Inspection on 16/07/07 for Chestnut View Care Home

This inspection was carried out on 16th July 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chestnut View Care Home 02/04/09

Chestnut View Care Home 13/03/07

Chestnut View Care Home 15/06/06

Chestnut View Care Home 27/10/05

Chestnut View Care Home 30/08/05

Chestnut View Care Home 06/07/04

Chestnut View Care Home 19/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Chestnut View Care Home Chestnut View Care Home Lion Green Haslemere Surrey GU27 1LD Lead Inspector Suzanne Magnier Unannounced Inspection 10:30 16th July 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut View Care Home Address Chestnut View Care Home Lion Green Haslemere Surrey GU27 1LD 01428 652622 01428 651145 admin@chestnutview.plus.com 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) St Cloud Care Plc Susannah Stanesby Care Home 60 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (48) of places Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be: OVER 65 YEARS OF AGE Up to twenty (20) of the sixty (60) service users may be accommodated for nursing care, four (4) of whom may be terminally ill (TI). 13th March 2007 Date of last inspection Brief Description of the Service: Chestnut View is a large detached property set in private gardens. St Cloud Care plc purchased the property from Surrey County Council, the previous owners in November 2001. The service currently provides twenty-four (24) hour care for up to sixty (60) older people. The property is close to the local town centre and a large supermarket and is within walking distance for those who are able to walk short distances. All rooms are single occupancy and there are spacious communal areas throughout the home including dining rooms. A separate unit for people with dementia/alzheimers is available, which also has a separate garden for people to use. The home has well maintained gardens and ample parking arrangements. The current fees per week range from £ 565.00 for residential care and £730.00 for nursing care. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and the registered manager represented the service. For the purpose of the report the individuals using the service are referred to as people living in the home. The inspector arrived at the service at 10.30 and was in the home for six hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The inspector spent time talking with people living at the home in order to seek their views about the home and the care they receive. Responses to questionnaires that the Commission had sent out and written comments have been included within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, the terms and conditions of residency in the home, care/person centred plans, daily records and risk assessments, medication procedures, staff files, a variety of training records, and several of the services policies and procedures. Following the previous key inspection in April 2007 the service has met all the requirements made. The home had submitted the Annual Quality Assurance Assessment (AQAA) prior to the inspection, some details of which have been added to the report. From the evidence seen by the inspector and comments received, the inspector considers that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. The inspector would like to thank the people living in the home, the staff and the manager for their time, assistance and hospitality during this inspection. What the service does well: Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 6 Some written comments received by the Commission for Social Care Inspection (CSCI) included ‘ The food is excellent’, ‘pleasant surroundings’ ‘On the whole cheerful and friendly’ ‘they do their best and the atmosphere is very nice’. ‘This is one of the best residential care places I have ever come across’. ‘The staff are always helpful and interact with resident and family members very well’. People who use the service are able to maintain bonds with family and friends. The physical layout of the home enables people who use the service to live in a safe and well-maintained environment. The management of the home is robust. What has improved since the last inspection? What they could do better: It is recommended that care plans be further improved to include a more person centred approach to reflect the individuality of the person receiving care and support in the home. An improvement has been recommended that the home use one system for recording when individuals have a general bath in order to ensure that records are accurate. It is recommended that the recording of end of life arrangements of people living in the home are more fully and accurately recorded to reflect peoples wishes and choices. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 7 It has been recommended that the home consider planning the implementation of the Gold Standard Framework Programme in order to continue to improve the provision of end of life care within the home. The serving of meals and the presentation of the dining experience for example table settings, available condiments and the serving of beverages in the home need to be improved in order to promote a more pleasant experience for the people living in the home. Where possible professional references should be obtained in contrast to personal references for prospective staff in order to assure validity of references and protection of people living in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 8 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 View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People who use the service have information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met. Terms and conditions/contracts of stay at the home are available to all individuals. People are encouraged to visit the home prior to residency. EVIDENCE: The inspector was told that the corporate Statement of Purpose and Service User Guide was currently being updated by the organisation. Current documents were sampled by the inspector and evidenced that appropriate information regarding the services of the home were clearly documented to inform prospective individuals or their representatives about the services provided by the home. