CARE HOMES FOR OLDER PEOPLE
Chestnut View Lion Green Haslemere Surrey GU27 1LD
Lead Inspector Catherine Campbell-Ace Unannounced 30 August 2005 10:00 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Chestnut View Care Home Address Lion Green, Haslemere, Surrey, GU27 1LD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01428 652622 01428 651145 St CLoud Care Plc Mrs Julie Ann East CRH Care Home 45 Category(ies) of DE(E) Dementia - Over 65, 8 registration, with number OP Old Age, 34 of places Chestnut View Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated wil be: OVER 65 YEARS OF AGE. 2. Additionally, one (1) named service user aged 64 years of age may be admitted in the OP category. 3. Up to eight (8) of the forty-two (42) service users may be accommodated for nursing care. Date of last inspection 06 July 2004 Brief Description of the Service: Chestnut View was previously owned and operated as a residential care home for adults by Surrey County Council. St. Cloud Care PLC purchased the home from Surrey County Council and registration was granted to St Cloud Care PLC in November 2001. There are major refurbishing works in progress at the present time. Chestnut View is a large detached property set in private gardens. The service currently provides 24 hour care to up to 45 older people. Chestnut View Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection lasted 5 and a half hours. The deputy manager, administrator, service users and staff assisted the inspector who was made very welcome during the inspection. Daily records, care plans, policies, the complaint procedure and accident records were viewed. The inspector spoke with service users and staff. The majority of service users were complimentary about the home and the staff were very welcoming and pleasant. The inspector viewed the premises and found that the laundry area was unsafe for staff to work in as the ceiling had exposed beams, with electric cables hanging down in loops and a strip light, which was not fixed securely. The inspector requested that the laundry be made safe immediately. What the service does well: What has improved since the last inspection?
The second phase of building work has been completed which included fitting ensuite facilities to 18 rooms.
Chestnut View Version 1.10 Page 6 Equipment provided by the home since the last inspection comprised of hi-lo beds, pressure mattresses, slings and slide sheets. All paperwork that states the National Care Standards Commission has been updated to reflect the change of name to the Commission for Social Care Inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or
Chestnut View Version 1.10 Page 7 by contacting your local CSCI office. Chestnut View Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Chestnut View Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: Standards 3 and 6 were not assessed during this inspection. Chestnut View Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 There is a clear and consistent care planning system in place that provides staff with the information they need to satisfactorily meet service users needs. The system for administering medication is satisfactory, however, the temperature of the rooms in which medication was stored was too high. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Care plans were evidenced to be clear, concise and updated as and when necessary. They included risk assessments for the environment and falls, activities, visits from multidisciplinary teams, nutrition assessments and wound care charts. Care plans were neither signed by service users or relatives and a requirement has been made that this is attended to. Service users choose their own General Practitioner and said that they are able to consult with them privately in their bedrooms. Eye sight tests are carried out regularly and service users are referred to the hospital for hearing tests if necessary. Chiropody was also available.
