CARE HOMES FOR OLDER PEOPLE
CHESTNUT WALK 15 Chestnut Walk Hungerford Berks RG17 0DB
Lead Inspector Rhian Williams-Flew Unannounced 20 April 2005 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 WALK Version 1.10 Page 3 SERVICE INFORMATION
Name of service Chestnut Walk Address 15 Chestnut Walk, Hungerford, Berks, RG17 0DB 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) 01488 683263 01488 68789 chestnutwalk@westberks.gov.uk West Berkshire Council Mrs Susan Marie Breakspear Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places CHESTNUT WALK Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: No Date of last inspection 14 October 2004 Brief Description of the Service: Chestnut walk is a care home run by West Berkshire Council. It is registered to care for 13 older people, it is not registered for older people with dementia. The home is purpose-built and is of single storey construction. The home is within a local housing development area with many local amenities close by. The main town centre of Hungerford is nearby as is, the GP surgery, library and churches of various denominations. There are 12 bedrooms, 1 of which is a double room. All of the rooms have wash hand basins. There is a large lounge, the main dining room is adjacent to the kitchen and there is a separate conservatory which is also adjacent to the dining room. CHESTNUT WALK Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9.10-18.00 hours on a weekday. The manager was present throughout the inspection. 12 of the 13 residents were spoken with throughout the day. A partial tour of the premises took place and five sets of care records were reviewed along with a number of other records concerned with the running of the home. The majority of the members of staff on duty throughout the day were spoken with. What the service does well: What has improved since the last inspection? CHESTNUT WALK Version 1.10 Page 6 The Statement of Purpose has been published and it reflects the services provided by the home. The management of medication has improved. The home has purchased brand-new commodes for all the residents. It has also been agreed that the home can have more staff. This includes both day staff and night-time staff. This has been in response to the increasing needs of the residents. This is a positive decision that can only enhance the service. The requirements of extra fire safety procedures have being completed however there is one door that still need some additional work. There is now record of all the training that members of staff have attended and what they still need to attend. These training courses are very important as they reinforced the need for all staff to act within the law so as to ensure the protection of residents and themselves. 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 by contacting your local CSCI office.
CHESTNUT WALK Version 1.10 Page 7 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 WALK Version 1.10 Page 8 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) 1,3,4 and 5. Standard 6 is not applicable to this home. People who are considered for admission to this home do have their needs assessed to ensure that the home can provide the care they require. They are also invited to a 6-week trial stay. The manager must be mindful to the category of registration when considering new admissions. EVIDENCE: Since the previous inspection the Statement of Purpose has been published and it reflects the information required by regulation. However, the Service User Guide has not been published, as was required following the previous inspection. The manager does recognise the importance of this document but explained that the publication had been delayed because the registered provider, West Berkshire Council, had been trying to ensure consistency in the document across its services. It is anticipated that it will be published within the next 6 weeks. New service users are only admitted following a full assessment either completed by, the care management team and/or the manager. A number of such assessments were reviewed and were found to provide detailed
CHESTNUT WALK Version 1.10 Page 9 information of the persons needs. A discussion was held with the manager, with regard to ensuring that during the assessment process consideration is always given to the registration category of the home, to ensure that the home only admits people of old age, not falling within any other category. For example, not admitting people whose primary needs are those of dementia and/or mental disorder. Many of the people spoken with whom live at the home expressed many positive comments, saying that the home was able to meet their needs. There was also evidence available to demonstrate that the home does have good links with other specialist practitioners, to offer the residents the support they require. All new residents are admitted for a trial stay of up to 6 weeks indeed, on the day the inspection a review meeting was being held for the most newly admitted person. CHESTNUT WALK 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. The written care plans must reflect the up-to-date care needs of the people who live in the home and should be reviewed every time there is a change in the persons needs. The observed care was seen to be delivered with respect. The residents were fulsome in their praise of the way staff assist them. EVIDENCE: The care plans of five residents were