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 10 The manager and the inspector discussed ways in which the Statement of Purpose and Service User Guide could be available to individuals with diverse needs for example sensory and memory impairment and the manager advised that a DVD could be made of the documents in order that all individuals would have access to information in a format suitable to their needs. All files sampled contained documented terms and conditions of the individuals stay in the home in order that they are fully informed of their rights of residency and cost of services provided by the home. The inspector a variety of care plans for people living in the home and noted that each contained a documented pre admission assessment about the needs of the individual. Some assessments had been completed with the support from a relative or representative, prior to the individual’s admission to the home. The manager explained that she or one of the trained nurses undertakes the pre admission process and the information gathered forms the initial care plan for the individual. Prospective residents are encouraged to visit the home and meet with other individuals and staff. The home does not provide intermediate care. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The health and personal care that people receive is based on their individual needs set out in their care plans. Monitoring of risk assessments is maintained to ensure the safety of people in the home. Medication procedures ensure that medication is administered to all individuals in a safe and appropriate way. Disposal/procedures of medicines were appropriate. People’s dignity and respect is promoted. The recording of end of life choices and preferences need to be more fully developed. EVIDENCE: The inspector sampled five individuals care plans. It was evident that the homes management and staff had made significant improvements regarding the planning and documentation of the care plans for example improved involvement by individuals about their care plans and staff training. Staff spoken with during the inspection were confident in telling the inspector how they use people’s care plans to provide care and how the plans are reviewed regularly to make sure that peoples changing needs are identified. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 12 The care plans sampled by the inspector related to individuals being supported in the nursing, residential and dementia/Alzheimers unit. The care plans illiustrated the differing care needs and how care and support were provided. All the care plans were well documented to reflect peoples individualised personal care needs, condition of individuals skin/pressure areas, sleep patterns, accident and falls records, nutrition and diet, mobility, daily records of care provided and activities undertaken throughout the day. Each care plan had a documented section which included a risk assessment relating to the activity in order to ensure the safety of the indivual. Whilst sampling the care plans it was noted that regular monthly reviews were being held and where necessary changes to the care plans were implemented to ensure that the changing needs of people in the home were recognised. The inspector and manager discussed ways in which the care plans could be further improved to reflect a more person centred approach which could include more details about the individuals identity, personality and communication, past occupation, their lifestyle history and their hobbies and likes and dislikes as it was recognised that the care plans were essentially task based. The manager acknowledged that this improvement and recommendation would benefit the individuals receiving care and support at the home and advised that this improvement would be implemented. Whilst touring the premises the inspector noted that on the dementia/Alzheimer’s unit the home had photographs of people on their bedroom doors and pictures bathrooms and toilet doors in order to assist people to identify their surroundings. Written comments and comments provided to the inspector at the time of the visit regarding the care provided at the home included ‘Excellent intervention with doctors’, the staff are very good at caring for me’, all my needs are well met’. ‘We get information when we ask but its not volunteered. We feel that are relatives are generally looked after very well. There will always be small issues that are annoying but the positives outweigh the negatives. We are always contacted if they are going to be admitted to hospital but there have been occasions when they’ve fallen and we’ve only discovered this at a later date.’ ‘A dedicated member of staff to look after a certain number of residents would be a big improvement’. ‘ I am positive that if my relative went into hospital they would phone me immediately’. The inspector discussed one comment received from a person’s relative regarding the lack of regular baths that their relative received. The manager explained that this concern had been discussed with the person receiving care Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 13 and their relative and that the person was now receiving a regular general bath to suit their needs. The inspector sampled some bathing records in one person’s care plan and the records indicated that they had not received a bath for two months. The manager explained that staff were using another method of recording for example a daily diary that the inspector sampled to confirm that individuals were receiving baths on a regular basis. It has been recommended that the home use one system for recording when individuals have a general bath in order to ensure that records are accurate. The care plans included detailed records of health care appointments that people had attended and also visits of health care professionals to the home. The health care professionals included the general practitioners, dieticians, chiropodists, physiotherapists, continence advisor, speech and language therapists, opticians, and specialised health care professionals. Written comments received from health care professionals regarding the home included ‘I have a good working relationship with the manager and deputy manager. Any instructions I give are usually acted upon in an appropriate and timely manner’. ‘The manager is approachable and is very keen to implement a training programme for continence management. At present I do continence, bowel care and catheter care three sessions. The staff often phone for advise and are keen to implement any suggestions.’ ‘I have always found staff knowledgeable about the homes clients when I undertake reviews. In addition they are always welcoming to visitors’. ‘I would say that my relative receives 100 cooperation with her needs’. One healthcare professionals comments received by CSCI were discussed with the manager regarding the advice recommendations, some care practice and process of referrals to a specific specialist. The manager advised that the comments would be looked into in order to ensure the safety and well being of the people in the home. The home has a medication policy and procedure. The inspector sampled one of the three medication trolleys in the home, which was stored in the locked clinical room in the home. The deputy manager explained that she had overall responsibility for the ordering, returns and stock taking of medicines in the home. The medication trolley was orderly, clean and was well stocked. The home has a monitored dosage system (MDS), which is supplied by the local Pharmacist. The deputy manager advised that some individuals prefer to self medicate and they are supported to maintain their independence and choice. The medication administration charts (MAR) indicated that people had this choice and documented risk assessments were in place to ensure that people were safely taking their medication. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 14 The inspector sampled the MAR charts which were generally accurately completed by staff administering medication The inspector noted that on one occasion a staff member had not signed for medication administered and the deputy manager identified the member of staff in order to rectify the error. The inspector sampled and undertook and audit of the controlled drugs in the home and it was evident that regular checks were carried out to ensure correct stocktaking and a clear audit trail. Staff training records indicated that regular training regarding the safe administration of medicines was undertaken. Written comments from a health care professional regarding the medication procedures in the home stated ‘Medicines management by the deputy manager are excellent’. During the inspection it was noted that there was a calm atmosphere throughout the home. Staff addressed people in a professional and caring manner. Individuals were addressed by their first or full name and where appropriate names of endearment were used to support trusting relationships. Staff were observed to preserve and maintain peoples dignity and privacy by knocking on their room doors and waiting to enter, supporting people discreetly to the bathroom and being observant and attentive to people who were not fully able to maintain their own dignity. Quiet areas in the home were available to people to use. Each care plan contained some documentation of the individuals end of life arrangements and included some relatives or significant others expectations of the home regarding the individuals end of life arrangements. It was noted that the documentation was not fully complete and could be misleading. The manager explained that this was an area of improvement, which would be worked upon in order to ensure that people’s wishes and choices are more accurately recorded with regard to their end of life arrangements. It has been recommended that the home consider planning the implementation of the Gold Standard Framework Programme in order to continue to improve the provision of end of life care within the home. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. People who use the service are able to exercise choice in the daily lives, maintain bonds with family and friends, and take part in social, cultural, religious and recreational activities. In general the home provides a healthy and balanced diet in a pleasant spacious dining area however further improvements need to be made to the presentation of the dining experience. EVIDENCE: The inspector spoke to a variety of people during the day all of which spoke highly of the activities, staff and general running of the home. It was noted that people were moving freely around the home, which included wandering in the garden, going to the local social centre across the road which also provided lunch, several people were observed reading the daily papers and chatting with other people in the home including staff. One person told the inspector that they get the bus to a local club, which has enabled them to make new friends with people outside of the home. Written comments and comments received during the inspection regarding the social activities in the home were varied and included ‘ I do far more here than Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 16 I did in the last place I was in’, ‘Good varied activities in the home’, ‘They take great care to ensure that outings etc take place as often as possible and the residents are stimulated to the best of their ability by visiting occupational therapists’, ‘Extensive activities programme’, ‘An improvement would be to spend more time in the garden, have BBQ’s or something to occupy resident’s minds’. ‘It would be nice if they enjoy the garden area more often at least it would be a change of scene’. ‘There is lack of cooperation between the care staff and the lady organising activities, which can mean that residents miss out on activities’. ‘It would