Chestnut View Version 1.10 Page 11 Service users stated that they were able to receive visits from friends and families in private. This was also the case when the General Practitioner visited. Staff were observed to knock on service user’s bedrooms before entering. The medication policy was viewed and the Medication Administration Records were examined and found to be in order. All medication was stored correctly and Controlled Drugs recorded accurately. It was noted that the temperature of the room in which medication was stored exceeded 25 degrees centigrade. At the time of the inspection, the temperature of the treatment room was recorded at 28 degrees centigrade. The manager is required to ensure that the temperature of the room in which medication is stored does not exceed 25 degrees centigrade. Chestnut View Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Service users were observed to live a full life with opportunities to take part in various activities. Family and friends are able to visit and service users exercise choice over their lives. The meals in this home offer both choice and variety and cater for special diets. EVIDENCE: It was evidenced that service users were given opportunities for stimulation through leisure. An activities booklet was available to service users to inform them of the activities on offer. The activities included exercises, bingo puzzles, sherry morning and pub lunch. A quarterly newsletter is available to service users and relatives which gives information regarding activities, birthdays and special events. The deputy manager said that two volunteers from the local church came to Chestnut View to give residents holy communion once a month. Service users stated that they could receive visitors without restriction and one service user said that her daughter joins her for lunch regularly. The majority of service users spoke well of the food. They said that they had a choice of meals at lunchtime and if the choice was not to their liking, an
Chestnut View Version 1.10 Page 13 alternative was offered. Menus were examined and were varied, nutritious and balanced. Special diets were catered for such as diabetic or pureed food. Chestnut View Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a complaints system. Service users and staff were aware that they could inform the manager when they had a complaint. Service users are protected by the homes policies and procedures and staff have excellent knowledge of adult protection issues, which protects service users from abuse. EVIDENCE: Service users and staff stated that they were aware that they could inform the manager if they had a complaint. The Complaints Policy and Procedure was viewed and contained the address and telephone number of The Commission for Social Inspection. It was evidenced that a record is kept of all complaints received and included details of investigations and actions taken. Staff, when asked about the home’s policies and procedures regarding abuse, were able to answer correctly. They had satisfactory knowledge of the Whistleblowing Policy. Service users said that they had access to their bank accounts and were able to use the home’s safe in which to deposit any valuables. The deputy manager said that staff were informed on induction that they were not to become involved in making or benefiting from service user’s wills Chestnut View Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 The standard of the environment is satisfactory, however, the environment inspected was observed to be unsafe and hazardous to service users, staff and visitors, and a letter of serious concern was sent to the registered Provider under separate cover. EVIDENCE: Chestnut View is at present undergoing major building work to provide accommodation for service users with dementia. The building work is in an area attached to the main home. On inspection of the environment, it was observed that a door between the main hallway on the first floor and the new build was accessible to service users, staff and visitors, creating a hazard. A wooden bar had been placed over the opening to the new construction work, to stop anyone entering the construction area. This was observed to be inadequate for safety purposes and the deputy manager was asked to keep this door shut and inaccessible at all times. Chestnut View Version 1.10 Page 16 The laundry area was inspected and found to be unsafe; the ceiling was exposed to the brickwork, electric cables were hanging down in loops and an electric strip light, lit at the time, was not fixed to the beam on which it rested. An immediate requirement was made that these areas of concern were rectified. The deputy manager was requested to document an urgent risk assessment of the area and make it safe immediately. The Health and Safety Executive was informed and will visit in the near future. Chestnut View Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 Staff in the home are trained and competent to do their jobs EVIDENCE: It was evidenced that all staff received induction training. Training files examined showed that staff had received mandatory training and training in dementia care, protection of vulnerable adults and safe administration of medicines. Ninety five percent of staff in this home achieved NVQ qualifications. Chestnut View Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Service users receive good quality of care and said that they were happy. Care plans were comprehensive and included risk assessments. Some areas of the home were found to be unsafe, as previously reported under standards 19 and 26. EVIDENCE: Service users looked smart and well cared for. They praised the staff and said that they were kind to them. The home carried out regular fire drills and fire safety training. Staff were trained in first aid, manual handling and food hygiene. It was evidenced that safety checks had been carried out on the electricity, water, lift and hoists. A fire risk assessment had been made and various risk assessments for the new building had been carried out.
Chestnut View Version 1.10 Page 19 On inspection of the building various areas were observed to be unsafe. Please refer to the assessment of standards 19 and 26 of the report. Chestnut View Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 1 x x x x x x 1 STAFFING Standard No Score 27 x 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 1 Chestnut View Version 1.10 Page 21 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 19 Regulation 23(2)(b) and (5) Requirement The laundry area must be made safe; the ceiling must be repaired, the loose cables tied back and the electric strip light must be fixed securely. The door between the main building and the new building must be kept shut and inaccessible to service users, staff and visitors. The temperature of the treatment rooms must not exceed 25 degrees centigrade. Service users plans must be signed either by the service user or representstive. Service users ensuite bathrooms must not be used as storage areas for equipment. Timescale for action Immediate 30/08/05 2. 19 13 (4) (a)and (c) Immediate 30/08/05 3. 4. 5. 9 7 19 13(2)(l) 15 23(l) Immediate 30/08/05 30/10/05 30/09/05 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 Good Practice Recommendations Chestnut View Version 1.10 Page 22 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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