Inspection on 16/09/05 for Chestnuts

This inspection was carried out on 16th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Chestnuts 02/04/08

Chestnuts 03/05/07

Chestnuts 14/06/06

Chestnuts 09/03/06

Chestnuts 06/01/05

Chestnuts 03/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Chestnuts 93b Wyke Road Weymouth Dorset DT4 9QS Lead Inspector Mike Dixon Unannounced 16th & 28th September 2005 10:30 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. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Chestnuts Address 93b Wyke Road, Weymouth, Dorset, DT4 9QS 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) 01305 784996 01305 780218 brian@chestnutcare.co.uk Mr Brain Stewart-Hart & Ms Anna Bodzon Ms Anna Bodzon CRH PC - Care Home Only 13 Category(ies) of OP Old age (13) registration, with number of places Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 6th January 2005 Brief Description of the Service: Chestnuts is a detached property situated in a quiet residential area approximately one mile from Weymouth town centre. The home provides care and accommodation to older people with low to moderate care needs in rooms at ground and first floor levels. There are parking spaces to the front of the house and an attractive garden to the rear of the property. The home is registered to accommodate up to 13 elderly people requiring residential care. The registered providers are Mr Brian Stewart-Hart and Ms Anna Bodzon; the registered manager is Ms Anna Bodzon. Service users accommodation is on the ground and first floors. A stair lift is fitted to the main stairs. All bedrooms are for single occupancy only. The home is not suited to the needs of severely disabled people including wheelchair users. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by the Commission as part of its regulatory duty to inspect all care homes twice a year. The purpose was to assess the home’s compliance with some of the key national minimum standards for older persons and to review the requirements and recommendations from the previous inspection report. The inspection took place over two days, lasting a total of 7.5 hours. The main part of the inspection was completed on the first day by M Dixon; on the second day, C Main, the pharmacy inspector, looked at the medication arrangements at the home. During the time spent at the home the inspectors spoke with seven service users, Mr Stewart-Hart, Ms Bodzon and three staff members. The inspectors visited all communal areas and a sample of bedrooms. They looked at the kitchen, laundry room, medication cabinet and a variety of records and documentation relating to the running of the home. What the service does well: The home is good at making newly admitted service users welcome and at helping them to settle in the first few weeks following their admission. Service users benefit from the close attention which they receive from the registered persons and staff alike. Service users are very happy with the care provision and the competence of the staff. Comments such as “everyone is nice and kind” and “they are marvellous” reflects the views expressed by service users on the day. Service users are encouraged to retain control over their own lives and to “personalise” their bedroom. There is a varied activities programme which gives the opportunity for both mental stimulation and physical exercise. Service users can receive visitors whenever they wish and their visitors are always made welcome by the staff. Service users enjoy the meals at Chestnuts. Several service users made such comments as “the food is excellent”, “the food is wonderful”. Meals are prepared from fresh ingredients and are prepared in the style of “home cooking”. The premises are well maintained, clean and entirely free of unpleasant odours. The rooms and areas that are accessed by service users provide a pleasant and comfortable environment. Bedrooms have sufficient light, they are well ventilated and stay warm in cold weather. Service users are happy with the laundry provision. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 6 The home is suitably staffed with a well-motivated group of staff. There is an open style of management at the home which encourages service users to feel confident about raising issues. They say that the registered persons are “approachable” and that the home is well run. One service user commented “everything is in apple pie order”. Staff members enjoy working at the home and receive the support which they need from the management. What has improved since the last inspection? What they could do better: The revised Statement of Purpose should be included with the Service User Guide that is located in the front hall. The documentation should be kept in a more visible place so that it is more accessible. Pre-admission assessments should be completed as fully as possible in order to ensure that the home has all the necessary information to determine the suitably of prospective service users. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 7 The format for the care plans should be revised so that the most up-to-date information is contained on the front of the sheets so that the information is readily accessible. Care plans must be updated so that they accurately reflect the current circumstances of service users. Care plans must include evidence that service users and/or their representative have been consulted regarding the content. There should be a manual handling assessment for each service user which documents what assistance service users may require when transferring. Risk assessments must be undertaken and recorded in relation to service users with a propensity to fall. The record of service users weight should be kept in a place which ensures the confidentiality of information retained. The current procedure for administering medicines must be reviewed and risk assessed. All medicines must be stored securely and the temperature of the fridge used to store medicines must be monitored daily with a maximum and minimum thermometer to ensure that the correct temperature 2 - 8°C is maintained. Some amendments should be made to the method of administering and recording