be nice to hear of more days out for the residents which has always been promised. Perhaps local outings would be nice, local seaside/garden centres’. ‘There is an excellent person who organising activities for the residents’. An activity newsletter is available in the home and the staff explained that people are involved in the planning and choices regarding meaningful activities if they choose to. The AQAA received by the commission detailed that the home welcomes and supports all denominations and staff advised the inspector that the home promotes peoples spiritual and religious beliefs by providing church services within the home and also support individuals to places of worship. One comment received stated ‘church representatives, often visit the care home which the residents seem to enjoy’. The inspector observed that there were visitors in the home who appeared at ease with the staff and were able to visit their relatives and friends in privacy. The inspector observed the midday meal, which consisted of a choice of a hot or cold meal, which included salad and mixed vegetables. The people spoken with generally enjoyed their meal and it was observed that staff were available to support people during the mealtime with discretion and dignity. The commission had received a variety of written comments regarding the quality of the meals served in the home and these included ‘my relative is on the 2nd floor and the food is often cold or not much left. The other dining rooms have hot meals and plenty of food’. ‘Occasional weekend chef is not as good’. ‘The standard of food is good’. ‘My relative says the food has gone down’. ‘Food is often cold, poor quality, few fresh vegetables and fruit’. The comments were discussed with the manager who advised that she was aware of some of the concerns regarding the standard of food and actions had been taken to rectify the concern which included meeting with the chef, making changes to the menu and being more proactive in seeking peoples views about the choice, quality and quanity of their food. The manager explained that the chef speaks with the people on admission to the home and at their request to discuss their meal preferences and also any specfic catering needs with respect to religous requirements to ensure the individuals needs Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 17 are catered for where ever possible. The AQAA received by the commission detailed that the home has a varied menu that is changed reguarly with an increase in the choice of meals at each serving for individuals. The inspector sampled the homes menus which refelced the above information. The dining areas in the home were spacious and well decorated however it was noted that improvements needed to be made in order to promote a more pleasant experience for people in the dining room. It was observed that the tablecloths on the tables were not ironed and there was a mis match of furniture; condiments and sauces/relishs were only available upon request and meals/deserts were served by staff from a trolley which included a large serving dish. These observations were discussed with the manager who agreed that improvements could be made and advised the inspector that new tablecloths had been ordered, and some improvements for example tablemats, centre piececs for the table, menu cards for each table and condiments would be considered in order to improve the dining experience for people in the home. It was also observed that the morning coffee and afternoon tea were served by staff from a large trolley. One written comment stated ‘They could improve by taking more care to ensure that tea and coffee is served from the trolley at the correct times, sometimes it is woefully late and cold’. The manager explained that the current way of serving the morning and afternoon coffee/tea would be reviewed in consultation with the people in the home and could include individual trays or serving the drinks from the dining area. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure. They are protected from abuse and have their rights protected. EVIDENCE: The home has a clear complaints procedure, which has been recently updated. No complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. The AQAA details that no complaints have been received since the last key inspection. Whilst sampling the complaints log the inspector noted that there was a detailed clear chronology of events for example dates of correspondence and outcomes regarding complaints received by the home. Written comments received by the commission regarding the homes complaints process included ‘I’m not sure how to make a complaint but would find out if necessary’, ‘If I had a complaint I would first go to the management which are excellent and always seem to rectify the problem and certainly spend time dealing with complaints’. ‘They are exceptionally good at responding to complaints. This is one of the best residential care places I have ever come across’. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 19 Some responses from people in the home indicated that they would not like to complain for fear of upsetting the staff that do a good job. This was discussed with the manager who advised that she would look into further promoting peoples rights to view their opinions openly. The inspector sampled that the home has the local authorities multi agency procedures for safeguarding adults and the manager advised that the home follows these procedures. The AQAA details that there have been two safeguarding referrals under these procedures since the last inspection, which have been concluded. The inspector noted that the home has a whistle blowing policy and procedure, which is available to staff in order to safeguard people in their care. Staff spoken with during the inspection demonstrated an understanding of the procedures for safeguarding adults. Staff training records detailed that staff receive awareness training regarding safeguarding vulnerable adults. Where some staff had not attended the training plans were in place for the staff to attend the in house training in order to safeguard people in their care. