Inspection on 05/05/09 for Chestnut Park Care Home

This inspection was carried out on 5th May 2009.

CQC found this care home to be providing an Adequate 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 19/01/09

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 12/10/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Chestnut Park Care Home 15 Magdala Road Mapperley Park Nottingham NG3 5DE Lead Inspector Karmon Hawley Key Unannounced Inspection 5th May 2009 DS0000070838.V375439.R01.S.do c Version 5.2 09:30 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Chestnut Park Care Home DS0000070838.V375439.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.V375439.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 January 2009 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 £335 to £450 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.V375439.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission 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 receive this back from the owner when we asked for it; therefore we did not use it as part of our planning for this inspection. 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. 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 staff and people using the service 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. Prior to this inspection the provider attended a meeting with the Care Quality Commission where it was decided that no further action would be taken at this time in regard to the statutory notices that had been issued on 10/11/08. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 6 What the service does well: A warm and welcoming atmosphere is evident within the care home and staff and people using the service appear to get on well and have good relationships. Staff spoken with are dedicated to their job and are able to discuss the support that people need and their personal preferences. People using the service tell us that they are happy and settled living at the care home and that they are well looked after. They say that the food on offer is good and plentiful and satisfies their needs. People are supported and enabled to access specialist services when they need to make sure that their health care needs are met. People using the service are given an opportunity to have a say about the activities that they do and the meals that they have by way of a weekly meeting. People are supported and enabled to maintain contact with people that are important to them and visitors are made welcome at the care home. The routine of the care home is flexible and people can spend their time as they wish and make their own choices and decisions in regard to their daily life. Staff training has developed and is at a good standard and staff spoken with feel supported in their training and development. What has improved since the last inspection? The statement of purpose has been updated so that people who may wish to use the service have all the necessary information they will need to be able to make an informed decision about whether they use the service. There has been some development in the care planning format so that these are more person centred so that people receive care and support in their preferred way. Some progress has been made in the care planning review practices so that people’s changing needs further are met. There is some evidence available to show that people using the service and their relatives are more involved in the care planning process. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 7 There is evidence to show that staff follow the advice and treatment plans devised by healthcare professionals to maintain people’s health and wellbeing. Where health care needs are identified during assessments there is now a care plan to advise staff on how to help people with their need so their health is maintained. Where they are concerns about people’s nutritional needs appropriate monitoring and records are now maintained to ensure their health and wellbeing. Staff treat people using the service with respect and maintain their privacy and dignity at all times. People who live at the service are now consulted about their social interests and these are mainly being provided for to make sure their social and recreational needs are met. Extensions to alarm calls in bedrooms and in the lounge have now been provided to make sure the people living at the service could summon help in an emergency. Some work has taken place to look at the staffing levels and the deployment of staff working towards ensuring that sufficient staff are on duty to meet people’s needs and a new duty rota is in place which highlights people’s positions and responsibilities. Some improvements have been made in regard to the recruitment and selection process working towards ensuring the people using the service are protected from unsuitable people being employed. The management of the service has begun to 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. A little work has taken place in regard to staff supervisions working towards ensuring that staff deliver care in accordance with the care plan so that people’s needs are met in a consistent way. Some development has taken place in regard to the quality assurance and quality monitoring system working towards ensuring that the home is being run in the best interests of people living at the service. What they could do better: Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 8 When the service begins to start admitting people to the care home again they need to make sure that they admit people that are reflected in their registration category. The assessment needs to be done by a person that is competent to do so and they people must receive confirmation in writing that the staff are able to meet their needs. The care planning process needs further development so that plans of care and risk assessment are in place for all identified needs, these are person centred and kept under review following consultation with people using the service or their relatives if able. Improvement in regard to the receipt and recording of medication received into the building and administered to people using must be improved upon to make sure that people are protected by the medication practices employed. Further training on the Mental Capacity Act 2005 must be given to all staff so that