Inspection on 27/05/06 for Chestnut Road

This inspection was carried out on 27th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chestnut Road 25/01/08

Chestnut Road 09/09/05

Chestnut Road 12/04/05

Chestnut Road 23/11/04

Chestnut Road 07/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Chestnut Road 44 Chestnut Road West Norwood London SE27 9LF Lead Inspector Mary Magee Unannounced Inspection 27th May 2006 12:00 Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 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 Road DS0000055761.V295513.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 Adults 18-65. 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 Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Road Address 44 Chestnut Road West Norwood London SE27 9LF 020 8761 3689 020 8761 9457 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) Caretech Community Services Limited Mrs Linda Lee Care Home 16 Category(ies) of Learning disability (16), Physical disability (0) registration, with number of places Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Where windows in bedrooms do not allow a view from a sitting position as specified in Minimum Standards it must be recorded on file that the service user or a representative has been made aware of this prior to admission and that they are satisfied with this arrangement. If service users are unable to reach light switches in bedrooms, they must be provided with an alternative means of allowing them to turn lights on and off. 9th September 2005 2. Date of last inspection Brief Description of the Service: 44 Chestnut Road is one of a number of residential homes owned and managed by Caretech. It provides care and accommodation for sixteen younger adults with learning disabilities. It is divided into three separate units. The ground floor has eight bedrooms and is suitable for people with learning and physical disabilities. The first floor has five bedrooms, the second floor has three bedrooms. All units have appropriate numbers of bathroom and shower facilities and have their own kitchens and communal areas. A passenger lift is available. At the rear of the premises is a wheelchair accessible garden, part laid to a lawn and a paved area. The home is located close to the main shopping area and public transport links in West Norwood. There is limited parking available on the driveway and on the roadside. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day. Present at the time were the manager, the area manager and the daytime care staff team. Three care staff were interviewed. Two service users spoke with the inspector. The inspector at a later date spoke with the parents of seven service users by telephone. A district nurse and two care managers were consulted with on the services. A selection of records were viewed, these included those relating to service users and staff. A tour of the premises was conducted. Four service users’ bedrooms and all the communal areas were viewed. What the service does well: Parents spoke positively about the standard of services provided and of how service users benefit from the lifestyle they experience. Parents feel reassured that the home has the capacity to meet individuals’ needs. One mother spoken to said “ I now sleep comfortably at night knowing that my son is safe and well cared for, he is very happy and enjoys a busy social life now”. The arrangements in place for service users moving to the home are very good. Where possible care staff visit prospective service users and work alongside with them so that they become familiar with their ways. The admission process is then phased in gently with short periods of stay initially to become acquainted with the surroundings. Service users are supported by staff when possible during hospital stays thus giving them security and confidence when medical intervention is necessary. One service user’s mother found the care and support received by her son had a great impact on his recovery when he was hospitalised. The staff team is stable with fewer changes experienced in staffing personnel. This has facilitated good communication and ensures consistency and continuity of care. An area commented on positively by a care manager was how effective staff are at good communication. Staff at the home she finds always keep her informed on how a service user is progressing and on other issues that may arise. The service user at the home was recently reviewed, she finds the lady is very comfortable with staff around her. She now feels secure in her environment and is happy to express her views, this is an indication of progress and of how well the home is meeting her needs. The relationship she observes between staff and service users she observed to be good. Another care manager spoke of the positive response by the home to recommendations made by appropriate healthcare professional involved with the care of service users. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 6 The allocation of key workers is very effective, with the best outcome possible for service users. Consideration is given to individual’s ages, gender and cultural backgrounds to ensure a good match of key worker. A service user’s mother spoke of the excellent relationship that has developed between her son and his key worker. The organisation provides an extensive training and development programme for staff that is now reflected in a more competent and well-equipped staff team. Staff have developed a good understanding of the needs of service users and have received additional training in empowering people. The organisation has an effective quality assurance system that reflects how the home is meeting its aims and objectives. What has improved since the last inspection? What they could do better: The home needs to sustain the improvements and continue to develop services further so that service users receive an excellent service. Improvements are needed in the procedures adopted by staff for the receipt of and administration of medications received at the home. Care must be taken by staff to ensure that fridge temperatures are regularly taken and that fridges are always working effectively. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 7 Many of the local community facilities are over subscribed. This shortfall affects service users. The home may consider this and strive to address, and develop services relevant and appropriate to the service user group. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 234 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Prospective service users have their needs and aspirations assessed, this ensures that the home does not offer a place to someone whose needs it cannot meet. Service users and relatives feel confident that the home is effective at meeting the needs of current service users. EVIDENCE: Service users have a full needs assessment completed before admission. Three service user files examined also contained copies of care management assessments. Individuals’ interests, needs and likes and dislikes as well as methods of communication are recorded. From these care and support plans are developed. The arrangements in place for a smooth transition in moving to the home are very good. Staff worked closely with a service user recently prior to her moving in. She was familiar with staff and did not experience too much difficulty with the change when she moved there. The home provides services to people with learning disabilities. The majority of service users on the ground floor also have physical disabilities. From direct observations made of the support given by staff with complex conditions it was evident that staff have been trained and are competent at managing these conditions effectively. Objects of reference are in use for service users to aid communication with staff. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 10 All six relatives spoken to by telephone are very pleased with the care delivered at the home. The mother of one service user spoke of her experiences. Initially there were some difficulties following admission but this has been resolved. Now she finds that her daughter is well cared for and that staff have developed a good relationship with her, they understand how to meet her needs. This has been a great consolation to her as a mother as she is unwell. In the earlier days parents spoke of some teething problems and the various changes encountered, however all the parents spoken to are confident that the home offers excellent services and the staff team has become stable due to the excellent management. Service users enjoy a good quality of life, one mother spoke of how much her son enjoyed living at the home and the great relationship that existed between him and his key worker. Service users are offered the opportunity to visit the home and have overnight stays before making a decision to move there. All admissions are planned carefully. The home offers respite care for one service user, it has an agreement with one local borough to offer a rolling respite service to residents from the area. In this way service users are familiar with the home and families are satisfied that the respite service user is consistent and meets the needs of service users and their relatives. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6789 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. The care and support arrangements for service users are good. All the necessary information on the required support necessary by service users and the management of risks is set out clearly in plans of care. Service users receive the necessary support to make decisions about their lives. EVIDENCE: Individual support plans are in place for service users. Three of these were examined. The plans identify the type and level of support required and based on needs assessments. These plans are agreed with the service user or family representative. The support plans are good and contain essential detail. They focus on what a service user on health support, individual likes or dislikes , communication methods preferred, how they will be assisted to meet their goals. Daily dairy records are maintained indicating the care delivered and that it is in accordance with care plans. At earlier inspections it was highlighted that these are restrictive for recording much detail and recommendations were made for improvements in daily recording formats. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 12 The registered manager has introduced an additional page to be used alongside the daily log. From observations made of these records the outcome is that more detailed information is recorded giving a clearer picture of the wellbeing of the service user is as well as an account of the care given. Individual risks are identified and recorded in risk assessments and accompany care and support plans. Behaviour management strategies are available for service users that display challenging behaviour. These programmes are agreed by the multidisciplinary team and the service user or family representative where possible. Incident reports are maintained of all incidents involving service users Care and support plans as well as risk assessments are reviewed every month. Formal internal reviews are completed every six months involving the service user and family/relatives. Risk assessments are also reviewed at this time. A formal external review is held annually involving the service user, care manager and family as well as allocated staff member from the home. Service users are supported to make decisions about their lives. Communication profiles are available for service users describing how they communicate their feelings and preferences and the support they need to do this. On observations made at the inspection it was evident that service users are comfortable with expressing freely their views when staff are present. A care manager reported on the observations that she has made, she has found staff to work in an open manner and to keep care management and relatives informed. There is evidence that on a monthly basis service users are provided with individual time known as “Talk Time”. Books are supplied to each service user in which allocated key workers record the outcome of this time with service users. It is set aside for individual work. During this period service users are supported to exercise choice of lifestyle, communicate their likes/dislikes and express their feelings about the services they receive. The registered manager has begun using objects of reference for service users requiring more assistance with communication. While the outcomes of reviews was evident that care and support is delivered in accordance with agreed plans issues relating to action plans are not always responded to as promptly as they should. A recommendation is made. The registered person should ensure that action plans agreed at internal and external reviews should be responded to promptly. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 15 16 17 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users have the opportunity and receive the assistance to lead fulfilling lifestyles. Staff are knowledgeable and demonstrate the competencies necessary to support service users safely that have difficulty in swallowing. EVIDENCE: Social diaries are maintained for service users recording participation in leisure and recreational activities. Families were written to with a request for further information on the type of facilities that service users may benefit from as well as comments. Comments received back were favourable. Programmes of activities are agreed with service users/relatives that enable skill development including social skills. The home has experienced difficulties in accessing educational facilities as colleges in the area have been oversubscribed. One care manager has found that staff are very good at accessing facilities in the community such as Mencap. However other avenues have been pursued and service users are supported to engage in fulfilling life and leisure facilities. A hydrotherapy pool located locally is used by a number of service users several times a week. Service users have Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 14 indicated how much they enjoy these facilities. Two of the parents spoken to find that their sons are enabled to enjoy life at the home and receive ample opportunity to participate in activities outside the home. Holidays and outings are planned with service users. Arrangements are in place for service users to have holidays at places that they choose over the summer holidays. Visitors are made welcome at the home. Relatives spoken to find that staff are welcoming and that the environment is relaxed and friendly both for service users and for visitors. Some like to participate and enjoy events at the home. Relatives spoken to find that staff keep them informed on all aspects affecting the service users, sometimes it might appear trivial but relatives like the fact that they too feel included as much as possible. Routines of daily living are flexible and in accordance with individuals’ choice. The inspector observed the rapport between service users and staff. Key workers were seen involved in play and pleasant banter. The mother of one of the service users observed to have developed excellent relationships with his key worker gave her views. She finds that the stability established has benefited her son. She described the periods when he visits the family home, he becomes very excited when it is time to return to the home. She is delighted that he is so happy and that his key worker relates well to his cultural needs also. Other parents spoken to described the positive interaction they observe when visiting the home between staff and service users. They observe staff interacting with service users and to provide the necessary stimulation. During the inspection service users were supported to use the sensory room, others were helped from wheelchairs and to sit on bean bags for periods. Care staff were observed comforting service users that were upset and deal with challenging behaviour appropriately. One service user’s mother commented favourably about staff for the way in which her son is cared for by staff. He is valued and respected by staff as an individual. She finds that he is safe and well cared for by a staff team that show commitment and are kind. Some service users have experienced changes to their nutritional needs and are receiving PEG feeds. Staff are trained on individuals needs, they know that some cannot be fed or receive drinks orally. Those receiving a soft diet have pureed meals that are nourishing and tasty. Two of these meals were being prepared by a member of staff. Records viewed provided evidence that staff and service users plan menus. The support plans in place include information on the special dietary, cultural and religious needs of service users, examples were seen where certain foods such as pork were not to be provided. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 15 Appropriate numbers of staff were present to assist those requiring support with eating. Staff have received training on supporting service users at risk of choking. A letter sent to the home from the occupational therapist from the MDT reported that staff were assessed as competent and that the additional support of her services was no longer required unless a new concern was identified. Relatives spoken to feel that staff are competent and well trained and know how to look after service users with swallowing issues. The nutritional needs of service users are assessed, records were observed of regular weights recorded and of the action taken to refer to appropriate professionals when necessary. Staff have developed well and work closely with other professionals, such as the specialist nurse from the enteral feeding team. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users with specialist needs are enabled access to specialist health services. Staff are competent in following guidance by health professionals and ensuring that the health care needs of service users is monitored closely. Prompt action is taken in response to any areas of concern identified. EVIDENCE: All service users have an allocated key worker. Indications were that the allocations were in accordance with service users’ wishes. Observations made as well as feedback received from relatives and two service users were that service users had a choice of staff that worked with them. It is recommended that records should be updated to reflect the changes to allocated key worker. Service users are involved in purchasing their clothing and choosing hairstyles that reflect their personalities. One service user attends the hairdresser regularly and takes pride in maintaining a trendy hairstyle. Service users have a routine that is flexible, examples were seen of how this is adapted to accommodate particular interests as well as external appointments. Meal times are adapted to individual needs as well as times for getting up and going to bed. Relatives spoken to find that routines of the home are very flexible and in accordance with the service users’ requirements. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 17 While present at the home staff were observed knocking on bedroom doors and not entering without permission. The home has systems in place to ensure that the healthcare needs of service users are met. Service users are registered with local GP practices. There are records maintained that evidence appointments with other healthcare professional such as hospitals. The healthcare needs of service users are monitored carefully. Records are maintained of visits by all professionals. Examples were seen of consultation with the doctor or the district nurse when issues of concern were identified. The district nurse spoken to visits the home a number of times every week to attend to service users. She finds staff to be kind and knowledgeable and that they monitor service users’ conditions closely. She also feels that they are competent and doing a very good job and knows that they will contact her immediately if there are any problems experienced in health care. One service user that she attends to weekly has a pressure sore, staff have responded positively to all the recommendations made, including the use of pressure relieving cushions and equipment. For service users with specialist needs such as PEG feeds have access to specialist professionals. Service users with PEG feeds receive regular visits from the specialist nurse. Records are maintained of the outcome of her observations, these include wellbeing and changes necessary in feeding regime. A number of staff have received training in this field to meet the needs of service users. There is always a trained member of staff on duty to oversee these regimes. Recommendations made by the specialist nurse are followed closely by staff and the actions recorded. Records viewed provided evidence that service users’ weights are recorded and that the nurse is kept informed of any significant changes. Observations made from these records and from discussions with staff demonstrate that the communication is good with external healthcare professionals. Some areas of work practices followed by the home are excellent. A service user was admitted for a period due to ill health, during this time staff from the home provided one to one support at the hospital. The service user’s mother spoke positively of the outcome for her son. She found that he adapted well to having a PEG feed inserted as familiar staff were present at the hospital to support him at this critical time. Another service user’s mother finds that any difficulties experienced by her daughter earlier on following her admission to the home have now been resolved. She has full confidence in the ability of staff to care for her daughter and knows that she is enabled access to healthcare professionals whenever needed. The home has medication policies and procedures. Medication is held in secure locked cabinets. Staff have received training from the dispensing pharmacist, Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 18 some have completed college course and are assessed as competent. None of the service users self medicate. Some discrepancies were found in the medication procedures. Staff felt that as medication was administered in a dosset system a check was unnecessary when it is received at the home. Therefore medication received is not always checked, ongoing audits of medicines held are not completed to ensure that records are maintained of medications held, some signatures were missing from MAR sheets, a count of medication held for one service user was inaccurate by one tablet. The registered person must ensure that procedures for receiving the storage and administration of medication are adhered to by staff. Regular audits must be completed of all medications held, all medications administered must be acknowledged on MAR sheet, medication received at the home must be checked for accuracy. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Improvements since the introduction of more robust procedures and working practices ensure that service users are safeguarded from abuse or neglect. The complaints procedure is more accessible to service users since it was developed in Widget form. EVIDENCE: Service users are given the opportunity to communicate their views in special one to one sessions such as “Talk Time”. Staff communication has improved. They demonstrate that they are knowledgeable and familiar with individuals’ needs, know when service users are unhappy by body language or by changes in behaviour. Three parents spoken to described how staff have developed good relationships with service users. Two of the parents acknowledged that initially following admission occasions had arisen when frequent changes were experienced in the staffing personnel. This was unsettling for all concerned, however all parents spoken with find that staff team has become stable and are familiar with the individual needs of service users. Service users are issued with the complaints procedure. This has now been developed in Widget form. The complaints records were viewed, no complaints were recorded for the home since the last inspection. Relatives spoken to find that the manager and staff are responsive when they raise issues. The home experienced an ongoing Adult Protection investigation last year. It took a long period of time to conclude. It was recently concluded, as a result the home and become more robust in adult protection procedures. All incidents are followed up promptly and necessary notifications are made to relevant Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 20 parties. All staff have received training in safeguarding vulnerable adults and demonstrated a good knowledge of the correct procedures to follow if there is any suspicion of neglect or abuse. New staff are given a copy of the Adult Protection Policy, signatures are maintained of staff to acknowledge that they have read and understood it alongside the code of practice. Recording including body maps are used for any changes observed, any such incidents recorded are responded to appropriately, necessary notifications are made and local adult protection procedures followed. Improvements are evident generally in the recording systems, more attention is paid to dating and recording all information accurately. Working practices are monitored more closely. Staff receive more direct supervision in the workplace. A senior is always in charge of units. The registered manager in accordance with organisational policy works on the floor alongside staff for at least one day every month. Relatives find that registered manager has a very visible presence. They find that she spends time meeting service users and observing how they are cared for, they feel secure in the knowledge that the home is therefore in safe hands. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 26 28 29 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users live in an environment that is pleasant and well furnished. It is maintained to a high standard. EVIDENCE: The home is divided into three units. Entry to each of the units is by the use of a key code. On the ground floor eight service users are accommodated. The majority of service users have physical disabilities and are wheelchair users. The corridors are spacious and accommodate these. Bathrooms are fitted with equipment such as ceiling hoists to enable transfer. Additional Parker baths are supplied on the ground level. The manager said that service users enjoy using these. On the ground floor is a Snoozelem which is very popular and in great demand by service users. The lounge and dining room is well furnished and accommodates service users comfortably. There is direct access from the lounge to the level garden at the rear enabling easy access for wheelchair users. The ground floor lounge carpet is stained and requires cleaning, the registered person should ensure that the lounge carpet is cleaned. On the first floor unit single accommodation is provided for five service users. Appropriate numbers of bathrooms and toilets are conveniently located. This unit has a dining room and lounge all furnished to a high standard. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 22 The third floor has accommodation for three service users. Appropriate numbers of toilets and bathrooms are available. It has a dining and lounge area. All three units have separate kitchens in which their meals are prepared. Four bedrooms were viewed. These are brightly decorated and well furnished. A service user recently admitted spoke of her choice of colour scheme. She had selected this before she moved to the home. Service users personalise their bedrooms and have objects and possessions around them that they like and that reflect their culture and interests. A range of equipment was observed that support service users with independence, these include standing and ceiling hoists, standing frames, bath seats. The home was clean and hygienic. On the first floor some high temperatures are experienced in the kitchen. This appears to have affected the efficient operation of the fridge as the fridge supplied is less than two years old. The fridge temperature had not been recorded; staff reported that a new fridge was on order and would be delivered. In the meanwhile it is essential that fridge temperatures are recorded daily. The registered person must ensure that the fridge temperatures are recorded daily. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users benefit from the presence of a staff team that are competent and well supervised. Consistency and continuity have been established. Staff get to know service users and develop relationships that enable them deliver a service that meets individual needs. EVIDENCE: Three staff were spoken to and three staff files were examined. These files contain details of employment , training records and supervision records. All staff have job descriptions. On commencing employment staff receive a copy of the codes of conduct expected in their roles, they sign to acknowledge this. A copy of this agreement is held on staff files. Staff are working closely as team and observations were made that this had assisted with the improvement found in communication Staff at the home have become familiar with the needs of individual service users. Particular attention is given to the age, cultural background and interests of service users. The inspector observed an excellent example of a care worker working well and engaging with a service user that is non-verbal. The service user showed his pleasure and how much he enjoyed his leisure time and the stimulation provided. His key worker is of similar age and cultural background and has a great disposition. The service user’s mother spoke of the excellent relationship that exists between the staff member and her son, she finds that her son relates so well to his carer, and feels that it contributes to Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 24 her son’s overall wellbeing. From discussions with the care worker it was evident how much he enjoys his role and that he is committed to making life as pleasurable as possible for the service user. Another care worker spoken to has developed much expertise in caring for people with learning disabilities. He has participated in a variety of training and demonstrates a good knowledge of issues that affect this service user group. He puts into practice the training he received and illustrates his knowledge of service users that he is caring for. He is also keen to pursue with his own professional development. Staff are interested and motivated. Morale is good with a good rapport observed between service users and staff. Parents spoken with find that staff are kind and that they have developed a good knowledge of service users’ needs. They find that they are reliable and take good care of service users and know what enhances their lives. All relatives spoken to feel that staff are competent at recognising if there any concerns about service users welfare and are confident that they take appropriate action as necessary. For a service user with particular health issues her mother finds that staff are reliable and that they contact the district nurse, they also keep her informed of her daughter’s progress. She finds that staff understand her daughter and always pay particular attention to her appearance. Since her daughter’s admission she has observed how staff interact with her. She knows her daughter is very happy and has full confidence in the home and in the staff that care for daughter. A record of training delivered to staff was viewed. All the staff receive a structured induction on the start of