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26. Quality in this outcome area is adequate. This judgement has been made using a range of evidence including a visit to this service. The physical layout and indoor and outdoor communal of the home enable people who use the service to live in a safe and well-maintained environment. Individual’s independence is promoted and maximised using specialist equipment. Individual’s bedrooms suit their needs. All areas of the home must be clean and hygienic. EVIDENCE: During the tour of premises the inspector observed that the home was generally well maintained and the handy person employed at the home was undertaking some minor repairs. The inspector noted that the corridor carpet on the top floor was frayed and the handy person immediately took action to rectify the hazard by placing tape over the affected area in order to reduce the Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 21 trip hazard. The homes indoor and outdoor communal areas were well maintained and appropriate access was available to all persons in the home. The inspector observed staff using equipment in the home for example portable hoists, walking frames and other mobility aids to assist people to safely move around the home or from one area to another. People spoken with in their bedrooms told the inspector that they liked their bedrooms, which were comfortable. It was noted that people’s bedrooms were individualised and some contained their own items of furniture, personal possessions, leisure items including televisions, radios, books, and equipment to promote individuals to continue with hobbies for example painting, drawing and gardening equipment. Some people told the inspector that they had telephones in their rooms, which they enjoyed having in order to keep in contact with friends and family. During the tour of the premises the inspector sampled the homes kitchen area. There were several observed shortfalls, which included a heavily soiled door mat and heavily scored brown chopping board which required replacing, the fly screen attached to a door required cleaning, the kitchen waste bin had no lid and the floor by oven needed cleaning. It has been required that all these shortfalls are rectified and the home must make suitable arrangements to prevent infection, toxic conditions and the spread of infection in the home and ensure that all parts of the home are kept clean. Other areas of the home were noted to be clean and hygienic throughout. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. The home has a robust system for the induction, training development and recruitment of staff to ensure peoples needs are met appropriately and safely. EVIDENCE: The inspector was advised that the home is currently supporting 56 individuals and have a total of 51 staff. The manager explained that no agency staff are employed by the home as the home has its own staff bank system. The staffing numbers on the day of the inspection were observed to meet the current needs of the people living in the home. Staff views regarding the staffing numbers were positive yet there was some discussion regarding the roles of the registered nurse on duty and their support to the care staff on occasion. This issue was raised with the manager during the inspection. The inspector observed throughout the day that call bells to summon assistance were answered promptly by staff. Written comments and comments received on the day of the inspection regarding the staff at the home included ‘My relative does have problems with certain members of staff, which are normally resolved but not always’. ‘There Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 23 are small issues that would make a difference to my relatives. It may be just be lack of thought on the part of the carers but I have often found the television switch has been turned off in my relative’s room and they are unable to reach it’. ‘Chestnut view is an exceptional home with very caring people’. ‘My relative’s chair usually needs to be moved so that they can look out of the window’. ‘Some staff seem to know what they’re doing and use their intelligence but other just do enough to get by’. ‘Most of the staff have English as their second language and this can cause problems with understanding what is said’. ‘They are kind and caring and do as much as they can for the resident’. ‘Very impressive facilities and lovely staff’. ‘The place could be made better by some of the attitude of certain staff apart from that it is 100 ’ ‘With a high proportion of the work staff being foreign it is apparent that at times they do not clearly understand when a resident makes a request’. ‘Basically they do a good job’. ‘The staff are very kind’. ‘We have to check if their hearing aids are working if their spectacles are clean etc…’ The manager explained that the home employs a multi-cultural workforce and equality and diversity issues are addressed both by people living in the home and staff. e.g. staff members observing the festival of Ramadan may wish to change to night duty during this period The inspector sampled four staff recruitment files. One file sampled did not contain a photograph of the staff member however this had been obtained but not placed in the staff file. It was noted that one staff file contained a reference from a friend and a recommendation has been made that where possible professional references are obtained in contrast to personal references in order to assure validity of references and protection of people living in the home. All files evidenced that the home in general undertakes safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home. The staff mandatory training records were sampled and evidenced that the home is committed to the ongoing training and development of staff and works closely with a local care association in order to ensure that the homes staff are suitably trained and competent in their duties. The records indicated that all staff had undertaken the necessary mandatory training and where refresher courses were needed these had been identified through the accuracy of the record keeping. The AQQA indicated that thirty one staff had achieved their National Vocational Qualification (NVQ) in care and trained staff are required to attend outside training on specialist subjects for example wound care, promotion of continence and update training from the diabetic nurse advisor in order to ensure peoples needs are met appropriately and safely. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is good. This judgement has been made using a range of evidence including a visit to this service. The management and administration of the home is robust and the home is run in the best interests of people who use the service. Peoples’ safety, financial protection and welfare are promoted. EVIDENCE: The atmosphere in the home was calm and orderly. The pace of the home was designed to meet the needs of the individuals living at the home and there was no sense of hurry. The manager advised that she had almost completed her NVQ4 Registered Managers Award. It was evident through observation and talking with people who use the service and staff that the manager had good knowledge about managing the care home and had the skills and experience to ensure the safety and well being of all persons in the home. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 25 Comments regarding the running of the home included ‘The home provides general care of health and welfare is good’. ‘We are happy with the way its run.’ ‘Excellent rapport between staff and management and residents’. ‘The home does well in providing the service required by residents of advanced age’. The manager explained that people’s views about the service were actively sought and quality assurance procedures were in place to seek the views of people who use the service and any visitors to the home. The inspector sampled some questionnaires that had been returned to the home which were favourable to ensure standards and quality. The inspector sampled the system and accounting process regarding the safekeeping of individuals money and all documentation was accurate and clearly recorded. The commission had received some comments of concern regarding the laundry system in the home. Comments received included ‘Clothes are washed every day’. ‘The laundry services need to be improved’. ‘They need to get laundry facilities better organised’. ‘We have had to replace lost clothes on a very regular basis despite marking everything with our relatives names’. ‘Other residents don’t have family members to look through their clothes and to return items that don’t belong to them’. ‘On the whole we are satisfied with the care provided but we also feel the need to visit on a very regular basis to check their clothes and to see what needs replacing’. ‘It would be nice to just visit and spend all the time with our relatives, but we have to firstly check all the drawers and wardrobes to see whether the returned laundry has been put’. These comments were brought to the manager’s attention. During the tour of the premises the inspector observed that the laundry of the home was orderly and well managed. The laundress explained her role within the home and advised that she had had a full induction regarding the safe use of equipment in the laundry. A system was noted to be in place to safeguard loss of people’s clothes however the laundress showed the inspector two baskets full of unclaimed laundry. The manager advised the inspector that the matter of unclaimed clothes would be dealt with without delay in order to ensure that all individuals in the home have their clothes returned to them. On arrival at the premises the inspector noted that the clinical waste bins in the car park were overflowing. This matter was brought to the manager’s attention and the contractors arrived without delay to rectify the situation by emptying the bins. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 26 The homes policies and procedures promote the health, safety and welfare of people in the home.service users and staff are protected. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 27 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 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP15 Regulation 12.4 (a) Requirement Timescale for action 16/10/07 2 OP26 23. (2)(d) The serving of meals and the presentation of the dining experience for example table settings, available condiments and the serving of beverages in the home need to be improved in order to promote a more pleasant experience for the people living in the home. Shortfalls identified in the homes 13/08/07 kitchen must be rectified in order to ensure that all parts of the home are kept clean. 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 OP7 Good Practice Recommendations It is recommended that care plans be further improved to include a more person centred approach to reflect the individuality of the person receiving care and support in the home. It has been recommended that the home use one system DS0000013849.V344763.R01.S.doc Version 5.2 Page 29 2 OP7 Chestnut View Care Home 3 OP11 4 OP11 5 OP29 for recording when individuals have a general bath in order to ensure that records are accurate. It is recommended that the recording of end of life arrangements of people living in the home are more fully and accurately recorded to reflect peoples wishes and choices. It has been recommended that the home consider planning the implementation of the Gold Standard Framework Programme in order to continue to improve the provision of end of life care within the home. It has been recommended that where possible professional references are obtained in contrast to personal references in order to assure validity of references and protection of people living in the home. Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chestnut View Care Home DS0000013849.V344763.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!