medication in order to comply with good practice guidance from the Royal Pharmaceutical Society and the home’s medication policy should be expanded to include the procedure for ordering and storing medicines. The home’s Adult Protection policy must be improved to properly reflect the guidance of the Department of Health document ‘No Secrets’. Fire drills must be conducted on a six monthly basis; the degree to which service users are included in the exercise should be determined through the home’s fire risk assessment. An assessment of the premises must be undertaken by an occupational therapist or professional of similar standing. Risk assessments must be undertaken in relation to hot water outlets to wash-hand basins which fully take into consideration the individual circumstances of service users accommodated at the home. The walls of the laundry room must be readily cleanable and impervious to fluids. The home should be able to provide evidence that there is an annual development plan for the home, based on a systematic cycle of planningaction-review and that there is continuous self-monitoring with an annual audit. 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. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3 and 5 The home has information about the service provision but it is not maintained up-to-date and is not readily accessible. The information obtained about service users prior to admission is not sufficiently comprehensive to enable the home to make an informed decision about the home’s capacity to meet their care needs. New service users are made welcome at the home and are assisted to settle during the first few weeks following their admission. EVIDENCE: The registered providers have amended the home’s Statement of Purpose to include all items required by regulations. The updated version was not in the folder containing information about the home (Service User Guide) which is kept in the front hall. The folder was located under the table and was therefore not very visible or accessible. Service users with whom the inspector spoke were not aware of the existence of written information about the home; however, they knew that they could ask the registered providers if they wanted it. The registered manager carries out an assessment of prospective service users and gathers information from a range of sources. The inspector looked at two examples of completed assessments which contained most of the necessary Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 10 information. There were some gaps in the documentation, including information about medication arrangements which were of particular importance in one case; there was no signature on one of the reports. In order to demonstrate that the manager has fully considered the home’s capacity to meet the person’s care needs the assessment should be as comprehensive as feasible. A service user who had arrived at the home in the recent past was very pleased with the welcome she had received at the home and the way the staff had helped her to settle. She had visited the home prior to making the decision to move there. She is staying at the home on a trial basis during which time the home is keeping her care needs under review. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 Care plans are informative but do not consistently reflect the current circumstances of service users. The arrangements for minimising risks to service users are not sufficiently robust to fully protect them. Service users receive the health care input from external professionals which they require to help sustain their quality of life. Staff treat service users with respect and dignity, promoting service users’ feelings of worth as valued members of the household and community. Records indicated that staff administer medicines as prescribed but the home does not follow some of the Pharmaceutical Society’s guidance on the administration and control of medicines and some medicines were not stored securely for the protection of residents. EVIDENCE: All service users have a care plan which contain a lot of useful information. Care plans are reviewed each month but changes to care arrangements are not consistently reflected in the care plan. There are no risk assessments in place for service users with a propensity to fall or who have developed a pattern of falling. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 12 From discussion with the registered providers it was clear that in most cases suitable strategies had been implemented to deal with the problem. The inspector recommended referral to an occupational therapist in one case. The home does not have a written manual handling assessment for each service user which would serve to protect both service users and staff members who assist them. Service users told the inspector that staff members consulted them about the care which they received; there was no documentary evidence to support this situation (e.g. signing of the care plan). Service users were very happy with the care provision and the competence of the staff. Comments such as “everyone is nice and kind” and “they are marvellous” reflected the views expressed by service users on the day. Staff carefully monitor the health care needs of service users and refer to the primary health care team, as necessary. There is access to dental, ophthalmic and chiropody services, as necessary. Doctors call on service users when required and the community nurses visit to carry out any nursing tasks that may be required. A physiotherapist is visiting one service user on a regular basis to assist with her mobility. Service users are encouraged to take daily exercise and there is plenty of “chat” between service users and between staff and service users which helps to promote a stimulating environment. The staff approach service users in a respectful manner and carry out personal care tasks sensitively, having due regard for service users’ wishes. Service users have their own bedroom and their privacy is respected. They have the option of locking their bedroom door if they choose. They may make and receive telephone calls in private and they receive their mail unopened. This