Inspection on 20/04/06 for Chestnut Walk

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Walk 14/11/07

Chestnut Walk 29/09/05

Chestnut Walk 20/04/05

Chestnut Walk 14/10/04

Chestnut Walk 05/05/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Chestnut Walk 15 Chestnut Walk Hungerford Berkshire RG17 0DB Lead Inspector Stephen Webb Unannounced Inspection 20th April 2006 10:00 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 Walk DS0000031280.V290282.R01.S.doc Version 5.1 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 Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chestnut Walk Address 15 Chestnut Walk Hungerford Berkshire RG17 0DB 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) 01488 683263 West Berkshire Council Mrs Susan Marie Breakspear Care Home 13 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (13) Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 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. Within this number up to 5 of these people could also have a diagnosis of dementia or mental disorder. 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 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 next to the dining room. Fees at the time of inspection were £630 per week. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit to this service was undertaken unannounced on the 20th of April 2006, though the inspection could not be concluded until additional information was received by the CSCI on 03/05/06 and 04/05/06, including the overdue Pre-inspection questionnaire. The site visit included time spent with service users, a relative, the manager and some staff. The inspector also toured the premises and examined key records, and had lunch with service users. Evidence was also gathered from various documents supplied to the inspector by the service, including the pre-inspection questionnaire, the report of the quality assurance survey, copies of rotas, menus, and an activities plan. There were eight returned service user questionnaires, though it is acknowledged that these were completed by staff on behalf of the service users in consultation with them. The home had a welcoming and calm atmosphere, on the day of the site visit and the staff were busy meeting the needs of the service users. It was positive to observe care staff engaged with service users in activities such as dominos and reading the newspaper, as well as in informal conversation with them. Few of the service users were able to give verbal feedback in any detail, though the inspector did briefly interview two of them, and have conversations over lunch with others. The inspector also met with one relative. What the service does well: The home meets the healthcare needs of service users effectively and provides well for their day-to-day care. It was evident that enhanced care was also provided where a service user was unwell in bed. External healthcare professionals are also consulted where appropriate. The service provides a reasonable range of activities and stimulation for service users, but there remains room for further development. It is positive that staff are expected to spend some one-to-one time with each service user on a daily basis and record how this was spent, in addition to the other scheduled and impromptu activities. Care planning is effective and staff demonstrated a good level of knowledge of the needs of service users. Medication management is appropriate. Service users are enabled to make choices in their day-to-day lives, and enjoy an appropriately varied diet. Some service users were able to confirm that staff treat them with dignity and respect. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 6 Service users, their relatives and relevant professionals express broad satisfaction about the service and care provided by the staff. The premises are generally well maintained and present as welcoming, homely and comfortable, and are free from unpleasant odours. They offer service users a range of alternative communal areas to meet their needs and space for indoor exercise. Service users bedrooms are individualised, though in some cases rather small, particularly where their occupant requires a wheelchair and/or assistance with a hoist to transfer. In these cases, staff have needed to devise an appropriate sequence of events to enable them to meet the needs of the service user effectively and safely within the confines of the available space. The needs of service users are met by a team of permanent staff, effectively distributed by rota, with senior supervision. Although there are two care staff vacancies, these are covered by regular, known agency staff wherever possible, to maximise consistency. The proportion of care staff with an NVQ remains over 50 . The publicising of the availability of the report of the quality assurance survey is good practice. Service users’ funds are appropriately managed and records maintained. What has improved since the last inspection? All of the previous requirements and recommendations from the previous inspection have been addressed. Care plans have continued to improve and reflect the needs of individuals. A range of additional core training had been provided to staff since the previous inspection, including first aid, medication, moving and handling and Protection Of Vulnerable Adults), POVA training, and more core training was scheduled. All of the windows and doors have been replaced, the corridors have been redecorated and the hallway re-carpeted since the previous inspection. A detailed quality assurance survey has been carried out, consulting service users, their relatives and relevant external professionals, and the results have been made available to interested parties in a report. An annual review of the service has also been carried out and an annual development plan for the next year has been produced. