CARE HOMES FOR OLDER PEOPLE
Chestnut Walk 15 Chestnut Walk Hungerford Berkshire RG17 0DB Lead Inspector
Rhian Williams-Flew Unannounced Inspection 29/09/05 9:00 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.V252236.R01.S.doc Version 5.0 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.V252236.R01.S.doc Version 5.0 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.V252236.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th April 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 purposebuilt 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 adjacent to the dining room. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced inspection took place during a weekday between 9:00 hrs and 17:30 hrs. The manager was present from the late morning. 8 of the 13 residents were spoken with to canvass their views and opinions of life in the home. 1 member of staff was interviewed in private. The emphasis of the inspection was to review the key standards that had not been examined on the last inspection. All previous requirements and recommendations were also reviewed. What the service does well: What has improved since the last inspection?
The home has had replacement doors and windows. This has improved the appearance and comfort of the home considerably. A number of the residents made appreciative comments about the improvements. The refurbishment of some flooring in the home has taken place or is due to take place. Issues concerning fire safety matters have also been addressed. Random samples of 3 care plans were looked at in detail. There has been a considerable improvement in the care plans since the previous inspection. It was clear that staff had spent time ensuring that the care plans reflected the needs of the residents. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 6 Permanent night staff have been employed and as of 1 October 2005 no sleeping in staff will be on duty. These changes have been made to reflect the increasing needs of the resident group. This is a positive initiative. 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.V252236.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 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 the following standard(s): 1. This home provides clear and up-to-date information regarding its services and provisions for the client groups it is registered for. EVIDENCE: A previous requirement has been met. The Service User Guide has been finalised, published and reflects the service provided at the home. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 9 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. The delivery of care to the residents who live in this home is generally good. The care plans of the residents are more thorough and detailed in their content than on previous inspections. Appropriately qualified professionals are not being used to assess the needs of residents who are prone to falling. The administration of medication is not being conducted safely. EVIDENCE: A sample of 3 residents care plans were reviewed and were noted to be much improved since the previous inspection. They were up-to-date and reflected the needs and wishes of the residents. All 3 residents were spoken with during the inspection and they confirmed that they felt that their needs were well met. They commented on the kindness of staff and the attention they are given. Risk assessments were in place and it was evident that other professionals are involved in ensuring that the residents receive appropriate care and treatment. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 10 There was good evidence that the health care needs of the majority of residents were addressed. This included ensuring regular checks on their hearing, sight and dental care as well as their specific individual needs whether this was physical and/or psychological. There was an exception to this good practice that involved a resident who had fallen 48 hours previously. They had sustained bruising to their eye and were complaining of a sore shoulder yet there was no evidence that medical assistance or advice had been sought. By the end of the inspection this issue had been addressed. The manager was asked to review with the members of staff when they should seek medical intervention for residents, particularly if head injuries are involved. It was also noted that another resident was sitting in a chair where the front legs had been elevated on blocks thus inclining her chair backwards. The result being that the person feet could not touch the floor. The staff advised the Inspector that the resident was at risk of falling and this action ensured that she remained seated. There was no evidence to suggest that this action had been assessed as appropriate by a qualified therapist nor was there evidence that this action had been risk assessed. Residents who are at risk of falling should be appropriately assessed by a suitably qualified person to ensure that correct interventions and actions are carried out to minimise the risk of falling. It was noted that a number of residents were spending long periods of time sitting in wheelchairs. Some residents commented that they preferred to remain in their wheelchair. However, some of the residents did not look as comfortable as they could have been and confirmed this when spoken with. Ordinary wheelchairs offer little support and comfort. Their primary purpose is a means of conveyance. The manager was asked to review why some of the residents were not being offered the opportunity to transfer to a more comfortable seat whilst they were in a communal areas. A review of the administration and storage of medication was not inspected in its entirety. However, it was observed at the start of the inspection that 2 residents who were still at the breakfast table had been left with their medication in small medicine pots. No member of staff was present to observe whether these residents administered their medication correctly yet in both cases the medicines administration records (MAR) had been signed. The practice should not occur. The members of staff at the home are very respectful of all residents who live there. This was confirmed by the residents themselves and through observations during the inspection. The atmosphere in the home is relaxed and the members of staff strive to ensure that the resident’s dignity is central to the care they deliver. It was clear that staff are very committed, sensitive and responsive to the residents who live in the home. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 11 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 & 15. The residents in this home clearly feel well supported by the staff team. They feel able to ask for assistance and appreciate the opportunity to make their own choices about how they conduct their daily lives. The meals provided are very good and much appreciated. The Cook clearly has an important role in ensuring good nutritional meals are provided. A review of the need for a dedicated activities assistant should be considered as some residents have noted that they do not participate as much as they used to. EVIDENCE: The routines in the home are flexible and geared to the resident’s choices. This is reflected in all aspects of their daily lives. Many of the residents made comments such as, nothing is too much trouble; if I want something the staff try hard to make sure I get it. Some of the residents commented on feeling more bored than they used to saying, we dont seem to be doing the things that we used to; we dont play as many games as we used to - the girls are too busy. It was noted that one of the care staff does have the role of providing activities for the residents but it is only possible to achieve this two to three times a week. Discussions were held with the manager with regard to these comments. Consideration also needs to be given to the needs of all service users particularly in the light of the recent changes in the
Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 12 category registration for this home and the reality that the majority of the residents have become more dependent and therefore require more care to be given. Therefore, a member of staff who provides activities in addition to their caring role finds that there is less time to devote to activities and socialisation. A review of the need for a dedicated activities assistant could be indicated. A number of the residents have very good family support and visitors are always welcome. Of all the comments made by residents during the inspection their most fulsome praise was reserved for the cook and the food they are offered. Comments such as, the food is out of this world. If I dont like it they dont give it to me and always offer me something they know I do like; you couldnt ask for better food; the cook knows I dont like certain foods so always gives me something else; we have lovely home-made cakes! The meal times are relaxed and unhurried and the members of staff offer assistance in a sensitive and discreet manner. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 13 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): These standards were not inspected on this occasion. EVIDENCE: These standards were not inspected on this occasion. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 14 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, 22 & 26. The home is clean, comfortable and homely. Since the previous inspection considerable investment has been made in the fabric and furnishings of the property. The home has a good selection of equipment to assist in the delivery of care. EVIDENCE: Previous requirements have been met. The home has been refitted with new doors and windows. This is a significant improvement, which is much appreciated by the residents of the home. The manager confirmed that the fire doors to the lounge area (room 17) are now functioning properly. The flooring in room 1 has also been replaced. This has significantly improved this room. Another requirement has not yet been met. However, it is likely to be met in the near future as the new carpeting for the hallway has been purchased, all that is required is a fitting date.
Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 15 The home does have aids and adaptations to meet the needs of the residents. They are shortly to take delivery of a specific hoist to meet the needs of one particular resident. With additional equipment, safe storage is becoming more of an issue. The manager is considering how best she can resolve this difficulty. As previously highlighted a suitably qualified professional should assess the needs of residents who are prone to falling. Particularly, to ensure that they have the correct chairs and facilities available to them. The home is clean, tidy, hygienic and homely. Each room is individually furnished and decorated. The residents commented on how hard the members of staff work to keep their rooms and home clean and comfortable. Presently, the member of domestic staff is on sick leave. Consideration may need to be given to providing agency cover for this role rather than the care staff having to fulfil the role in addition to their caring responsibilities. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 16 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): 28, 29 & 30. A significantly high proportion of staff have achieved nationally recognised training awards in care. Members of staff are keen to attend training courses. Staff are recruited following robust recruitment procedures. EVIDENCE: Over 50 of the staff have achieved NVQ 2 or 3. One member of staff (who was spoken with) has recently attended dementia training, which they enjoyed and found very relevant to their role. The manager commented that she intends to encourage other members of staff to attend this training. The recruitment records of the most recently employed member of staff were reviewed and found to contain all the required documentation. The opportunities to attend training courses seem to have increased since the previous inspection. However, the manager commented that often courses are oversubscribed and members of staff have to wait up to 6 months to attend the next cycle of courses. The Registered Manager and Responsible Individual need to ensure there is sufficient access to courses so members of staff receive appropriate training when it is required. As of 1 October 2005 the home will have night staff on duty. They will no longer be staff providing a sleeping in service. This staffing change has been made to reflect the increased needs of the residents.
Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 17 Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 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 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): 33, 35 & 38. There are systems in place within this home to ensure that it is run safely and with accountability. The development of the new quality assurance review will be an important tool to ensure that the quality of care delivered is consistently good. EVIDENCE: West Berkshire Council is devising an annual review of the quality of care in all its care homes. The Responsible Individual Ms Butland is leading this. The proposal documents were seen and if implemented they will ensure that effective quality assurance and quality monitoring systems are in place. At present, the home does canvass the opinions of the residents and their relatives with regard to their satisfaction and whether they consider any improvements could be made.
Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 19 A random sample of monies being safeguarded for residents were reviewed and found to be accurately accounted for. The manager was in the process of making provision for a more secure storage facility. The majority of the members of staff have now attended most of their mandatory training with the exception of the need to attend infection control training. A significant proportion of staff still needs to attend this training; this must be addressed. Random samples of other documents to ensure that the health and safety of the residents and staff is promoted and protected by the manager were reviewed and were found to be in order. The manager acknowledged that she needed to purchase another two approved door closure mechanisms for her office and the staff room. She undertook to complete this purchase. Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 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. 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X 2 X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 21 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 OP8 Regulation 13(1) Requirement The manager must ensure that all residents receive the necessary health care treatment and advice particularly if they are at risk of falling or, have fallen and sustained injuries. Medication must be dispensed and administered safely. The manager must ensure that all staff complies with the guidance for the safe administration of medication. The Responsible Individual should also ensure compliance. Unnecessary risks to the health and safety of residents should, so far as possible, be eliminated. The correct furnishings and equipment must be provided to meet the particular needs of residents (especially those prone to falling). A suitably qualified professional should assess their needs. Once the equipment and furniture has been provided its suitability should be regularly reviewed by the said professional. No resident should be subject to physical restraint.
DS0000031280.V252236.R01.S.doc Timescale for action 31/10/05 2 OP9 13 (2) 31/10/05 3 OP22 13(4) & (7) 17/11/05 Chestnut Walk Version 5.0 Page 22 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 OP8 Good Practice Recommendations For the manager to review why residents continue to remain seated in wheelchairs (unless it is their preference) when they are visiting the communal areas of the home where alternative comfortable seating is available. The Registered Manager and the Responsible Individual, particularly in the light of the changed categories of residents who can be admitted to the home, should consider a review for the need of a dedicated Activities Assistant. The implementation of the proposed quality assurance review will be an important tool to ensure that the quality of care delivered in the home is consistently. The Responsible Individual is asked to inform the CSCI office of the implementation date. The Registered Manager is to confirm to the CSCI office that she has completed her undertaking to purchase two approved door closure mechanisms for her office and the staff room. 2 OP12 3 OP33 4 OP38 Chestnut Walk DS0000031280.V252236.R01.S.doc Version 5.0 Page 23 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.V252236.R01.S.doc Version 5.0 Page 24 - 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!
