CARE HOMES FOR OLDER PEOPLE
Chestnut Lodge 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ Lead Inspector
Jill Brown Unannounced Inspection 30th January 2006 13:15 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.V281461.R01.S.doc Version 5.1 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.V281461.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chestnut Lodge Address 135/137 Church Lane Handsworth Wood Birmingham West Midlands B20 2HJ 0121 551 3035 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.V281461.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th September 2005 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 residents that wish to sit outside in fine weather. There is parking for 2-3 cars at the front of the property. Residents accommodation is 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. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over three and half hours on a day in January. Three residents care records and three staff files were looked at. Eight residents were talked to during the inspections. A tour of the residents’ areas was undertaken. An announced inspection took place in September, which covered many more of the core standards. It is recommended that this report be read in conjunction with this report. What the service does well: What has improved since the last inspection?
The home had responded to almost all of the previous requirements. Two bedrooms had new flooring and as a result the home was fresh in all areas. The steps to access the upper level of the garden had been replaced and a handrail made available to ensure that residents that were able had the chance to see the whole garden. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 6 The home has purchased a system of recording the assessment and care planning processes for individual residents. This system has good updating parts and provides a way of reviewing the care plan and the assessment of the resident. The home had started recording the weights of residents. A full time cook had been recruited. Evidence of the required inspection of the passenger lift and a copy of fire training and the homes evacuation procedure had been sent to the Commission prior to this inspection. 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. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 7 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.V281461.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion. No new residents had been admitted since the last inspection. The home had a requirement to ensure that only admit residents that are within their category of registration and this was removed on this inspection. A number of the residents have dementia and are substantially impaired but have been resident for some time. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 &10 Arrangements of care planning needed to improve to keep residents well and safe. Residents were kept well and treated with respect. EVIDENCE: The home had changed its method of recording assessments and care planning. The new forms prompt monthly reviews and continual updating of the assessment. The assessment also has charts to assess the level of dependency. However, the home had only started the system in December and the forms varied in the quality in the way they were completed. The home needed to ensure that the forms were completed properly if the full benefits of the system can be realised. Mobility and moving handling assessments needed more work. The home was starting to develop personal information on residents to assist their care giving process. Details included resident’s previous pets names, preferred programmes on the television and family contacts. Care plans were still very general and needed to give more specific details about how personal hygiene needs were to be met.
Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 10 It was clear that residents received visits from health professionals such GPs district nurses and so on if needed. The home had a good working relationship with district nurses in the area. Resident’s weights and falls were recorded appropriately. Residents spoken with that were able to respond said all the staff were very good. The residents received when they needed with one resident saying that they take him across the road to the doctor’s surgery when he wants to go. Other residents appeared to have their personal hygiene needs attended to and were spoken to in a respectful manner. Relationships between residents were good with a number of supportive friendships between residents being fostered by the home. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, Further development of activities for people with dementia and recording of these would enhance residents’ lives. EVIDENCE: On the day of the inspection the home had one of its regular sessions of exercise for the elderly. Residents spoken to enjoyed these sessions. One resident said you could join if you want to or not. Another resident said that he enjoyed watching the racing on the television on a Saturday and this was always on for him. Another resident said that they liked to play bingo when this was arranged. Details of an individual’s care plan for activities must be kept especially for residents with a dementia. A record of activities have joined in with kept. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The home had responded to the requirements made at the previous inspection and was clean and fresh. A good environment enhances residents’ lives. EVIDENCE: A tour of the resident’s areas of the building was undertaken and improvements were found. The home had replaced the flooring in two bedrooms to make them fresher. Residents’ furniture had had handles replaced where there were missing. The home had also replace the steps in the garden with a new set that have rails to assist residents to the next level if they wish to see further into the garden in the summer. Residents spoken to said that they enjoyed sitting outside on a summer day. The home was clean and fresh at the time of the inspection. The home must consider the upkeep of the home as part of their quality assurance programme. A previous requirement for the home to have a maintenance plan was included in the quality assurance requirement at standard 33.
Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 & 30 The checks on prospective staff had improved and the training of staff was comprehensive and this protects residents. EVIDENCE: The staff files showed that appropriate checks were undertaken prior to staff starting work. The home had improved the level of information kept on staff files. All staff had undertaken training with only isolated gaps in statutory training. On the day of the inspection the manager had arranged training from the district nurses on diabetes and the use of the blood sugar monitoring machines. The home had in the past arranged training on dementia and this remains an appropriate course for newer staff to the home. The home had appropriate books for reference of staff including ‘A Care Assistants Guide to Dementia published by the Journal of Dementia Care and this is good practice. A previous requirement to employ a cook had been achieved by this inspection. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 &36 The lack of a quality assurance system and regular supervision prevents the home planning for the future. This means that improvements that would enhance residents’ lives may be missed. EVIDENCE: The manager of the home had yet to complete the registered managers award and the time scale set was proving difficult to achieve and this was negotiated to give further time. The home had yet to implement a formal quality assurance system that ensures the ongoing development and improvement in the home for residents. Staff supervision was not reaching the required frequency and this does not ensure that staff have a way of advising the manager of concerns or that the manager can influence staff’s development. However a number of staff
Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 16 supervision’s recorded included a demonstration of competence in a particular task of caring such as bathing. This checking of competence is good practice. Previous requirements to ensure that there was an independent inspection of the lift was undertaken, staff received fire training and that rooms be numbered had been undertaken before this inspection. A previous requirement to ensure the policies and procedures were personalised to the home and understood by the staff was not assessed on this occasion and was brought forward. Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 17 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 X X X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X 2 X X Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 18 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 OP7 Regulation 15(1) Requirement Care plans must contain details of how staff are to care for residents and manage all areas of need including any risks. (This remained outstanding since 31/10/05) The home must ensure that more detail is recorded on moving and handling assessments of individual residents to ensure safe transfers. Individual residents must have an activities plan and a record must be kept of residents involvement in activities. The registered manager must attain the Registered Managers award by A formal quality assurance programme is implemented in the home. It is recommended that areas of audit are implemented month by month to complete all areas by 12 months. (This requirement was outstanding from 28/02/05)
Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 19 Timescale for action 31/03/06 2 OP8 13(5) 31/03/06 3 OP12 16(2)(n) 31/03/06 3. 4. OP31 OP33 9(2)(b)(i) 24(1)(a) (b) 30/10/06 31/03/06 5. OP36 18(2) 6. OP37 17(1) Formal documented supervision must be provided for every member of the care staff at least 6 times a year. (This requirement was outstanding since 28/02/05) The home must ensure that all policies and procedures are personalised to the home and understood by the staff. (This requirement was not assessed and was brought forward.) 31/03/06 30/04/06 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 OP9 Good Practice Recommendations It is recommended that highlighting the Medicine Administration Record (MAR) chart that the medicines are not in the Monitored Dosage System to ensure all medicines are administered as prescribed at all times. It is recommended that medicinal creams be sent back at the end of each prescription cycle to prevent microbacterial infection. (These recommendations were not assessed at this inspection and were brought forward.) Chestnut Lodge DS0000016897.V281461.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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