employment, foundation training is delivered within six months of start. The induction training is LDAF accredited. Staff performances are monitored, records viewed demonstrate that necessary actions are taken to address disciplinary issues. Two staff members are temporarily suspended until a full investigation is completed and the results are analysed. Staff receive regular one to one supervision with written records kept. Team meetings are held regularly and are minuted. All staff receive mandatory training, records viewed for staff members included the following topics, health and safety, first aid, communication with people with a learning disability, quality assurance, Makaton, Autism, report writing, team building, the use of physical intervention, medication administration, sex and sexuality, promoting empowerment. In addition senior staff have received training in delivering supervision, one staff member is completing NVQ Level 4 in care. Twelve care staff are currently undertaking a course on Equality and diversity. There is a dedicated training budget with a training officer employed by the organisation to coordinate training for the staff team. A number of staff have Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 25 received further training directly linked to the specific needs of service users, one of those was on supporting service users with PEG feeds. The training and development programme includes all the necessary training and it is linked to service users’ needs. However efforts should be made to ensure that individual training and development needs of staff are assessed and that the training and development programme is linked to these assessed needs. Senior carers are given the opportunity for further development. A new management programme is in operation by the organisation that enables senior carers to develop and complete the registered manager’s award. A senior carer from the home is participating in this programme. Staff personnel files regarding recruitment are held at the head office. An agreement is in place between CSCI and the organisation whereby the Provider Relationship Manager examines a selection of recruitment files at regular intervals. Recruitment procedures have been found to be satisfactory. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 41 42 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to the home. Service users enjoy living in a home that is well run and in which service users and staff feel valued. Staff work well as a team under the guidance and support of the manager. EVIDENCE: The manager is experienced in running a service for people with learning disabilities and has worked hard for the past year in making improvements. She has paid particular attention to developing and supporting the staff team. Registration has taken place with CSCI. Parents spoken to find that “she has a hands on approach” and is ever present on the units. She shows good leadership skills which service users and relatives and professionals value. Her management skills has enabled practices to be improved. She has encouraged and supported staff with development. She has shown commitment and dedication to addressing shortfalls found in earlier days. This has resulted in service users and relatives having confidence in the service. Staff morale is good at the home with staff demonstrating more confidence. Staff spoken with appreciate the leadership shown by the Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 27 registered manager and are keen to develop professionally and develop best practice. The home has an effective quality assurance system in place. The outcome of these audits were viewed. Results are positive and demonstrate that actions are taken to address any shortfalls identified. All three units are evaluated as part of the process. Team meetings for staff include quality assurance issues. Recordkeeping is good. The inspector found that all areas relating to service users are dated accurately. Spot checks are undertaken at night to ensure that service are delivered in accordance with agreed care plans and to support and guide staff on good practice. Formal handovers are completed at change of shift to ensure that all the necessary information is communicated verbally as well as in writing. The home is clean and well maintained. Records that acknowledge the servicing of essential equipment were viewed, these included the servicing of boilers and lifts, fire fighting equipment. Records maintained were evident of regular fire drills and of weekly testing of fire alarms. Visits in accordance with Regulation 26 visits are undertaken, copies of these are forwarded monthly to the Commission. Chestnut Road DS0000055761.V295513.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 Adults 18-65 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 x 2 3 3 3 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 x 28 3 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 3 x 3 3 x Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 29 NO Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 (2) Requirement The registered person must ensure that procedures for receiving the storage and administration of medication are adhered to by staff. Regular audits must be completed of all medications held, all medications administered must be acknowledged on MAR sheet, medication received at the home must be checked for accuracy. The registered person must ensure that the fridge temperatures are recorded daily and that the a new fridge is supplied to the kitchen on the middle floor. Timescale for action 30/08/06 2. YA30 18 (1) (c) (i) 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The registered person should ensure that action plans DS0000055761.V295513.R01.S.doc Version 5.2 Page 30 Chestnut Road 2 3 YA24 YA35 agreed at internal and external reviews are responded to promptly The registered person should ensure that the lounge carpet is cleaned The registered person should ensure that the individual training and development needs of staff are assessed and that the training and development programme is also linked to these assessed needs. Chestnut Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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 Road DS0000055761.V295513.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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