they understand when and how they must assess and record decisions about capacity. Records and documentation management must be improved upon to make sure that people’s health and wellbeing are maintained and current legislation is complied with. Systems must be further implemented which assesses the dependencies of people using the service and staff deployment. This will demonstrate and ensure that there are sufficient staff available to meet people’s needs. Improvement in regard to the recruitment practices is required to ensure that people using the service are protected from unsuitable people being employed and supporting people. The Care Quality Commission must be informed of the management arrangements that will be put into practice when the acting manager leaves employment. This will ensure that we are aware of who will be managing the service and provide assurance that the service is being run and managed safely and effectively. Further development in regard to the quality assurance systems is required to ensure that they care home is being run in the best interests of people using the service. Further development is required to make sure 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. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 9 Liaison with the Fire Authority must take place in regard to the routine testing of fire systems. This will ensure that people using the service are protected from the risk of fire. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 10 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.V375439.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose supplies people who may wish to use the service with all the information that they require to enable them to make an informed decision about whether to move into the care home. People are assured that their needs will be assessed and that staff can meet these before they make a decision to move into the care home. EVIDENCE: A consultant employed by the provider has rewritten and up dated the statement of purpose, this is now going to be printed and made available to people currently using the service and potential users who may wish to come to live at the care home. The statement of purpose now contains all the necessary information people will need about the service. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 12 The suspension of the contract with the Local Authority has been lifted since this inspection and the service is now able to receive new people into the care home. A new admission assessment has been devised to ensure that people’s needs are fully assessed. The acting manager will visit people within the community prior to admission to carry out these assessments so that she can be sure that staff are able to meet people’s needs. People may also come and visit the care home and spend time there so that they can get a feel for what it would be like to live at the service. Staff spoken with said that they receive enough information about people when they move into the care home so that they can support them as needed. One person using the service said that they had come to have a look at the care home before they made decision to move in. We were unable to assess compliance with two requirements that had been set at the previous inspection due to the fact that there have not been any new people admitted to the service. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new format used for care planning is much more organised and offers a good level of information for staff to support people using the service, however as some care plans and risk assessments are not in place as required, people may not be fully protected and their needs not fully met. People using the service are not fully protected by the medication practices employed. EVIDENCE: The consultant employed by the provider is currently updating and rewriting plans of care using a new format. The new format offers clear and concise information so that staff are aware of people’s needs. Plans of care are more personalised and are written in the 1st person so that people’s choices and preferences are upheld. Within this format people undergo general assessments so that their specific needs are highlighted; this assists in the development of plans of care. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 14 However we saw that if up to date information is not made available then plans of care are not in place, for example within one case file there is no information about behaviour that may be challenging despite issues being evident from the notifications that we have received. As this had not been documented in the older format that was used as a guide to update the new format, this was not transferred and was consequently lost. There is a section that now discusses people’s capacity to understand and consent to things so that their rights and choices are upheld. Information about people’s daily routine is available so that staff know how people prefer to spend their time and the activities they like to do throughout the day. There is no actual documentary evidence stating that people or their relatives have been involved in the care planning process, however we saw that some input had been given from people using the service and relatives due to the information that is available. In the new format, risk assessments are more in-depth and advise staff how to manage and reduce risks to make sure that people remain safe. However due to lost paper work as previously mentioned this consequently meant that a risk assessment was not in place in regard to behaviour that may be challenging to ensure that this is managed effectively and people remain protected. The older type format remains unchanged and most plans of care still follow this. Although detailed information is available within assessments and daily records some plans of care such as end of life care and the care of a syringe driver to deliver medication are not in place to ensure that people’s needs are fully met. In the older style format it is difficult to evidence if reviews are always taking place due to a lack of dates on assessments and care plans. We saw that one case file had not been updated when significant changes had occurred in the person’s condition, however following discussions with staff and through observation we ascertained that appropriate care and support is being offered. Risk assessments are in place within the older format; however these only offer brief information in regard to supporting people in managing these. Staff spoken with are able to discuss people’s needs and the support that they require on an individual basis to ensure that their needs are met. People using the service tell us, “I am very happy here, all the staff are very good particularly the night staff as I don’t sleep very well, they bring me honey and hot drinks, they look after me, they are kind and considerate,” and “we are looked after well, the staff are always helpful.” Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 15 Plans of care are now in place in regard to people’s health care needs, these offer a good level of information and what staff should do in the event of an emergency. We saw documentary evidence that people are supported and assisted to obtain specialist services such as the doctor, optician and dentist when required and we saw the district nursing visit the care home on the day of our visit. There is evidence within plans of care to show that staff follow out the instructions of specialist visitors to the care home to make sure that people’s receive the care and support that they need. During the tour of the care home we saw that specialist equipment such as beds, mattresses and cushions are available for people who need it. One staff member spoken with said “People can see the doctor when they need to. The district nurse visits regularly as does the hairdresser and optician.” People using the service offer the following comments “I have my own special chair which helps pain control, I also have brought in my own bed, which is very comfortable,” “I use the equipment to help me to move and I can see the doctor when I need to.” Staff who administer medication have been trained to do so, however on examining the controlled drugs register we found that medication had not been recorded as required. The register is not up to date and 60 morphine tablets (very strong pain killers) that had been received into the care home had not been documented as being received. The controlled drugs register is in disarray, because different types of medication are logged on one page, which causes confusion with the amounts that have been administered and that which is remaining to show a clear audit trail. We had to audit the medication and the medication records to establish that medication is in fact not missing or unaccounted for as the records suggest. The acting manager had no explanation for this happening when we asked her. We left an immediate requirement for this to be dealt with straight away so that people using the service are protected by the medication practices. Following the inspection we received evidence which tells us that the provider has now dealt with this issue and complied with this requirement. When we examined the other medication records we saw that medication that has been administered is signed for with the exception of some food supplement and medication charts clearly identify when medication should be administered. Throughout the inspection we saw staff treat people with respect when supporting them with their needs. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 16 Staff spoken with are able to discuss how they ensure people’s privacy and dignity is maintained by way of knocking on doors before entering and ensuring that people are covered when offering personal care. People using the service offer the following comments; “staff are always very respectful and kind,” and “they are always respectful and always knock on doors.” Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people using the service feel that the lifestyle that they experience satisfies their needs and expectations. People using the service are supported and enabled to make their own choices and decisions and to maintain contacts with people that are important to them. EVIDENCE: So that people using the service are involved in the planning of activities a weekly meeting is now held so they can say what they would like to do. We saw evidence that these meetings take place and feedback is recorded saying what people had done and if they had enjoyed it. Although there are plans to provide further activities and stimulation, staff spend time with people each day supporting them with activities such as reminiscing, dominoes, I Spy, bingo, pub quizzes and sing a longs. Outside entertainers also visit the care home on a regular basis and carry out an exercise programme. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 18 So that there is a designated area to carry out activities a new table has been purchased and placed in the lounge, large dominoes have also been brought for people to use. People using the service offer the following comments, “there are some activities but not enough to keep me stimulated, we have bingo sometimes but I enjoy sitting here watching the squirrels out of the window,” “we play bingo and do quizzes, I like the entertainment but I would like more,” “I enjoyed the church service today it was nice, I would like to go to church but I have not had the chance,” and “we are all different and have different needs, some expect more than others. There is no real stimulation however I am not that bothered.” Staff spoken with said although I am not here much when they do activities I have seen people doing them and there has been a trip out. During the inspection we saw that a good relationship is maintained with people using the service and staff and people joined in a game of Bingo and participate in a church service. So that people can maintain contacts with people that are important to them there are no restrictions on visiting and visitors may be received in private. People using the service confirm that people can come to see them when they wish. We saw several visitors throughout the day, staff made them welcome and there is evidence of good relationships being maintained. One staff member spoken with said that they have done some work on the Mental Capacity Act and that they feel that this is used in every day practice and they stated, “people can make their own choices and decisions, we always give them choices to make sure their rights are upheld, for instance offering them choices in their everyday life, knowing their individual likes and dislikes, special needs, we treat them how we would want to be treated, we have to treat people differently or they would be upset.” People using the service tell us that they are happy and settled in the care home and that the routine of the care home is flexible and they can spend their time as they wish. On the day of the visit we saw that people are enabled to make their own choices and decisions and spend their time doing as they wish. A wholesome and appealing menu is created weekly with input from people using the service. To enable this to happen a weekly meeting takes place where people are given the opportunity to put forward suggestions for meals that they would like to try. We saw that people have choices at each meal and that the portion size is good. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 19 One person using the service said, “the food is very good and there are choices,” and another said “we have very nice food, we had a change after the meeting which is good.” Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s complaints may not be fully resolved and they may not be fully protected from abuse at all times due to the record keeping practices of the management. EVIDENCE: So that people using the service know how to make a complaint the complaints procedure is on display around the care home. Weekly meetings also take place where people can express any views and opinions about the service. The service has not received any complaints since the previous inspection. Staff spoken with are able to discuss how they would deal with a complaint should one be received to make sure that this is dealt with effectively. One person using the service said that they are happy to approach staff if they were unhappy about anything. Staff have received training in safeguarding vulnerable people and when spoken with they are able to discuss this to a good level and the actions that they would take should they feel that abuse is taking place. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 21 There has been one safeguarding alert to the Local Authority since the previous inspection in regard to a disagreement between two people using the service and this is still being investigated. However on requesting the information in regard to this incident the acting manager was unable to locate it to demonstrate action had taken place. One staff member spoken with is able to discuss how they would deal with behaviour that may be challenging to ensure that people using the service are protected; “I would calm people down, ask for support from other staff, try and work out any issues reasonably in a calm manner, I would then inform the manager.” They are also stated that they feel that it is important for people to have a good quality of life and have anything they want and come to no harm. A requirement set at the previous inspection in regard to the allegations that staff 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 was not completely dealt with. This was discussed with the acting manager and owner who both initially stated that they were not aware of this incident, despite this being on the inspection report; therefore an investigation has not taken place. However after consideration, they then said that staff have been spoken with in regard to this but no written evidence of this taking place is available. During this inspection no allegations or concerns were raised by people using the service. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a comfortable and homely environment which is well maintained. EVIDENCE: There is evidence of ongoing maintenance taking place and records of this are available. The environment is well maintained and furnished in a comfortable and homely way. Specialist equipment such as assisted baths and hoists are available for those people that need them. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 23 The garden is well maintained and secure and the lounge windows overlook this with access through French doors if required. Within one room we saw that a portable radiator is in use, however no risk assessment has taken place to ensure the safe use of this, therefore the consultant stated that they would remove this from use immediately. A new buzzer system is in place so that people using the service are able to call for help more easily. All areas of the care home accessed are clean and tidy. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by staff that are trained and competent to carry out their job role, however they are not fully protected by the current recruitment practices. EVIDENCE: A new staff rota system has been introduced which highlights each person’s position and who is in charge of each shift so that clear lines of responsibility and accountability is available. One staff member spoken with said, “we have a very dedicated staff team, the staff team get on well together and morale is good, however there is not enough staff at times and although this does not affect the care that people receive we are very busy and it is hard work.” People using the service offer the following comments in regard to the staffing levels; “there are enough staff to help me when needed, I am settled here and I thank God for the place every day,” “they are always short of staff, they do their best, I have to wait sometimes it depends on how many staff are on” and “the staff are always good but they are always busy, I like living here, I am happy.” Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 25 The provider and the consultant both feel that the staffing levels are adequate therefore they are currently looking at the way that staff spend their time and the way that they do their work so that any issues can be addressed. Six members of staff have attained the National Vocational Qualification level2 (a nationally recognised work and theory based qualification designed to enhance peoples knowledge and skills in caring for people). So that new staff are aware of their roles and responsibilities when first starting employment they undertake an induction. The induction in use is now of a recognised format so that staff are working towards the National Minimum Standards. All staff currently employed that have not attained the National Vocational Qualification will also be starting this programme to make sure that they follow up to date and best practice. All staff files examined contain the necessary documentation required by law to ensure that people using the service are protected from unsuitable people being employed. We did find however the when staff have a criminal record that there is no evidence that this has been discussed with the person or a risk assessment completed to make sure that people are fully protected from unsuitable people being employed. There is also evidence that some staff start with only a POVA 1st check in place (a check to see if a person has been placed on a list of people that have abused a vulnerable person in the past) there is no evidence to show that these staff are being supervised until their Criminal Record Bureau check is returned to make sure that people are protected from unsuitable people caring for them. One member of staff spoken with confirmed that they had a Criminal Record Bureau check (a police check to see if an individual has a police caution or criminal record) before they started working at the care home. Staff training files examined show us that staff continue to work towards completing compulsory training such as manual handling, health and safety and safeguarding vulnerable adults. The acting manager has received training in the Mental Capacity Act which she did plan to cascade to junior staff to make sure that they are all fully aware of the need to uphold people’s rights and choices, however she will soon be leaving employment therefore further plans are to be made to make sure that staff receive this training. One member of staff spoken with is able to discuss the basic meaning of the Act and how they implement this in their every day work. One staff member spoken with told us that they feel supported in their training and development. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 26 One person using the service told us that they feel that staff are good at their jobs and that they are well trained. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a care home where the general management of the service is improving and they are now afforded more of a say in how the service is run and managed. Staff supervisions are currently not successful in achieving the aims of monitoring and development of staff knowledge and skills. The general management of records does not ensure people’s best interests are fully safeguarded. EVIDENCE: The acting manager has not completed the application to become the registered manager of the service as she intends to leave shortly; however Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 28 there are arrangements currently being made for a new acting manager to be employed. One staff member spoken with spoke very highly of the acting manager and stated that they feel very supported by them and that they work very hard. One person using the service also expressed that they feel that the care home is well run and managed. So that people using the service have a say in how the care home is run and managed they are enabled to have a say by way of meetings and questionnaires. We saw that meetings have been taking place on a weekly basis and that people are enabled to express their views about the service and the activities they undertake and the food on offer. The questionnaires in use cover areas such as, staff, hospitality, appearance of staff, privacy management and the environment. We saw from the most recent questionnaire results that people using the service and their relatives are very happy with the service provided and the care received. The following comments are extracts from these questionnaires: “this is a most comfortable residence of quality standard. It is obvious that very thoughtful care is provided for every resident by a dedicated staff, in an extremely clean and friendly environment,” the atmosphere is welcoming for everyone,” “the daily menu offers both a nourishing and appetising choices for the tastes of all residents,” and “Chestnut Park” compares very favourably with other homes that I have visited, clean, comfortable and staff appear genuinely interested in the welfare of occupants.” The only negative issue that was raised is the lack of privacy when visiting people using the service as people’s chairs are close together. This was discussed with the acting manager who stated that people are able to go to their rooms should they wish to have more privacy than the communal rooms allow. The information received from these questionnaires is yet to be consolidated and displayed for people to see, however there are plans to do this as soon as possible. Feedback from the meetings and questionnaires are to be used as part of the service’s business plan for the forthcoming year so that people’s views are fully considered. Staff meetings sometimes take place so that areas of practice can be discussed and good practice recommendations put into practice. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 29 People’s money is not retained on the premises, if people wish to purchase anything; the service will pay for this and bills that person or who is ever responsible for their finances. The arrangements for staff undertaking supervisions has only just begun to take place and only a minority of staff have undertaken a supervision since the previous inspection and there is still no official policy in place in regard to this. Those supervisions that have taken place are simply based upon questions that are put to staff, there is no evidence of input from the acting manager on their performance and areas that they may need additional support in for staff to carry out their job role effectively. One member of staff spoken with said that they have undertaken a supervision however they did not find it that helpful. When we look around the building we found a large amount of documents stored in the bath of the staff and visitors toilet. This was discussed with the consultant due to the implications of the Data Protection Act and maintaining people’s confidentiality, he removed this to a secure storage area immediately. On requesting several items of documentation such as the safeguarding information the acting manager was unable to locate this. The fire log book examined shows us that despite starting a new book as the previous one has been mislaid, these are still not taking place as required by the Fire Authority to make sure that people are protected in the event of a fire. The hoist and lift maintenance certificates examined show us that routine maintenance and testing is being carried out as required to make sure that people are protected. Accident records examined show us that minimal accidents are occurring and when they do staff are taking the appropriate action to make sure that people get the support and attention they need. Staff have undertaken training in health and safety and are able to discuss the relevant issues in regard to their job roles. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 30 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 2 2 Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 31 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 OP3 Regulation Section 24 Care Standards Act 2000 Requirement People must not be admitted to the home whose needs are not reflected by the registration categories and the content of your statement of purpose in order to ensure their assessed needs can be met. 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 Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 32 Timescale for action 06/05/09 2 OP3 14(1) 06/05/09 3. OP7 14(2) 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 staff give them people the support they need. Some progress has been made, however further development is required to ensure that full compliance is achieved. 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 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. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Care plans must be person centred and record people’s preferences as well as their needs so the staff can support them with these appropriately and in line with their wishes. Some progress has been made, however further development is 30/07/09 4 OP7 15(1) 30/07/09 5 OP7 12(2)&(3) 30/07/09 Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 33 required to ensure that full compliance is achieved. The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Plans of care must be in place for 30/07/09 people’s identified needs such as behaviour that is challenging and the care of a syringe driver. This will ensure that people’s needs are met. Risk assessments and management plans must be in place for people’s identified needs such as behaviour that may be challenging. This will ensure that risks are managed and reduced and people are protected. Systems must be in place to ensure that medication is recorded and stored as required. 6 OP7 15(1) 7 OP7 13(4) 30/06/09 8 OP9 13(2) 07/05/09 9. OP14 18(1)(c)(i ) This will ensure that people using the service are protected by the medication policies and practices. Staff must have information or 30/07/09 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. Some progress has been made, however further development is required to ensure that full compliance is achieved. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 34 10 OP18 13(6) The timescale for this requirement will be extended for a final time and must be complied with to avoid further action being taken. Records and documentation in regard to safeguarding incidents and investigations must be kept and made available for inspection. 30/06/09 11 OP27 18(1)(a) This will ensure that people are protected from abuse and we are able to monitor the service. Systems must be further 30/07/09 implemented which assesses the dependencies of people using the service and staff deployment. This will demonstrate and ensure that there are sufficient staff available to meet people’s needs. Staff with only a POVA 1st in 15/06/09 place must be supervised until a satisfactory Criminal Record Bureau check is received. Evidence of this supervisory practice must be made available. This will ensure that people using the service are protected from unsuitable people supporting them. Risk assessment and management plans must take place should a staff member’s Criminal Record Bureau check be returned with evidence of a police caution and/or conviction. Documentation of this assessment and the outcome must be available for inspection. This will ensure that people using the service are protected 12 OP29 18(2) 13 OP29 13(4) 15/06/09 Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 35 14 OP31 9, Section 11 Care Standards Act 2000 from unsuitable people being employed. The Care Quality Commission 20/06/09 must be informed of the management arrangements that will be put into practice when the acting manager leaves employment. This will ensure that we are aware of who will be managing the service and provide assurance that the service is being run and managed safely and effectively. There must be an effective 30/07/09 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. Some progress has been made, however further development is required to ensure that full compliance is achieved. 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 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. Some progress has been made, however further development is required to ensure that full compliance is achieved. The timescale for this requirement will be extended for 15 OP33 24 16 OP36 18(2) 30/07/09 Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 36 17 OP37 22 a final time and must be complied with to avoid further action being taken. Records as required must be stored appropriately and made available for inspection. This will ensure that people’s health, safety and welfare is maintained and that legislation is complied with. Liaison with the Fire Authority must take place in regard to the routine testing of fire systems. This will ensure that people using the service are protected from the risk of fire. 30/07/09 18 OP38 23 30/06/09 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. 2. Refer to Standard OP12 OP12 Good Practice Recommendations Further resources and arrangements for activities are made available. 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. 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 DS0000070838.V375439.R01.S.doc Version 5.2 Page 37 3 4 OP14 OP16 6. OP16 Chestnut Park Care Home people living at the service should be made aware of this system. Chestnut Park Care Home DS0000070838.V375439.R01.S.doc Version 5.2 Page 38 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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