reviewed. These people had also been spoken with, regarding their care. Members of staff were also spoken with to establish what they considered to be the persons care needs. Also, throughout the day the Inspector was able to observe how the staff met the needs of the residents. The residents were very complimentary about the care and attention the staff gave them. Many comments such as, they are very good and kind to me; they are always willing to help when you want it; nothing is too much trouble for them were expressed. The members of staff displayed a good knowledge of the residents needs and from observations it was clear that the residents needs were a priority for the staff. However, when the care plans were reviewed the up-to-date care needs of some of the residents had not been adequately recorded. This matter was discussed and evidenced to the
CHESTNUT WALK Version 1.10 Page 11 manager and the two senior residential care officers on duty. All accepted there were significant deficits present. It was concerning that some of these deficits related to the health care needs of the residents. Recording the changing needs of the residents had been a deficit on the last inspection. The manager undertook to ensure that a full review would be held of all the care plans and that staff would be reminded that it is imperative that the up-to-date care needs of residents are recorded. The manager indicated that the care plan format is due to be changed in the near future. It would be important to include all aspects of the persons health care needs including dental, optical, nutritional, psychological and pressure area care in these revised care plan formats. (Reference the National Minimum Standards) Medication was stored, handled, administered and recorded appropriately. Clear photographs of the residents were evidenced in the medication file. 12 of the residents were spoken with during the day and all were very positive about the respect they were afforded by staff. It was observed that the residents were treated with dignity when personal care was offered. The rapport between the staff and residents was very good. CHESTNUT WALK 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 and 15. The social stimulation and activities provided has a positive effect on the residents. Meals are nutritious and well presented. Staff engage with residents whenever they are in contact with them. EVIDENCE: From conversations with the residents and observations during the day it was very clear that the routines of daily life are flexible and varied to suit the individual persons needs. During the day various activities (skittles and a quiz) were observed which, the majority of residents took part in and enjoyed. The interaction between the residents increased during these activity times, as they supported and encouraged one another to take part. Some of them also enjoyed having their hair washed. Several of the residents also had visitors during the day; they were made to feel most welcome. All three main meals of the day were observed during inspection. The mealtimes were unhurried and staff were offering assistance with sensitivity. The dining room is adjacent to the kitchen serving hatch, which allows for the residents to give direct feedback to the cook about the quality of the meals. It also allows the cook to observe what each resident prefers to eat and if necessary to offer an alternative. The cook is also familiar with each resident’s
CHESTNUT WALK Version 1.10 Page 13 preferences and ensures that these are provided for. All of the people spoken with were very complimentary about the quality of food provided for them. They were particularly appreciative that their meals are homemade and that the cook makes excellent cakes! CHESTNUT WALK 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. This home has not received any complaints with regard to the service provided to residents. EVIDENCE: There have been no complaints with regard to the service provided at this home to either the home manager or the Commission for Social Care Inspection. The home does have an accessible complaints policy. CHESTNUT WALK 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 and 26. The delay in refurbishing the doors and windows should be followed up as a priority by the Responsible Individual. Ill-fitting doors cannot compromise the fire safety of the home. The recarpeting and refurbishment of one room in the home must occur. EVIDENCE: A previous requirement has not been met. The external decoration of the building is still in need of refurbishment. It was envisaged by the Responsible Individual that funding had been approved to renew all the doors and windows of the home. However, no date has been identified as to when this was to occur. During the day the manager attempted to establish when this date would be but was advised that the works might not go ahead due to funding constraints in West Berkshire Council. The Responsible Individual should review this issue as a requirement remains. At teatime the fire alarm and fire doors were activated. It was noted that the double doors on room 17 (the lounge doors) did not provide a complete seal