positive view of the home was confirmed both by service users on the day of the inspection and in comment cards received from service users and relatives subsequently. Staff currently make a note of service users’ weight on a chart in the bathroom where water temperatures are logged; the inspector recommended that the information be kept in a place which is more confidential. A risk assessment for one resident who self-medicates was seen. A sample of 4 MAR charts was checked with the medicines in stock and the audit trails agreed with the records. The reason for use of some medicines prescribed “when required” was not recorded on the MAR chart. When medicines were handwritten on the MAR chart they were not countersigned to confirm that the details had been checked. Five of the staff who give medicines have done a course on the safe handling of medicines and Mrs Bodzon said that others have been trained in the home and have been registered on a course. The current procedure for administration of medicines involves some re-dispensing from the monitored dose system in advance of administration, which is not recommended. From Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 13 the records checked the person who re-dispenses does not administer the medicines. The medicines policy does not include procedures for obtaining and storing medicines. There was no controlled drugs (CD) cupboard for storing CDs and some medicines were stored in an unlocked cupboard. The maximum and minimum temperature of the medicines fridge was not monitored and advice on this was provided. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 14 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 home offers a varied programme of activities, thus providing a stimulating environment for service users. The home makes visitors welcome and thereby helps service users maintain contact with the local community. The home serves appetising, nutritious and well cooked meals which meet the expectations and dietary needs of service users. EVIDENCE: The home has an activities programme information about which is displayed in the dining room. The music and movement session planned for the morning did not take place; the staff member who takes charge of activities was away on leave. A recent hat making competition which involved service users and staff provided a great deal of entertainment; photographs taken on the day leave a colourful record of the event. Trips to places of local interest occur in fine weather. Service users’ interests are recorded in their care plan and for the most part the service users with whom the inspector spoke said that they were happy with the activities that were offered. In many cases service users pursue their own routines and interests, which may include listening to music, watching TV and/or videos and reading a newspaper or a book. One visitor expressed a view through a comment card that there could be more activities for service users. Service users receive visitors whenever they wish and their visitors are always made welcome by the staff. It was evident to the inspector from speaking with Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 15 service users that friends and relatives of service users were encouraged to participate in the life of the home and to maintain contact. Information regarding visiting arrangements is contained in the statement of purpose. Service users enjoy the meals at the Chestnuts. The following comments reflect the favourable views expressed by all the service users with whom the inspector spoke: “the food is excellent”, “the food is wonderful”, “we’ve had beautiful food all week”. Meals are prepared from fresh ingredients and are prepared in the style of “home cooking”. Freshly baked cakes were in evidence in the kitchen on the day of the visit. The kitchen looked to be in a clean and well ordered condition. Account is taken of service users’ likes and dislikes and of any specific dietary needs. A choice of items is offered at breakfast and teatime; at lunchtime there is a set main course; an alternative is offered if service users do not like it. The registered provider reported that staff members had attended a nutrition course. Service users are encouraged to take their main meal at lunchtime in the dining-room but their wishes as to where they eat their meals are respected. The dining room is a light and pleasant environment in which to eat. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 16 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 and 18 The home has a complaints procedure, which enables service users and/or their representatives to address any concerns they might have. The measures in place for responding to allegations of abuse are mainly satisfactory, but do not entirely comply with guidance and therefore do not provide service users with full protection. EVIDENCE: The home has a complaints procedure, which complies with regulations and meets National Minimum Standards. The correct details of the regulatory body, the Commission for Social Care Inspection, were entered in the home’s documentation on the day of the inspection. The procedure is displayed in the front hall and reference is made to it in the home’s Statement of Purpose. Service users who spoke with the inspector indicated that they would feel comfortable about raising concerns either with staff or with the registered persons. The manager and staff have undertaken training on the topic of adult protection. The written policy/procedure has not been updated to reflect guidance and therefore does not provide staff with the correct advice on action to take in the event of an allegation of abuse. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 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 standard(s) 19-26 The premises are well maintained and clean, providing a pleasant environment for service users. Fire precaution measures are mainly robust but do not provide full protection to service users. The lack of an assessment of the premises and facilities by a trained professional means that the home is not able to demonstrate that it has all the necessary resources to meet the physical needs of service users. The bedrooms and communal rooms are furnished, heated and lit in such a way as to promote the comfort of service users. Improvements to the health and safety arrangements in the home have created a physical environment where service users are better protected from harm. Laundry facilities are sufficient to provide service users with clean clothing and linen and meet service users’ expectations. EVIDENCE: The premises are maintained in a good condition, including bedrooms, communal areas and bathrooms/WCs. The first floor bathroom currently contains extraneous items and is not ordinarily in use, although it is part of the registered accommodation. The registered providers are giving consideration Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 18 to improving the facilities in this bathroom so that it provides a more useful resource. A considerable amount of upgrading has taken place this year: the replacement of the stair lift, the fitting of radiator guards in most communal areas, and the laying of a new floor in the laundry room. Future projects will involve the replacement of some carpets in communal areas, including the rear stairway, and the completion of the upgrading of the laundry room. The registered provider undertakes measures with regard to the promotion of fire safety, including the training of staff. A fire drill has not yet been carried out, as required in previous inspection reports. There is a mermaid hoist in the ground floor bathroom and a variety of aids such as raised WC seats and grab rails to assist less mobile service users. The home’s design and lay-out is not suited to very frail service users and in recognition of this fact there are no mobile hoists or stand aids. An assessment of the premises/facilities has not yet been conducted by a qualified occupational therapist. The registered provider said that an assessment would now be arranged. Communal rooms include a large lounge, dining room, a small lounge and an additional sitting area in the front porch of the home. The rooms are comfortably furnished and lit in a domestic style. The service users are happy with the lay-out of their bedroom and the items of furniture contained within it. Bedrooms have sufficient light, they are well ventilated and stay warm in cold weather. Service users bring in their own pictures and other features of interest to “personalise” their bedroom. The home is centrally heated with radiators in all areas accessed by service users. A programme of fitting radiators to all unguarded radiators is under way and is due for completion in the short-term future; in the meantime risk assessments have been conducted to take account of the current situation. Service users said that there was always a hot water supply for them to wash or take a bath. Staff keep a record of the bath water before service users get in the bath. The water temperature to wash-hand basins is very hot and is not controlled by fail-safe devices. There are no risk assessments in place regarding this aspect. The home was clean and free of odours. Service users confirmed that their rooms were cleaned regularly. Service users also commented that their clothes and linen were laundered quickly and efficiently. The laundry room is in the process of being upgraded to bring it up to the recommended standard. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 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 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) 27,28 and 30 The stable and well-motivated staff group ensure that all duties at the home are carried out efficiently. The home is making progress in establishing a work force that is accredited with nationally recognised qualifications, in the interests of promoting service users’ quality of life. Staff receive the training which they need to meet service users’ care needs. EVIDENCE: The staff team comprises the registered provider, manager, care assistants, domestics and a chef. The registered provider and care staff carry out cooking duties in the chef’s absence. The staff are well motivated and supportive of each other. There are staff on duty in sufficient numbers to ensure that service users’ care needs can be met and to carry out all the necessary duties in the home. Ordinarily, there are two care assistants on duty throughout the day and night, supported by the registered provider and manager. Service users confirmed in discussion with the inspector that staff were always available to assist when needed. The manager reported that six of the thirteen care assistants at the home had achieved NVQ level 2 and a further two were about to commence preparation for the award. The home is now close to a position where 50 of the work force has achieved the recommended qualification level for care workers. As indicated earlier in the report, the service users have a high regard for the competency of the staff. The home now has an induction programme for new staff members which complies with National Training Organisation specifications; two care assistants Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 20 attended an external induction course earlier in the year. Two staff members informed the inspector about the training which they had received. Where a need is identified the manager arranges for training sessions to take place, e.g. a session regarding Parkinsons Disease is about to occur. The individual training needs of staff members are considered at their annual appraisal. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 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 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 33 There is an open style of management at the home which enables service users and staff members alike to participate in decision-making. The registered persons keep the service provision under review and thereby promote the interests of service users. EVIDENCE: The inspector spoke with seven service users and three staff members who indicated that the registered persons were approachable and that they would feel comfortable raising issues/problems should they arise. One service user commented: “Anna and Brian will do anything for you”. Service users are consulted about arrangements that affect their daily lives such as food preferences and activities. Staff consider that they receive sufficient support from the manager and have the opportunity to exchange ideas both informally and in staff meetings. The registered persons carried out a survey of service users’ views earlier in the summer. The results have been analysed and give a very positive view of Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 22 the home. Action has been taken on the minor points raised by the survey. The intention is to do a similar exercise for visitors to the home. The registered persons are in daily contact with the home and monitor the home’s progress in meeting its aims and objectives in an informal manner. There is no written annual development plan; through observation and discussion with the registered persons it was clear that thought was given to the future well-being of service users and the home. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 4 COMPLAINTS AND PROTECTION 2 3 2 2 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x 3 2 x x x x x Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 24 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 7 Regulation 15(2) Requirement Care plans must be updated so that they accurately reflect the current circumstances of service users. Risk assessments must be undertaken and recorded in relation to service users with a propensity to fall. They must be kept under review and updated accordingly. Care plans must include evidence that service users and/or their representative have been consulted regarding the content. Where this has not been possible to achieve or where the persons concerned do not wish to be involved, a note to this effect should be made in the record. The current procedure for administering medicines must be reviewed and risk assessed. All medicines must be stored securely and the temperature of the fridge used to store medicines must be monitored daily with a maximum and minimum thermometer to ensure that the correct temperature 2 8°C is maintained. Timescale for action 30/11/05 2. 7 13(4) 30/11/05 3. 7 15(1) 31/12/05 4. 5. 9 9 13(2) 13(2) 30/11/05 30/11/05 Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 25 6. 18 13(6) 7. 19 23(3) 8. 22 23(2) 9. 25 13(4) 10. 26 13(3) The homes Adult Protection policy must be improved to properly reflect the guidance of the Department of Health document ‘No Secrets’; in particular there must be clear information regarding the importance of proper reporting and investigation of suspected, (not only alleged) abuse. Previous timescale of 28/2/05 not met. Fire drills must be conducted on a six monthly basis. The degree to which service users are included in the exercise should be determined through the home’s fire risk assessment. This requirenment has been amended to reflect that it has been partially me; previous timescales not met, most recently 28/2/05 An assessment of the premises must be undertaken by an occupational therapist or professional of similar standing. Previous timescales not met, most recently 31/5/05 Risk assessments must be undertaken in relation to hot water outlets to wash-hand basins which fully take into consideration the individual circumstances of service users accommodated at the home. Previous timescale of 15/2/05 not met. The walls of the laundry room must be readily cleanable and impervious to fluids. This requirement has been amended to reflect that it has been partially met; previous timescales not met, most recently 31/5/05. 31/10/05 31/10/05 31/10/05 31/10/05 31/12/05 11. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 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. Refer to Standard 1 Good Practice Recommendations The revised Statement of Purpose should be included with the Service User Guide that is located in the front hall. The documentation should be kept in a more visible place so that it is more accessible. Pre-admission assessments should be completed as fully as possible in order to ensure that the home has all the necessary information to determine the suitably of prospective service users. All reports should be signed by the person completing the report. The format for the care plans should be revised so that the most up-to-date information is contained on the front of the sheets so that the information is readily accessible. A new care plan should be drawn up where there have been a large number of amendments to ensure that the content is clearly visible. There should be a manual handling assessment for each service user which documents what assistance service users may require when transferring. The home should follow guidance from the Pharmaceutical Society on the administration and Control of Medicines as follows: § Medication should never be removed from the original container until the time of administration; it should never be secondary dispensed for someone else to administer. § The reason for use of “when required” medicines should be included on the MAR chart. § When medicines are handwritten on the MAR chart a second competent person should check the details are accurate and countersign. § The medicines policy should include a procedure for ordering and storing medicines. § The home should have a cupboard that complies with the Misuse of Drugs (Safe Custody) Regulations 1973 for storing Controlled Drugs (CDs). The record of service users weight should be kept in a place which ensures the confidentiality of information retained. D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 27 2. 3 3. 7 4. 5. 7 9 6. 10 Chestnuts 7. 33 The home should be able to provide evidence that there is an annual development plan for the home, based on a systematic cycle of planning-action-review and that there is continuous self-monitoring with an annual audit. This recommendation is made for the fourth time. 8. 9. 10. 11. Chestnuts D55 S26781 Chestnuts V248624 160905 Stage 4.doc Version 1.40 Page 28 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole Dorset, BH17 0NF 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. 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