CARE HOMES FOR OLDER PEOPLE
Chestnut Lodge Nursing Home 302 Norton Road Norton Stockton-on-Tees TS20 2PU Lead Inspector
Lyn Burrell Unannounced Inspection 11th November 2005 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 Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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 Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chestnut Lodge Nursing Home Address 302 Norton Road Norton Stockton-on-Tees TS20 2PU 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) 01642 551164 Mrs Joan Mary Stead Mrs Dawn Anne Brown Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Two named individuals who are under the age category are allowed to reside in the home, until such a time as the placements are no longer required. 20th April 2005 Date of last inspection Brief Description of the Service: Chestnut Lodge is a care home providing personal and nursing care for up to 18 service users. The home is owned by Mrs Joan Stead and is situated in Norton on a main bus route into Stockton and has shops and amenities close by. The home has a minibus, which the service users enjoy going out in usually each Monday to places the residents choose. Chestnut Lodge opened in 1989 and is a converted house. There are 3 bedrooms and a lounge/diner on the first floor and 15 bedrooms, 14 single and 2 double rooms are available. On the ground floor that has an extension to the side and rear of the house. There are two spacious lounge/dining rooms on the ground floor and three bathrooms in the house. A stair lift is available to access the first floor. One bedroom as had an en-suite has been fitted with a toilet hand basin and shower in the first floor bedroom. The gardens have been paved for easier access for people who are dependant on wheelchairs and there are potted shrubs and flowers around. The home has successfully achieved the Investors in People Award. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A positive inspection, whereby all of the National Minimum Standards looked at were met. The inspection lasted three hours with one inspector; three residents were interviewed. During this inspection discussion with residents took place, the inspector walked around the home, reviewed the medication records, residents monies and maintenance certificates. A tour of the home showed that it was clean, tidy and well decorated throughout. What the service does well: What has improved since the last inspection?
The staff identified that there were residents being admitted to the home who were physically ill but also had some problems with confusion. To ensure staff were able to manage people who were at times confused due to the nature of their illness specific training has been put into place. The residents chose to purchase a widescreen TV for the lounge with a DVD and video player, using the residents’ fund which events had raised money for. A range of new films have also been bought.
Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 6 The home follows a decoration programme; several rooms have been redecorated since the last inspection along with curtains and bed linen. Following discussion with the residents several changes to the menu has been made, this meets with their approval. 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 Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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 Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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): 6 Intermediate care is not provided at Chestnut Lodge. EVIDENCE: Although intermediate care is not provided at Chestnut Lodge short term or temporary placements can be arranged. An example being a person could be admitted to the home for the management of a wound or pressure sore and then transferred home when the person is well enough. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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): 9 Medication administration and recording arrangements are appropriately managed. This will ensure that service users receive their medication as prescribed by their GP. EVIDENCE: There are no resident’s who self medicate at this time but the manager confirmed that this is the residents’ choice if they are able to manage their medication safely. The manager orders the prescriptions monthly from the residents GP; these are then forwarded to the local pharmacy where they are dispensed to the home. The medicines recording sheets are completed by the Registered Nurse on duty prior to them being administered to the resident’s. In Chestnut Lodge only Registered Nurses give out the medication. Should any drugs need returning to the pharmacy they are collected and signed for by the pharmacist at that time. A drug fridge is used for specific medicines and a record of the temperature is kept to ensure it is in working order.
Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 10 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): 13,14 Families and friends play a large part in residents’ lives and information is given to residents to allow them control over their lives. EVIDENCE: Visitors are welcomed into the home at any reasonable time, special occasions such as an anniversary or birthday is always celebrated. Some residents said they go out with families or if they are able they can go out alone. If assistance were needed from an independent person the staff would contact the Citizens Advice Bureau and request an advocate to act on the residents’ behalf. A resident said that the manager helped her to contact the advocacy service as she needed some legal advice. The notice board displays relevant information about services that are available to older people. Most residents’ families manage their financial matters on behalf of the resident. Residents are promoted in maintaining their independence for as long as they are able or choose. A man who was staying in the home temporarily said that he was satisfied with the care he received but was looking forward to going home when his health improved.
Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 11 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): 18 Robust procedures are in place to ensure that service users are protected from abuse. EVIDENCE: The manager has developed a detailed risk assessment for each resident to identify any areas of abuse that may be presented. The policy that is in the home follows the “No Secrets” policy that is used throughout Teeside. 75 of the carers have achieved a National Vocational Qualification in care one of the modules within this training covers the Protection of Vulnerable Adults. The remaining staff have received the appropriate training to recognise and manage untoward situations should it occur. The staff spoken to were aware of the procedure to follow should abuse be suspected. The nurses that are employed are registered with the Nursing & Midwifery Council and personal index numbers are checked periodically to ensure the nurses are eligible to practise. The nurses are also bound by the Nursing & Midwifery Council to adhere to their code of practise. They are also accountable to the Nursing & Midwifery Council for their actions when giving care. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 12 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): 19,25,26 The home is clean, well decorated and maintained. This can help promote a positive image for service users, and ensure they remain safe. The home has a pleasant environment with comfortable furnishings and is clean and tidy throughout. EVIDENCE: The building was well maintained and in good decorative order. Recently there has been new carpets fitted in some of the bedrooms in the home, this is part of an ongoing refurbishment plan. The handyman keeps effective records that show when minor repairs have been done and also the monitoring checks that maintain safety in the home. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 13 Each resident’s room has equipment provided that will help with their care needs. During a time of redecoration residents are included in choosing colour schemes or they are painted in a neutral colour. One resident said she chose to have her own curtains and bed linen in her room and also had small items of furniture that she had brought from home. Rooms are clean and tidy throughout. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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): 28,29 Residents are supported by an experienced group of staff; this is enhanced by more than 50 of the care staff achieving appropriate qualifications. A Registered Nurse is on duty at all times. Staff recruitment practice protects service users and record keeping in respect of new staff employed in the home is robust. The records contain sufficient information to ensure that service users are protected. EVIDENCE: The home has a commitment to training, this includes a range of subjects such as health and safety, basic food hygiene, fire training, first aid. Staff records are current and up to date. A robust recruitment system is in place and the records are well maintained. Each staff member has a personnel file that is kept in accordance with data protection. To ensure the residents are safe each employee completes an application form and explains any gaps in employment. Two references are requested by the manager, one of the references is from the previous employer. Photographic identification and birth certificates are copied and a criminal records check is sought at an enhanced level. Nurses personal identification numbers are checked with the Nursing & Midwifery Council to ensure the nurses are eligible to practice. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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): 35, 38 Residents’ are asked by the by staff about how they want their support to be provided so that their rights and best interests are promoted. The health and safety of the service users is promoted by a well managed staff team. Arrangements satisfactory. EVIDENCE: Small amounts of money are kept in the home, which the residents can access at any time. There is a record that shows every transaction there are two signatures for each entry. The manager periodically checks that the money and records are in balance. for the handling of service users’ personal money are Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 16 The home is safe and well maintained with certificates of maintenance that are up to date and show that a suitably qualified person has checked essential services in the home. There are environmental risk assessments in place to ensure the residents are living in a safe well maintained place. Other agencies have visited the home such as environmental health office and fire safety. Certificates are in place to demonstrate they are satisfactory. Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 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 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 X 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 18 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnut Lodge Nursing Home DS0000000159.V258945.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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