CHESTNUT WALK Version 1.10 Page 16 where the two doors met. Addressing the recommendations by the local fire service had been an outstanding requirement since May 2004. Whilst it was considered by West Berkshire Council that they had met these recommendations, following the last inspection by CSCI, it will be necessary for the fire safety of these doors to be reviewed as a priority. The carpet in the hallway of the home, particularly outside the area where the toilets are situated, is worn and stained. This carpet needs to be replaced. With the exception of one room the home was very clean and free of odour. Several of the service users commented how clean and tidy the home is kept. The exception concerns room 1. It is imperative that the odour in this room is addressed promptly. The manager indicated that it is likely that the carpet and some of the furnishings will need to be replaced as, in spite of regular deep cleaning the odour persists. CHESTNUT WALK 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) 27 Increasing the staff allocated to this home is a positive decision and reflects the increasing needs of the people who live at the home. EVIDENCE: There has been a recent review of staffing requirements for this home and an additional 29 hours of day care staff time has been allocated. This is in addition to the review of the night time cover where it has been decided that two waking night staff need to be on duty. With the exception of these posts the home is fully staffed. CHESTNUT WALK 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) 32 and 38. The management of the home is open and transparent. The health, safety and welfare of service users and staff are seen as a priority by the manager. EVIDENCE: Several of the residents spoken with gave positive comments about the manager of the home. It was clear that she was approachable and attentive to the residents and their visitors. There was no evidence to suggest that the manager is not open and transparent in her management of the service. All of the five previous requirements have been met. There is now a clear record of staff training however, a number of staff have applied to do mandatory training but have not been able to achieve a place on
CHESTNUT WALK Version 1.10 Page 19 the courses due to oversubscription. If the situation were to persist some staff will not receive their mandatory training in the required timescales. This deficit will need to be reported to the training department of West Berkshire Council to ensure that sufficient training is provided when it is required. It was noted that food is properly stored in the kitchen appliances and larder. It will be necessary for the cook to receive updated food hygiene training as a priority as her certificate expired two months ago. The fire evacuation of the residents (following the fire alarm at teatime) was conducted in a calm and safe manner. The residents were reassured and escorted to a safe area with members of staff in attendance. CHESTNUT WALK 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 2 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 1 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x x x x 2 CHESTNUT WALK Version 1.10 Page 21 yes 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 1 Regulation 4 Requirement The Service User Guide must be finalised and published. A previous timescale of 30 November 2004 was not met. Once the document is published a copy should be forwarded to the CSCI within 28 days. The document should also be made available to the residents and their representatives. A previous timescale of 28 December 2004 was not met. All care plans must accurately reflect the up to date care needs of the residents and be explicit in how the care is to be delivered. Reference to Schedule 3 paragraph 3 (k-o). Records must be kept in line with the above reference to regulations to ensure that the health care needs of residents are recorded. The delay in refurbishing the doors and windows must be followed up as a priority by the Responsible Individual. A previous timescale of 30 April 2005 is still in place. The fire safety strips on the edge of the doors to room 17 must be checked to ensure they are
Version 1.10 Timescale for action 8 July 2005 2. 1 6 08 July 2005 3. 7 15 (2) (b) 10 June 2005 10 June 2005 4. 8 17 (1) (a) 5. 19 23 (2) (b) 31 July 2005 6. 19 23 (4) RI written to requesting
Page 22 CHESTNUT WALK effective. 7. 19 & 26 16 (2) (k) The odour in room 1 must be addressed. Replacement of the floor covering and furnishings need to be considered. Replacement of the hall carpet is required as it is worn and could present a trip hazard if the wear continues. Sufficient training must be provided or accessed by the registered provider to ensure that staff can attend mandatory training when they are required to do so. The cook must be provided, as a priority, with the required mandatory training in food hygiene as her previous certification expired two months ago. action within 7 days. 31 May 2005 30 June 2005 30 June 2005 8. 19 13 (4) (c) 9. 38 18(1)(b) 10. 38 18(1)(c ) 31 May 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 7 Good Practice Recommendations The manager is mindful of the category of registration for the home when considering the admission of new residents. As the format of the care plans are to be reviewed reference the the National Minimum Standards could assist in ensuring that all the care needs of residents are included. CHESTNUT WALK Version 1.10 Page 23 Commission for Social Care Inspection 1015 Arlington Business Park Theale Berks RG17 9DB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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