Inspection on 19/01/09 for Chestnut Park Care Home

This inspection was carried out on 19th January 2009.

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

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 Park Care Home 05/05/09

Chestnut Park Care Home 19/08/08

Chestnut Park Care Home 11/12/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Chestnut Park Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE Lead Inspector Linda Hirst Unannounced Inspection 19th January 2009 10:30 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 Park Care Home DS0000070838.V374032.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 Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Park Care Home Address 15 Magdala Road Mapperley Park Nottingham NG3 5DE 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) 0115 960 8935 0115 960 2791 Chestnuts (Arnesby) Limited Manager post vacant Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Chestnut Park Care Home DS0000070838.V374032.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 the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old Age not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 15 19th August 2008 Date of last inspection Brief Description of the Service: Chestnut Park Care Home provides residential care for up to 15 older people in an adapted property in its own grounds. The home is in Mapperley Park, which is approximately a mile from the centre of Nottingham with its range of shops, places of worship and leisure and recreational facilities. Parking is available on the premises and there is good access to local transport on Mansfield Road. The communal areas consist of a large lounge and a dining room. The bedrooms are on the ground and first floors and there is a vertical lift which gives access to other floors for people who have mobility difficulties. The home has front and rear gardens which can be accessed by ramps. The current fee levels at the home range from £325 to £399 per week. The fees do not include charges for hairdressing, private dental treatment, private optician fees, transport for activities and chiropody. The service user guide and the statement of purpose are on display in the reception area of the home and these are given to all prospective residents. A copy of the latest report was not displayed. This is available for people to read at the home if they ask at the office. Chestnut Park Care Home DS0000070838.V374032.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 0 star. This means that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We did not received this back from the owner when we asked for it, though we did receive it in time to use it to plan our visit and to decide what areas to look at. The form was not fully or comprehensively completed and we have given the owner some guidance on how to fill this in next time. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. We sent out 5 surveys to people living at the home, and 5 to staff to get their views on the service being provided. We received The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the people who live at the service at the moment. The staff team come from a wide variety of backgrounds and experiences. We spoke with two members of staff, two people who live at the service and one relative to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence a continued breach of regulations concerning care planning, providing for people’s nutritional needs, safeguarding training, making safeguarding referrals, staffing levels and the supervision of staff. As these are outstanding requirements, we issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to seize Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 6 evidence and interview staff with a view to assessing the findings in relation to enforcement action. What the service does well: What has improved since the last inspection? Everybody who lives at the service now has a plan of care and the acting manager has started the process of writing new plans for everyone and giving these a consistent format so staff can find information easily. The staff are much better at identifying when people may be at risk of developing pressure sores and they report any concerns to the District Nurse quickly so treatment can begin. They also have a better understanding about how to prevent infections passing between staff and people who live at the service. This has made significant improvements in people’s health and wellbeing. The arrangements for medication have significantly improved; we now consider the way staff store, give out and record medication to be safe and people get their medicines as their Doctor prescribed. There are some activities being provided along with trips out, though improvements are still needed (See below). The staff are better at trying to get people to have something to eat so they do not lose weight and become unwell. A complaints procedure has been developed and this is prominently displayed in the home so people who live there and their visitors know they can complain and how to do this. The policy on safeguarding has been rewritten and it offers clear guidance to staff on what to do if someone is being abused. The owners have employed more staff and there are more people on duty to help than there were on the last time we visited, however, some concerns remain, (see below.) Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 7 The staff have done much more training since we last visited to make sure they work safely and understand their role. An acting manager has been appointed and the staff and people living at the home like her a lot and think she is making improvements to the home. One of the owners is based at the home now and she has taken responsibility for making sure that the service continues to improve. They have both worked very hard since our last inspection of the service and many areas of the service have improved. There are no longer any concerns about how money is handled as people no longer leave their money for safekeeping at the home. Some people who live at the service said they were a bit upset about the fact that they have no money to spend though. The checks and servicing of equipment at the home has all been done as required and people’s health and safety is protected. What they could do better: The statement of purpose has been updated but this still does not have all of the information which it should have in to make sure that people could make informed decisions about living at the service. The care plans are not being written with the people living at the service and their relatives, and they do not focus on the individual preferences and choices of people who live at the service enough. Because of this the staff are not aware of some key information about people and there is an inconsistent service being delivered at the moment to people. The staff do not know about a new and important Law called the Mental Capacity Act, which says that people must be allowed to make their own decisions unless they cannot (by a certain test) do this. The care plans are not being kept up to date when people’s needs change and the staff are not always following the care plans and providing care consistently. Not all of people’s health care needs have a plan of care and because the staff who work at Chestnut Park are not nurses, it is important that they have clear information and guidance about how to meet people’s health needs. We found that in one case a person is not having help from staff follow the treatment plan devised by a health care professional to improve their health. We found the staff are still not consistently assessing people’s nutritional needs, where people are losing weight the records to show what action the staff are taking are not good enough and they don’t show they are monitoring properly. People are not being weighed consistently and the food they do eat is not being recorded at every meal so accurate reports can be made to their Doctor. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 8 We found that although some staff are described as kind and caring, not all of the people who work at the service treat those who live there with dignity and respect. Although the service has started providing activities, people are not happy with them and say they have become less frequent. One person told us they get, “beyond bored at times.” We were concerned about the arrangements for safeguarding people who live at the service. People told us some staff “grumble,” or “shout,” at people who live at the home, and a staff member told us of an incident which should have been reported to Adult Social Care services. When we talked to the member of staff we found they do not fully understand what to do if allegations about abuse are made. We are concerned that this lack of knowledge may compromise the ability of the staff to keep people safe from harm or abuse. We found that not all of the people who live at the service can reach their call alarms to summon help in an emergency. The owners have given us a date by which this system will be replaced. We also found one window which will not close properly; the owners have told us they will repair it. We found that the staffing rota is still not being completed in a way which would show us who is working and in what capacity at any given time. Although the staffing levels have increased, the people living at the home and the staff we spoke with told us there are not enough people on duty to meet people’s needs. The acting manager has not yet applied to become registered with us, in spite of the fact that we have asked her to do this many times and we have told her it is an offence not to. This matter must be resolved to make sure there is a responsible manager working at the home. The owners have not started quality assuring their service yet to make sure it runs well and in the best interests of the people who live at the home. The manager has not been supervising the staff to make sure that their performance is discussed, monitored and improved. 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 Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 9 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 Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 10 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, 2, 3, 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who want to live at the service cannot be assured that they have the information they need to make informed decisions. EVIDENCE: We looked at the statement of purpose for the service and found that this has been updated since our last visit to the service. However, it does not contain all of the information required by Law. A relative and a person living at the service told us, “I didn’t get any written information at first, but I have now.” The owner told us in her Annual Quality Assurance Assessment that they offer an “excellent tailor made transition period to individuals to settle at Chestnut Park.” Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 11 There have not been any new admissions to the service since our last inspection. This is because the placement contract with the Local Authority is suspended at the moment. As a result we were not able to check that the requirements we set in this area have been complied with. We will therefore extend the timescale and will check these requirements during our next visit. Intermediate care is not provided at the service and this standard is not applicable. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 12 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, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not have their personal and healthcare needs fully assessed and the staff are not providing care to people in line with their care plans which could result in ill health. People are not being treated with dignity and respect. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that people are involved in care planning, “where we can.” We looked at the care plans of four people who live at the service to make sure they are up to date, and give staff clear guidance about how to meet people’s needs in a person centred way. We found that there is some evidence of personal preferences and of people’s choices being recorded, but these are not explored in enough detail for them to Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 13 be meaningful to staff. The details about people’s daily routines provide enough information to ensure basic needs and preferences are met, but not to provide person centred care. We found for example that staff were not aware of some people’s religion and how this may affect their wishes around death and dying. We found no evidence that people (or their relatives if appropriate) have been involved in planning their care, and plans are not being reviewed monthly or are not up to date and reflective of people’s current needs. As we suspect a continued breach of the Regulations we issued a Code B Notice to enable us to seize and assess evidence and decide what further action to take. A person who lives at the service told us, “I have not seen my care plan.” We also found that care is not always carried out by all staff in the manner identified in their care plan, for example, a relative told us, “they have told me (my relative) has two strip washes a day,” but when we spoke with the person concerned they told us that sometimes this is just once a day. The relative also commented, “I notice sometimes (my relative) has dirty fingernails.” Staff we spoke with told us, “We have just introduced a new system, (the acting manager) writes the care plans and the senior carers write updates daily. She asks us and speaks to people about their likes and dislikes and so on. The new care plans are more person centred with the old care plans not everything was written down. I think the plans are detailed enough to guide staff and ensure a consistent approach.” The staff we spoke with gave us good levels of detail about people’s needs, but the evidence suggests that consistent care may not be delivered. The owner told us in her Annual Quality Assurance Assessment that people are enabled to access outside professionals i.e. opticians, chiropodists, the District Nurse, hairdresser, and Hospital visits. She also told us that nutritional screening is undertaken on all of the people who live at the service. When we looked at the care plans we found that they are still not detailed enough about people’s health care needs, and some identified areas of need (from the assessment) are not covered as part of care planning. Ones which were notably absent revolved around health care needs (both physical and mental health) . We found the plans on people’s nutritional needs were not adequate. One person who is losing weight has no nutritional assessment, in another case the assessment has not been reviewed and updated in light of changes and in particular weight loss. The service has not recorded the actions taken to investigate weight loss, and, of significant concern is the fact that the staff have not consistently monitored and recorded people’s weight and food and fluid intake as stated in their care plans. Where staff have recorded people’s food intake this has not been an accurate or useful record. For example we saw evidence that staff have recorded people ate a, “medium,” dinner. The Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 14 acting manager acknowledged that staff do not always understand the importance of accurate documentation. People who live at the service told us, “My Doctor comes in when I need it, my physical health is not good, I get pain but the staff give me Paracetamol.” A person who lives at the service expressed concerns to us that they do not receive consistent support from staff to do their exercises and follow the guidance of the Physiotherapist. The person told us, “I am supposed to do exercises twice a day and the Physiotherapist has photographed the position (my limb) should be supported. They don’t do exercises with me (as they should), some do, some don’t. My (relative) does them with me when (they) come in. I had (my limb) properly supported before lunch, but (my relative) repositioned the cushion when I came back from lunch for me.” The relative commented, “I think (my relative) needs the staff to motivate (them) to do the exercises.” When we asked the senior carer about how often the person we spoke with should do the exercises the Physiotherapist has advised, she was under the impression it was only once a day. The acting manager confirmed that it should be twice a day when we queried this. However, the relative also expressed satisfaction that an infection his relative was admitted with has now cleared up well and the District Nurse’s services are no longer needed. Staff we spoke with told us, “the dentist comes, the District Nurse, the Doctor, no one has any current pressure sores but the District Nurses come out really quickly.” She told us that various pressure relieving mattresses and cushions are in use, “the falls prevention team are giving us training tomorrow. As a group of staff I feel we are quite good at recognising when people need assessment and treatment. No-one has infectious illnesses, we have aprons and gloves and we report infections straight away to stop it spreading.” When we asked staff about weight loss, they told us they try and encourage people to eat and they record what the person does eat. A senior told us, “weights are done every month, usually by a senior care. I would look at what people are losing, and if it is more than a couple of pounds a week I would start monitoring food.” Our Pharmacy Inspector has visited the service since our last inspection and found that the arrangements for the storage, administration and recording of medication have significantly improved. We looked at the arrangements for medication for the people we case tracked and found these to be safe. The Medication Administration Record is fully completed, and if a Doctor changes any prescriptions this is recorded and clearly marked. A random check of boxed medication found that the amounts remaining tallied with the records of administration. People who live at the service told us, “The staff look after my tablets, I wouldn’t want to look after my own. They bring me my tablets with water and they see me take them straight away.” Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 15 The staff we spoke with have received training on how to manage medication safely since our last inspection and we saw certificated evidence of this. They talked through safe practice in terms of administration. They commented, “I feel we give out medication safely.” People who live at the service told us, “The staff are fabulous, the staff have never been rude or funny to me, but I get annoyed sometimes as I get less attention.” A relative told us, “I think the staff are fair, they are friendly, some of them are not as good at promoting independence as others.” However people also told us that staff sometimes “grumble” at people when they won’t eat their food or take their tablets, and another told us the staff sometimes shout, “oh shut up,” at a particular person who lives at the service. When we asked the staff about this, they told us, “the staff are normally quite patient, we had a night which was quite hectic and staff got a bit fraught, but I have never heard staff tell anyone to “shut up,” if they have that’s not right.” We did notice that a member of staff we spoke with referred to people as, “wanderers,” which is not respectful, but reduces people to a collection of their symptoms. These matters have been brought to the attention of the acting manager for her to investigate and address. The staff were able to tell us how they maintain people’s privacy. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 16 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, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people who use the service are able to make choices about their life style but this is not consistent. Social and recreational activities do not meet individual’s expectations. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that there has been more entertainment since our last visit. Activities including BINGO, large cards, quizzes, I Spy, Karaoke, keyboard players, puzzles, and art have been provided and the owner told us they have started going out on trips. We did not see any activities advertised around the home so people would know what was available, but we looked at the record of activities, and found in the past month there have been card games, nail care, games of bingo, reminiscence sessions, sing-along, motivation sessions and activities are recorded virtually every day. The service is not recording who took part in these activities however. During the afternoon of our visit the staff did a quiz with the people who live at the service. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 17 The people who live at the service told us, “There is hardly anything to do, we have had no entertainers recently, though they reckon to have them twice a week. I get more than bored, half of the time the television and the music are on together and I can’t hear it. Two of us went into the Christmas markets in Nottingham and that was good.” Another commented, “I just look at the television really, sometimes we play BINGO, or listen to music, sometimes entertainers come in or we play a beanbag game, but I don’t like it, it’s more like a kiddies game really.” The staff we spoke with told us, “We play BINGO or Snakes and Ladders, we try and do an activity every morning and afternoon, it can be hard as some people want to watch TV and activities interrupt them. Activities are not displayed, we do try but a lot of the time people don’t want to join in. We had a Christmas trip out, three people went. When the weather is better they like the garden, but there is not enough time for activities and these could be better.” We saw relatives visiting the home during our inspection and we spoke with one relative who told us, “I can come here when I like, I came on Christmas day and I spent the whole day here. They baked us a cake for our wedding anniversary and did a party tea. They are planning get togethers for relatives. They don’t tell me much really, but they probably would if there was anything serious.” People who live at the home told us, “I always go to bed at the same time because I like to read in bed, but I don’t go to sleep until 11 or 12 o’clock at night. I am up early, always by 8 o’clock and downstairs by ten past. I missed my vote at the last election. I miss doing the lottery.” Another commented, “You are supposed to be able to go to bed when you want. I like to go to bed at 9 o’clock, but sometimes it is earlier and sometimes later. I like to be up for 8 o’clock at the latest, but it is always later than that. The night staff say, “The day shift will get you up.” I sometimes have to wait.” As we have stated (see OP7) there is some information on people’s personal preferences and choices to guide staff, but there could be far more detail to ensure the service being delivered meets individual needs and expectations. Staff we spoke with told us, “People can get up and go to bed when they like, they can have a bath when they like. I think we are brilliant at offering choices. I have not heard of the Mental Capacity Act.” The acting manager and the owner have started holding residents’ meetings, we saw minutes of a recent meeting where everybody was asked individually what they would like to eat. These preferences have been recorded and their preferences in terms of activities are also recorded. The acting manager has told us that consultation with people living at the service is the area they want to focus on next. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 18 We looked at the menus and found them to be interesting and varied. A homemade vegetarian meal is made every day as an alternative to the meat dish. We saw plenty of evidence of home cooking and home baking at the service. We observed lunch; people sit together in the dining room in small groups to eat. Meals are brought to people pre plated, but we saw staff asking people what they would like to eat from a choice of two things. Fresh fruit is available in fruit bowls and the menus are displayed on people’s tables. We observed a variety of different drinks being served with the meals. The food looked and smelled appetising. People who live at the service were very complimentary about the food, they told us, “I would give the food 10 out of 10 easily. It is served so well. I sit at the same table every day, we get plenty to eat and drink. Breakfast is lovely. I have a sherry with my lunch. The desserts are fabulous.” Another commented, “I am very faddy with food, but it is good here. The cook knows I like chicken so she has been making that for me. I enjoyed my dinner today.” One person told us that she had to wait 20 minutes for staff to bring her a cup of tea at night and this issue was reported to the acting manager for her to take action. The staff we spoke with told us, “The food is varied, the dinner today was quite nice, they always have a couple of choices, we always offer people fruit and we try to give them their 5 a day. Breakfast is the best meal as they have loads of options. The stocks of food are not too bad, though we run out of the odd thing, but the owner or the acting manager will go to the shops.” Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. The system for dealing with complaints and concerns is not robust enough to ensure that people are appropriately responded to when complaints are made. The staff are not trained in safeguarding and do not understand or follow the procedures designed to keep people safe when incidents occur. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that there is a robust complaints procedure and that all complaints are recorded. We saw the complaints procedure displayed in the main entrance, and this complies with legal requirements. We asked to see the complaints procedure but none have been recorded since our last visit. We have not had any complaints made directly to us about the service since our last visit. People who live at the service told us, “I did make a complaint a while since, I can’t remember what it was about, I was happy with their response. I have various items of clothing missing but they don’t give me the money to replace the items. I wouldn’t hesitate to complain.” Another person told us, “ I have never complained, I don’t suppose they would take it out on me but I wouldn’t Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 20 want to rock the boat. I did say I would like a bigger room, but they have not responded to me, they also said they would get me a new bed but that was months ago.” We passed these comments on to the acting manager and the provider who told us what action they have taken. There is, however no written evidence to show that they have taken this action. We have therefore recommended to the acting manager that minor concerns and comments be recorded in line with best practice. Staff we spoke with told us, “I have never dealt with a complaint, only from one member of staff about another.” We looked at the safeguarding policy and found that this was updated in September 2008. It covers whistle blowing and details types of abuse and the signs which may suggest abuse is taking place, it also tells staff what to do about it. We have received two safeguarding allegations since our last visit, one concerning financial abuse, and another concerning emotional abuse. The correct procedures were followed in both instances and safeguarding referrals were made. The safeguarding issues from the last inspection are still not concluded and contact from the Police is awaited to conclude the matters. People who live at the service told us, “I have never seen staff behave badly. I have seen them grumble at people but not proper falling out. It is one of the best places for attention.” Another commented, “I feel safe here, the staff are generally good, some staff shout a little bit, but the residents are sometimes nasty as well. I think I would report to the manager if I saw someone behave badly.” Staff we spoke with told us, “I have had safeguarding training but not here,” the senior (who is sometimes left in charge of the shift) demonstrated a poor understanding of the actions to be taken if someone makes an allegation, and the actions described could compromise evidence. The senior knows that there is a policy on safeguarding but does not know what it says, the person is also unfamiliar with local safeguarding procedures. The senior also disclosed that a person living at the service had assaulted another and that this had not been reported under safeguarding procedures. When we brought these matters to the attention of the acting manager and the owner, they told us they are unaware of the incident. The acting manager confirmed that staff have not received any safeguarding training, but said, “we have had a conversation with staff about it.” Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 21 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 is safe, clean and well maintained and it provides comfortable and homely accommodation to the people who live there. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that that they provide a very homely and safe environment and that some people were given a choice about the décor of their room. We did a partial tour of the accommodation including all communal areas and a sample of bedrooms to make sure the home is safe, well maintained, comfortable and clean. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 22 We found the home to be comfortable, warm, homely and clean throughout. Several of the bedrooms are large, and most of those we saw are personalised by the people living at the service. We found that there are still call alarms which are not accessible, but the owner has given us a date when the system will be replaced which will eradicate the problem. There is a window in the first floor bathroom which cannot be closed, and the owner told us she would see to this as soon as possible. People who live at the service told us, “My bedroom is lovely. I have my own bed, bedding and my own TV. It is beautifully clean, my bed is changed every week, they never miss. They have put me a toilet in my room.” Another commented, “the home is kept clean and it is comfortable, it is warm and we have good quality quilts, I have my window open in my room as I get too warm.” The staff we spoke with told us, “I think the home is very well maintained, we have the best cleaner. We do the laundry, sometimes things are misplaced, but we have name tags now.” Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is not enough staff on duty to meet people’s holistic needs. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that the limitations on improvement have been generated by staff shortages, inheriting unsuitable staff and difficulties in recruiting. She told us they have recruited senior carers now, done training and in house inductions, they do supervisions and aim to continue National Vocational Qualifications. We looked at the staff rota and found that this still does not identify the designation of the staff member making it difficult to identify care staff and ancillary staff. The rota shows that there are three staff members on duty, plus the owner and the acting manager who help out if needed. However, people who live at the service told us that the number of staff on shift is not sufficient to meet people’s needs, they said, “I don’t think there are enough staff, they could do with more on. If any of the residents need help the staff in the lounge ask me to go and ask staff in the other room to come and Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 24 help them. There is not someone in the lounge all of the time, definitely not, but they will come if we shout for them. We ought to have a bell so we can ring for them.” Another commented, “I think there are only two on nights and in the daytime they are rushing round every time. They do come quickly if you ring, but it can be difficult to reach the buzzer. They could do with more staff, especially when people want to go to the toilet. The staff say, “Yes in 5 minutes,” but people know their five minutes. If everyone wants to go to the toilet they queue up in the passageway.” Staff we spoke with told us, “We could do with at least another one per shift. On average there are three, there are problems with the toilet but that is because there is only one toilet and they all want to use it at the same time. Most days we are really busy, but not every day, some days things fall into place.” Another commented, “There could be a few more staff. There are always enough in an afternoon but there are times when there is no one in the lounge, quite often. We do find it a struggle to meet all needs when they all want your attention at the same time. It can be hard.” As we suspect a continued breach of the Regulations we issued a Code B Notice to enable us to seize and assess evidence and decide what further action to take. The service provides induction training for staff and we looked at what this consists of, the training covers continence, medication, falls prevention and nutrition. We saw evidence of certificates for induction. We have issued a Statutory Notice about staff files and there being evidence that people are safely recruited and we have visited the since to look specifically at compliance in this area. That visit found a continued failure to comply and at the time of this inspection this issue was part of an ongoing legal process, which meant we have not looked at staff files on this visit. As a result we were not able to check that the requirements we set in this area have been complied with. We will therefore extend the timescale and will check these requirements during our next visit. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 25 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, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some strengths in the management of the service but not enough to ensure that people are safe and that the service is running in their best interests. EVIDENCE: The owner told us in her Annual Quality Assurance Assessment that the acting manager is “highly trained,” and there are management supervisions. She told us that Quality Assurance questionnaires will be sent quarterly to people who live at the service and their relatives. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 26 Since we did our last inspection a new acting manager has been appointed but has as yet failed to apply to become registered. This is an offence and the situation must be rectified. We have found improvements in the service since our last inspection, and we acknowledge the hard work which has gone into making these, but as can be seen from this report there remain a number of areas where the service must do much better to improve outcomes for people living at the service (OP7, OP8, OP10, OP12, OP14, OP16, OP18, OP27). One of the owners now works at the home and she also has started to write reports once a month on how the service is being conducted. We looked at these reports and found them to be very good, including comments from people who live at the service, staff and details of improvements which have been made in the past month. People who live at the service told us, “I think the home runs well, truthfully. When we had a meeting last year they asked me if I had any complaints and I said, “yes, the entertainment,” it got better but it has dropped off again.” Another person agreed and said, “From what I have seen, it has improved here since we first came, but there are still things that could be better like the entertainment.” The staff we spoke with praised the acting manager and told us, “The good thing about her is she will help out if we need her. She always helps and is always there, she puts the clients first. She does really try hard, I think some staff resent her as she is bringing in new policies for the benefit of the residents, but I think they have realised that things will get better for them too. She listens and works with everybody but she does not try and please everybody. The owner is different to other providers, at Christmas she went flat out, Christmas trimmings, presents, she knows the needs of every resident here, you don’t normally get that with owners.” Another commented, “The home has changed for the better. The acting manager is brilliant, she is great, I can talk to her about everything and she is very fair.” The owner and acting manager have started the process of consultation with people who live at the service via residents’ meetings (See OP14.) Since our last inspection, the owners have taken the decision not to retain people’s money on the premises. If people want anything, the service pays for it and then bills the person or their relative. Where this has got rid of the risks of financial abuse, it has meant that people who live at the service do not have any money on the premises, which some commented is hard for them. “We can’t keep any money here now so I have to ask my daughter to bring some in for me, I miss doing the lottery.” We looked at the arrangements for the supervision of staff and found that this crucial part of monitoring and improvement has not yet started. The acting manager told us that she is constantly checking on performance but Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 27 acknowledged that this is not enough, “I need to do supervisions, I know that has to be a priority.” A senior we spoke with told us about a situation which had arisen regarding a staff member’s performance and attitude, and although the senior had spoken to the staff member, nothing was recorded. The owner told us in her Annual Quality Assurance Assessment that all Health and Safety testing has now been undertaken to make sure people are safe and protected. We found accidents are being properly recorded and from the records it appears that staff are taking appropriate action in relation to accidents. We also found the staff have been doing a number of course to ensure their health and safety and that of the people living at the service. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 28 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 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X 2 X 3 STAFFING Standard No Score 27 1 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X N/A 1 X 3 Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4, Sch 1 Requirement There must be an up to date statement of purpose which covers the areas specified in Schedule 1, to provide people wanting to live at the service with up to date information on which to base their decisions about living at the home. This must include a copy of the summary of the latest inspection report. This requirement has not been fully complied with. Timescales of 31/1/08 and 13/11/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Section 24 People must not be admitted to Care the home whose needs are not Standards reflected by the registration Act 2000 categories and the content of your statement of purpose in order to ensure their assessed needs can be met. DS0000070838.V374032.R01.S.doc Timescale for action 01/05/09 2. OP3 19/01/09 Chestnut Park Care Home Version 5.2 Page 30 3. OP3 14(1) This requirement has not been assessed during this visit. The timescale of 15/10/08 still stands and compliance will be assessed on the next visit to the service. People must not be admitted to the home unless they have been assessed by a suitably qualified and competent person and you have confirmed in writing that their needs can be met at the service. Information from any assessment must be passed on to the staff without delay so that they can meet people’s needs and protect their health and wellbeing effectively. This requirement has not been assessed during this visit. The timescale of 15/10/08 still stands and compliance will be assessed on the next visit to the service. Care plans must be kept under review so that they reflect the current needs of the people living at the service and so the staff give them the support they need. This requirement is outstanding - timescale of 11/1/08 and 13/11/08 not met. We have seized evidence which we will assess to decide what further action to take to secure compliance. 19/01/09 3. OP7 14(2) 01/05/09 4. OP7 12(2)&(3) Care plans must be person centred and record people’s preferences as well as their needs so the staff can support DS0000070838.V374032.R01.S.doc 01/05/09 Chestnut Park Care Home Version 5.2 Page 31 5. OP8 OP7 15(1) 6. OP7 18(2)(a) 7. OP8 13(1)(b) 8. OP8 13(4)(c) them with these appropriately and in line with their wishes. There must be evidence that people (or their relatives) are consulted about and involved in developing their care plans unless there are valid, written reasons why this cannot happen. So they can make decisions about the delivery of care. Staff must be properly supervised to ensure that they deliver care in accordance with the care plan so people’s needs are met in a consistent way. Where health care needs are identified during assessments there must be a care plan to advise staff on how to help people with their need so their health is maintained. All of the people who live at the service must have nutritional screening on admission and those identified as being at risk must have food intake and weight records to ensure their health and wellbeing. This requirement is outstanding - timescale of 31/10/08 not met. We have seized evidence which we will assess to decide what further action to take to secure compliance. The staff must follow the advice and treatment plans devised by healthcare professionals to maintain people’s health and wellbeing. The performance of staff must be closely supervised to ensure that they treat the people living at the service with consideration, respect for their dignity, privacy and upholding their right to DS0000070838.V374032.R01.S.doc 01/05/09 01/05/09 01/05/09 01/05/09 9. OP8 13(1)(b) 01/05/09 10. OP10 18(2) 01/05/09 Chestnut Park Care Home Version 5.2 Page 32 confidentiality. This requirement has not been fully complied with timescale of 15/10/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. 16(2)(m & People who live at the service n) must be consulted about their social interests and these must be provided for to make sure their social and recreational needs are met. This requirement has not been fully complied with. Timescales of 31/1/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Staff must have information or 01/05/09 training on the Mental Capacity Act 2005 and they must understand when and how they must assess and record decisions about capacity. This will ensure people living at the service have the right to make their own decision if they have capacity. The allegations that staff 01/05/09 grumble and shout at people who live at the service must be investigated and a copy of the outcome must be sent to us to ensure that the staff are responding appropriately and professionally to people at all times. All staff must have training on 01/05/09 DS0000070838.V374032.R01.S.doc Version 5.2 Page 33 11. OP12 01/05/09 12. OP14 18(1)(c)(i ) 13. OP18 13(6) 14. OP18 13(6) Chestnut Park Care Home safeguarding adults to ensure they understand what kind of behaviour is abusive and they must put their knowledge into practice if allegations are made by following local safeguarding procedures to protect people from harm and abuse. This requirement is outstanding – timescale of 3/3/08 and 31/10/08 not met. We have seized evidence which we will assess to decide what further action to take to secure compliance. All allegations of abuse (including neglect) must be reported in line with local safeguarding procedures to the Local Authority and the Commission for Social Care Inspection to make sure people are safeguarded properly. This requirement is outstanding – timescale of 31/10/08 not met. We have seized evidence which we will assess to decide what further action to take to secure compliance. 