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 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 Walk DS0000031280.V290282.R01.S.doc Version 5.1 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 the following standard(s): 3, 6 Quality in this outcome area is adequate. Though in two cases the assessment documents were considered satisfactory; in one case, no assessment documentation had been obtained, either prior to the service user’s admission, or subsequently. Had this been addressed, this outcome area would have been judged “Good”. Standard 6 is not applicable in this case, as intermediate care is not provided. EVIDENCE: Detailed pre-admission assessments were available on file for two of the three case-tracked residents. The manager reported that despite requests to the local authority and the resident’s previous placement, and the holding of the post admission review, no copy of the assessment for the third resident had yet been received. Despite this the resident had been admitted as an emergency, without the unit having obtained essential information. No resident should be admitted without obtaining a detailed assessment of need, either prior to admission, or as soon Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 10 as practicable thereafter, in the event of an emergency. In the absence of this documentation, the unit had, however, devised a care plan for the service user to meet their perceived needs. The missing assessment documents should be obtained as a matter of urgency and reviewed, to ensure that any identified needs can be met by the service and that steps have been taken to ensure that these needs are being met. Some service users had little or no awareness of the details of their assessment process, owing to their needs, but two said their needs were met by the unit. Care plans are addressed in detail in the following section. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. Improvements noted at the last inspection appear, for the most part to have been maintained. However, the manager should ensure that all care plans are dated to ensure prompt and regular review. EVIDENCE: From the service user care plans and healthcare records, it was evident that the home had consulted a range of external health professionals, including Community psychiatric nurses, GP’s, district nurses, a Parkinson’s Disease specialist nurse, chiropodists and occupational therapists. Consultation had taken place with the “wheelchair clinic”, via an OT referral, to maximise the comfort on one service user who chooses to remain in their wheelchair for extended periods. Discussions with a sample of care staff indicate they had an understanding of the individual needs of service users. Limited discussion was possible with service users, owing to the level of dementia and other medical conditions, but some were able to indicate that the staff met their care needs well. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 12 The content of care plans was detailed and addressed individual’s needs. There was evidence of the plans addressing needs identified within assessments and reviews and regular care plan reviews were taking place. One of the sampled care plans was undated, which would make it difficult to plan an effective cycle of review. This should be addressed. One service user, who was currently being cared for in bed, had an additional enhanced care plan in place, which addressed relevant current care needs owing to their illness, and included records of fluid and food intake. These documents were seen in use in the service user’s bedroom, where staff had ready access to maintain their recording. This was good practice. Appropriate consultation had taken place with the service user’s relatives regarding the service user remaining in the home to be cared for in familiar surroundings and by staff with whom they were familiar. Each service user’s file had a ‘record of falls’ sheet, which enabled changes in health etc. to be monitored readily. Where one service user had had three falls over a short period, the GP had been called out and the resident referred to hospital for investigation, which resulted in a prompt diagnosis of an infection and appropriate treatment. Good records of routine medical/health appointments were also in place. The medication administration and recording procedure was observed for five service users and found to be appropriate. Medication records include a photograph and the quantities of medication received into the home, any refusals of medication and any returns are recorded on the medication administration record, (MAR) sheets. All of the Residential Care Officers have received recent medication training, and some of the care staff have previously received such training. Night staff were also undertaking medication training via a distance-learning package. Although few of the service users were able to comment in detail about their care, several did indicate they were happy that they were treated with respect and dignity. Observation of the interactions between staff and service users also confirmed this, with warmth and humour being evident from both service users and staff. The needs and comfort of the service user who was ill in bed, were seen to be addressed regularly by staff. This was confirmed via the enhanced care plan records. The daily records examined as part of case tracking included some details re activities and contact with relatives and professionals, though in some others there was room for more detail. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Although there have been positive improvements in the level and range of activities provided, there remains room for further development in this area and the possible benefits of reminiscence work should be explored. EVIDENCE: It was stated that each service user has daily one to one time with a staff member as well as any specific activities they might engage in. This might be a conversation in the lounge or conservatory or in their bedroom if preferred. Service users referred to a small number of activities being available including games and board games, but two commented that they felt bored at times. One relative felt that although there had been some improvement in activities, there was a need for more activity targeted to the needs of the individuals. During the inspection, staff were observed engaged in dominos with a service user and reading and discussing the newspaper with two others. One service user said that her family visit her and take her out on occasion. Service users had all taken part in planting up a series of pots with bulbs etc. and these were displayed in the garden outside the conservatory. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 14 One service user’s daughter visited during the inspection and brought the wherewithal to enable her mother to do some flower arranging with her support. This appeared to engage the attention of a couple of other service users who might benefit from this activity. It was understood that flower arranging used to be provided and was popular with service users. It was also commented that a staff member from another service used to visit the home to run activities, but that this no longer happened. There was no activities programme posted for the current month, though it was stated that this was the usual practice. A copy of the daily programme for the previous month was provided to the inspector. The programme included a range of activities including exercise, word and other games, hymn singing, skittles, external entertainment and naming flowers. However, the inclusion of the hairdresser and chiropodist as activities is questionable. The religious needs of service users are met by visiting vicar who comes on a monthly basis to take communion and will see anyone who wishes, alone. It was reported that none of the current service users are particularly active in terms of worship. Two service users are Roman Catholic but had not asked for a visit from a priest, when this was offered. One service user confirmed that she took communion from the vicar, but that was the extent of her wishes. One of the senior staff had previously attended a training course on providing chair-based exercise for service users, and provides the aforementioned exercise. The manager and a senior had also attended recent training on “singing for the brain” and were hoping to begin this soon. The session planned for that week was felt unlikely to go ahead as the service users who were planned to take part were unwell. Although staff referred in conversation, to informal reminiscence work, this did not appear to be a regular part of the activities or stimulation provided. The possible benefits of further development of this aspect should be considered. Of the current service users, eight were said to have regular family contact and some were taken out from time-to-time by their relatives. Both staff and service users referred to service users having opportunities to make choices in their daily lives. Two service users talked about having decided when they get up and go to bed, and one said it was her choice not to be monitored at night so she was not disturbed. The day’s menu was written up on a white-board in the dining room, and included choices, particularly at breakfast and lunch-time. Conversation with service users indicated they were aware there was a choice and observation at lunchtime confirmed this. One service user said they did not like the options that day, but that there was usually something she liked available. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 16, 18 Quality in this outcome area is good. The management should consider exploring the reasons for the absence of any complaints to the unit, and whether the service can further improve their openness to feedback from service users and others. The manager should address the shortfalls in on-site recruitment records to ensure that the full range of checks have been carried out by the Authority. (Requirement made under staffing section Standard 29, below). EVIDENCE: The service has a written complaints procedure in place, and made available to service users and relatives. However, examination of the complaints log reveals no entries, so it was not possible to judge the effectiveness of the procedure through tracking its use. Feedback from residents and relatives indicated that there were some minor issues and dissatisfactions, which had not been brought to the attention of the management. Though it was not possible to establish the reasons for this, there did appear to some reluctance to raise issues in order not to appear demanding. The annual review and development plan for the service, dated April 2006, notes the lack of any recorded complaints but makes no comment or suggestion as to any implications or possible development in this area. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 16 The summary of the survey of residents, relatives and professionals, carried out in November and December 2005, indicates a general high level of satisfaction with the service provided, though in some areas there were significant absences of response, perhaps for a variety of reasons. The management team should consider reviewing the operation of the complaints procedure to try to ensure that it is as open and accessible as possible and that potential complainants are not put off in any way, from raising any concerns they may have, in order to continue to develop the service. The benefits of a survey of residents and relatives on the issues surrounding comments and complaints should be considered. Six of the staff had attended Protection Of Vulnerable Adults (POVA) training recently and the remaining staff are reported to be due to attend this in May. Staff confirmed that they had attended a range of other training related to the protection of service users, including moving and handling, use of hoists, working with dementia, dementia and challenging behaviour, infection control and first aid. The service has a vulnerable adults protection policy and a whistle-blowing policy/procedure in place, and a detailed recruitment policy for the Authority. However, there appeared to be some shortfalls in the available evidence of recruitment checks, from the sample of three records examined, which could potentially compromise service user safety. This is addressed in detail below in the staffing section. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 19, 26 Quality in this outcome area is good. The development of more appropriate storage areas for essential equipment should be considered, in the context of risk assessment of the current storage arrangements. EVIDENCE: The home has a light, airy and welcoming entrance hall and communal areas are pleasantly decorated and furnished. The corridors have been redecorated and the hallway re-carpeted since the last inspection. All of the doors and windows have also been replaced, and the front door security improved. Service users have a choice of where to spend their time, including the conservatory, lounge, dining room and a further quiet seating area. The bedrooms are individualised and pleasant, though some are rather small to of meet the greater support needs of some service users, particularly where wheelchairs and hoists are required. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 18 Staff have devised detailed individual sequences of equipment use to work within these constraints which tend to be passed on verbally. It is suggested that as part of a risk assessment strategy, such specific plans are documented to ensure consistency and enable management monitoring of their ongoing suitability as needs change. The home has one shared room, and the remaining bedrooms are singles. The service users/next of kin were consulted about sharing and the service users had known each other previously. Limited feedback from two of the service users indicated they liked the building and were happy with their bedrooms. No urgent maintenance issues were noted throughout the unit. The wheelchairs in use were observed to have the required footplates, which were used by staff when moving service users. It was observed, however, that several hoists and wheelchairs were ‘stored’ in the corridors when not in use. This was because of a lack of appropriate storage locations within the building. This issue should be risk assessed in terms of the risk of falls over the equipment and the partial obstruction of one of the fire escape routes. The creation of suitably located storage for this essential equipment should be considered. There were no unpleasant odours anywhere in the unit. Appropriate laundry facilities were available and standards of hygiene were seen to be good. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. However, the Manager should ensure that there is sufficient evidence available to establish that an appropriately rigorous recruitment process is in place for all staff employed at the home. Any staff without a current CRB must have this undertaken as a priority. EVIDENCE: The needs of the service users are met by a team of permanent staff distributed via a rota so that the usual staffing is at least one Residential Care Officer and three carers, throughout the waking day. At night there are two waking night staff on duty. On the day of inspection a further RCO was on duty, whose duties included preparation of the lunch as the cook was on a day off. This occurs on two days each week because the assistant cook post remains vacant despite ongoing recruitment attempts. Staff rotas were available detailing the staff cover. The current staffing levels enable the staff on duty to meet the needs of service users including spending one to one quality time with each service user on a daily basis, and engaging individuals in some activities. At the time of inspection there were two vacant care staff posts. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 20 There had been two new day care staff recruited since the previous inspection, but both had since left to return to their previous job. Three new night staff had been recruited in the same period and were undertaking their induction and foundation training, before commencing their NVQ level 2. Over 50 of the staff team have attained their NVQ at either level 2 or 3. Examination of the recruitment records for three of the recent recruits indicated some areas of concern, which suggest that the process may not have been as rigorous as required. In one case the applicant’s previous employer had not provided a reference, and there was evidence of only a POVA first check having been carried out without this being followed up with a full CRB check. No evidence was available regarding any previous disciplinary history, and the induction record had not been fully signed off. In another case the evidence of identity check for the CRB form, was blank and there were no dates recorded within the employment history on their application form, and no evidence that this had been pursued at interview. The level of completion within the reference request forms was poor in some instances. Though it is acknowledged that it can be difficult to obtain thorough references, evidence should be available to indicate that all reasonable attempts were made to obtain appropriate details. The unit can access a staff training programme beginning with induction and core training in the first six months followed by NVQ. There are a range of other courses provided as well as refresher courses where required. One of the RCO’s has delegated responsibility for overseeing staff training. Training received by staff included fire awareness, first aid, moving and handling, food hygiene, Parkinson’s disease, dementia, protection of vulnerable adults (POVA), dementia and challenging behaviour. Half of the staff had completed all of their refresher training, and the other half were due to attend in these in the near future. All of the staff had received infection control and moving and handling training recently. The manager and one RCO had attended “Singing For the Brain” training recently and were planning to introduce some service users to this once they were well enough. The limited feedback available from service users and one relative indicated that they felt the staff were very caring and worked hard to meet their needs, though it was commented that they were often very busy, and were not always able to provide enough stimulation and activities for service users. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. The manager should establish individual records of accidents to service users, as part of the individual records of their care. EVIDENCE: The manager has sufficient experience at a senior level and is responsible only for the management of this unit. She has addressed all of the requirements and recommendations arising from the previous inspection. Appropriate areas of responsibility have been delegated to the senior team. Staff confirmed that the manager was available to them and that she spent some of her time observing care and recording practice. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 22 The service had carried out a cycle of quality assurance in November and December 2005, providing questionnaires to residents, their relatives and external professionals, (including GP’s, district nurses, hairdresser and others). Given the need for support for service users in completing their questionnaires, staff from another service had been used to try to provide some independence. A summary report had been produced detailing the findings under the headings of catering, staff, services and social fulfilment. The report was based on a high rate or return of the questionnaires, and indicated that most service users, were satisfied with most areas of the service they received, though there were some areas where this was not as clear. It appeared that almost half of service users did not understand the question about keyworking, so it is suggested that further thought be given to rephrasing this area of enquiry on future surveys. There was some concern expressed about the length of time taken to answer call bells at times, from almost a quarter of service users and also some suggestions for improving the activities provision. All of the relatives and professional respondents were either satisfied or very satisfied with the service provided. A notice posted in the entrance hall states that the quality assurance report is available. This is good practice. The Manager had produced an annual review of the service and annual development plan as required, and this was copied to the inspector. The format of this report indicted that further development of the quality assurance and review process was planned in the future though a broader methodology. The home also holds service user meetings on the first Sunday of the month, though few of the service users are able to contribute in detail. These meetings are minuted. Where the home manages personal allowance monies on behalf of service users, these are recorded and signed for on individual record sheets and the money kept in individual wallets within a safe. Monies withdrawn for spending by or on behalf of service users are signed for by staff or service user, (if able), and receipted. The wallets are regularly checked and bank statements reconciled. Other financial matters are managed by relatives or are subject to Power Of Attorney (3) or Guardianship (2). Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 23 The home is operated with due regard to health and safety and appropriate risk assessments are in place in most cases. However, as mentioned with the premises section of the report, there is a need to undertake a risk assessment on the current storage of wheelchairs and hoists within the corridors. (Requirement made under Standard 19). Also there were no records of accidents within individual service user files as is required, in addition to the collective accident records, which were available. A record of any accidents to a service user must be maintained within each individual’s care file. From examination of the collective accident records it was possible to establish that two of the case tracked service users had had accidents over the past year. The records indicated the response of the service had been appropriate in each case. As already noted, the laundry facilities are appropriate to maintain standards of hygiene, including the provision of a sluice cycle. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 24 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 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 2 Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 25 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 OP3 Regulation 14(1)(b) 14(1)(c) 14(1)(d) 16(2)(m) 16(2)(n) 23(2)(l) 13(4) 17(2) & Schedule 4.6 and 19(5)(d)& Schedule 2 17(1)(a)& Schedule 3.3(j) Requirement The manager must obtain copies of any missing assessment documents, and review the individual’s care plans with reference to them. The manager must continue to develop the provision for appropriate activities and leisure pursuits for service users. The manager should risk assess the current storage arrangements for hoists and wheelchairs. The manager must ensure that the required evidence of staff recruitment checks is available for inspection on site. The manager must establish and maintain individual records of accidents to service users, within their care files. Timescale for action 04/06/06 2. OP12 04/08/06 3. OP19 04/06/06 4. OP29 04/07/06 5. OP38 04/06/06 Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 26 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. 3. Refer to Standard OP7 OP12 OP16 Good Practice Recommendations The manager should ensure that all care plans are dated to enable prompt and regular review. The possible benefits of reminiscence work with service users should be explored. The manager should review the operation of the complaints procedure to ensure that it is as open and accessible as possible. Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chestnut Walk DS0000031280.V290282.R01.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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