required’ must have the reason and frequency of dose documented. DS0000070886.V373129.R01.S.doc Timescale for action 15/01/09 2. OP9 13 28/02/09 Chestnut Lodge Version 5.2 Page 23 3. OP30 13(6) The manager must make arrangements, by training staff, or by other measures, to prevent residents being harmed, or being placed at risk of harm, or abuse. This refers to the need for all staff to undertake Safeguarding, Moving and Handling and first aid training. 30/03/09 4. OP1 4 (1) 5. OP38 13 4 © The registered manager shall 28/02/09 complete a written statement (Statement of Purpose) which shall consist of the aims and objectives of the care home, facilities and services which are provided and all matters referred to in Schedule 1) A copy of this to be provided to the CSCI within the timescale of this requirement. The registered manager to make 30/03/09 sure that unnecessary risks to the health or safety of individuals who live in the home are identified and as far as possible eliminated. This refers to the need to undertake risk assessments where there are uncovered radiators. 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 OP30 Good Practice Recommendations Training records to be completed for all staff and these to be audited as part of the auditing of the home systems DS0000070886.V373129.R01.S.doc Version 5.2 Page 24 Chestnut Lodge 2 OP30 and to ensure training is being undertaken as required and reviewed or updated where necessary. The manager to make sure staff have seen copies of relevant guidance and this is recorded that they have done so. Chestnut Lodge DS0000070886.V373129.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000070886.V373129.R01.S.doc Version 5.2 Page 26 - 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. 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