16. OP22 13(4)(c) Extensions to alarm calls in bedrooms and in the lounge must be provided to make sure the people living at the service could summon help in an emergency. This requirement is outstanding – timescale of 31/10/08 not met. As the providers have given Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 34 15. OP18 13(6) 01/05/09 01/05/09 us a date for the replacement of the system we are prepared to extend the timescale for a final time. This must be complied with to avoid further action being taken. 17. OP19 23(2)(b) The identified window must be repaired or replaced so that it closes fully to so that the warmth and security of the people living at the service is maintained. There must be an accurate record of the hours worked by all staff and in what capacity to make sure that these are sufficient to meet people’s needs. This requirement has not been fully complied with. Timescales of 15/10/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. The staffing levels at the service must be reviewed and you must be able to demonstrate to us that there are sufficient staff on duty to ensure that people accommodated are safe, receive the care they need and have their holistic needs met. This requirement has not been fully complied with. Timescale of 15/10/08 not met. The timescale for this requirement will be extended for a final time and must be Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 35 01/05/09 18. OP27 17(2) Sch 4(7) 01/05/09 19. OP27 18(1)(a) 01/05/09 20. OP29 19, Sch 2 complied with to avoid further action being taken. Staff must not start working at the home until all the necessary recruitment checks have been carried out including a Protection of Vulnerable Adults First check and a satisfactory Criminal Records Bureau disclosure. These checks have to be applied for and obtained before staff commence employment to ensure that people living at the service are protected from those who may harm or abuse them. This requirement is outstanding - timescale of 21/12/07 not met. Statutory Requirement Notice issued. Date for compliance 10/11/08 This requirement has not been assessed during this visit as the legal process was still ongoing at the time. The timescale of 13/1/09 still stands and compliance will be assessed on the next visit to the service. 19/01/09 21. OP29 19, Sch 2 Staff files must contain the information and documentation specified in Schedule 2 to ensure that people who live at the service are protected from those who may not be suitable to work with vulnerable people. This requirement is outstanding - timescale of 29/2/08 not met. Statutory Requirement Notice issued. Date for compliance 10/11/08 19/01/09 Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 36 22. OP31 9, Section 11 Care Standards Act 2000 This requirement has not been assessed during this visit as the legal process was still ongoing at the time. The timescale of 13/1/09 still stands and compliance will be assessed on the next visit to the service. The manager must submit an application to become registered with the Commission for Social Care Inspection to ensure the service is being run and managed safely and effectively. This requirement is outstanding - timescale of 31/1/08 and 31/10/08 not met. 01/05/09 23. OP31 10(1) The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. The management of the service 01/05/09 must improve to ensure that the issues raised by this inspection are addressed and that the home runs in the best interests of the people who live there. This requirement is outstanding - timescale of 31/10/08 not met. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. There must be an effective 01/05/09 quality assurance and quality monitoring system in place to ensure the home is being run in the best interests of people living at the service. DS0000070838.V374032.R01.S.doc Version 5.2 Page 37 24. OP33 24 Chestnut Park Care Home This requirement is outstanding - timescale of 29/2/08 and 31/10/08 not met. As the providers have started to consult with people living at the service we are prepared to extend this timescale for a final time. It must be complied with to avoid further action being taken. There must be evidence that staff are closely supervised and monitored and that any issues raised about their performance are recorded to ensure that people living at the service are supported by a caring and effective staff team. This requirement is outstanding – timescale of 31/10/08 not met. We have seized evidence which we will assess to decide what further action to take to secure compliance. 25. OP36 18(2) 01/05/09 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 OP12 Good Practice Recommendations Planned activities should be advertised within the service so people know what is available if they would like to join in. Consideration should be given to the location of activities to try and minimise disruption for people who want to watch television in the lounge. DS0000070838.V374032.R01.S.doc Version 5.2 Page 38 Chestnut Park Care Home 2. 3. 4. OP12 OP14 OP16 5. OP16 6 OP33 There should be a record of who is taking part in activities to ensure everyone is having the opportunity for social activity. Arrangements must be made so people are able to exercise their right to vote in elections. Concerns and comments should be recorded and responded to as well as formal complaints to ensure that people feel the issues they raise are being taken seriously and addressed. A system should be in place to recompense people if their personal items go missing and cannot be located. The people living at the service should be made aware of this system. The results of service user surveys should be published and made available to people living at the service and the Commission for Social Care Inspection. Outstanding for two inspections. Chestnut Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Park Care Home DS0000070838.V374032.R01.S.doc Version 5.2 Page 40 - 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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