CARE HOMES FOR OLDER PEOPLE
Chestnuts 93b Wyke Road Weymouth Dorset DT4 9QS Lead Inspector
Mike Dixon Unannounced Inspection 9th March 2006 11:00 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 Chestnuts DS0000026781.V286147.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. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Chestnuts Address 93b Wyke Road Weymouth Dorset DT4 9QS 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) 01305 784996 01305 780218 Mr Brian Stewart-Hart Ms Anna Bodzon Ms Anna Bodzon Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th September 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 a maximum of 13 older people with low to moderate care needs. 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. There are parking spaces to the front of the house and an attractive garden to the rear of the property. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted as part of the Commission’s regulatory duty to inspect all care homes twice a year. The purpose was to review the home’s progress in implementing the requirements and recommendations from the previous inspection report. The purpose was also to assess the home’s compliance with the remaining key national minimum standards for older persons that had not been considered during the previous inspection visit. In order to obtain a fuller picture of the home the reader should refer to the earlier inspection report dated 16 September 2005. During the visit which lasted five hours the inspector spoke with six service users, Mr Stewart-Hart, Ms Bodzon and one staff member. He looked round the accommodation, observed practice and inspected records relating to service users’ care, staff recruitment, medication, health and safety and other documentation relating to the running of the home. What the service does well:
Service users confirmed to the inspector that they were well looked after by the staff who respected their privacy and dignity. Service users have confidence in the competence of the staff and they are able to come and go as they please. Staff are quick to respond when their help is needed. The following comments reflect the positive views expressed by service users to the inspector: • • • The staff are marvellous The staff are very good and thoughtful You can do as you please. Service users were wearing well-laundered clothes, their rooms were clean and well maintained. Staff were observed going about their duties with a cheerful disposition and approaching service users in a friendly and helpful manner. There is good liaison between the home and the primary health care team. Doctors and community nurses visit, when needed, to assess service users’ health care needs and to provide treatment. Service users retain control over their own lives and they are able to come and go as they please. They may bring in items of furniture, pictures and ornaments in order to “personalise” their bedroom and arrange their room as they wish. The registered providers and manager are experienced at running care homes. The manager, Ms Bodzon, keeps abreast of care-related matters by periodically
Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 6 attending courses. Some aspects of health and safety are well attended to, including the carrying out of an audit of accidents, the servicing of equipment and the training of staff. What has improved since the last inspection? What they could do better:
There are eleven requirements and six recommendations arising from this inspection, including those which have been brought forward from the last inspection report. It is a matter of concern that some requirements have been made on repeated occasions. Where failure to meet requirements has a detrimental effect on the health and safety of service users, consideration will be given to enforcement action if requirements are not met within the revised timescales set. These matters will be reviewed at the next inspection. 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. Care plans must include evidence that service users and/or their representative have been consulted regarding the content. A care plan must be drawn up within five days, following the admission of a service user on an emergency basis. 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.
Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 7 The current procedure for administering medicines must be reviewed and risk assessed. 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. 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 work to the laundry room should be completed so that the walls are readily cleanable and impervious to liquids. The registered persons must not employ a person to work at the home until all the necessary checks have been completed. The registered manager should attain NVQ level 4 in care. There must be a written health and safety policy which is available for staff to read at all times. Cleaning materials which pose a hazard to health must be stored securely. Night staff must receive fire instruction at quarterly intervals. The registered person must ensure that the home complies with the relevant regulations with respect to the servicing and inspection arrangements for the lifting equipment, i.e. the stair lift and the bath hoist. 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 DS0000026781.V286147.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 Chestnuts DS0000026781.V286147.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): None of these standards were considered during the inspection. EVIDENCE: Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 10 Where care plans are in place they provide useful information to staff but they do not demonstrate that there has been consultation with service users regarding the content. Whilst risk assessments have improved they are not sufficiently comprehensive to give sufficient protection to service users. Service users are treated with respect and their right to privacy is safeguarded. EVIDENCE: The inspector looked at the care records for four service users. There was no care plan for one service user who had been admitted to the home on an emergency basis three weeks earlier. Information concerning her health and care needs was recorded on file. Other care plans for service users were being maintained up to date, with regular evaluations/reviews. None of the care plans seen by the inspector gave an indication of consultation with service users regarding the content of the care plan. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 11 The home is now making use of the multi-agency guidelines for the prevention and management of falls and work has been done on risk assessments. There are still shortfalls with the recording of risk assessments which do not clearly set out the action to be taken to minimise the risk or how the matter in question is to be monitored. In the case of one service user who had been admitted from hospital where it was established that there was a history of falls, no reference to any risk of falls was mentioned in the care records until six weeks after she had been admitted to the home. The problem is primarily a lack of suitable documentation; it was evident from talking with the manager and from looking at the records that due consideration had been given to meeting the service user’s care needs. It was also evident that there was good liaison between the home and the primary health care team. Doctors and community nurses visit, when needed, to assess service users’ health care needs and to provide treatment. In discussion with the inspector, service users confirmed that they were well looked after by the staff who respected their privacy and dignity. Service users have confidence in the competence of the staff and they are able to come and go as they please. Staff are quick to respond when their help is needed. The following comments reflect the positive views expressed by service users to the inspector: • • • The staff are marvellous The staff are very good and thoughtful You can do as you please. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 The home encourages service users to pursue their interests and preferred lifestyle where feasible, enabling them to retain some measure of control over their lives. EVIDENCE: Service users choose how and where they spend their time, in their bedroom or in one of the lounges. They can come and go as they choose and they retain control over their own lives as much as is feasible, pursuing their own interests. They may bring in items of furniture, pictures and ornaments in order to “personalise” their bedroom and arrange their room as they wish. All service users have either a relative or a friend who remains in contact with them and at present no one has a need for an external advocate. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 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): None of these standards were considered during the inspection. EVIDENCE: Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 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): None of these standards were considered during the inspection. EVIDENCE: Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 15 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): 29 The home does not carry out all the necessary checks on prospective staff members and therefore potentially puts service users at risk. EVIDENCE: The home has appointed one new staff member since the previous inspection. Some of the necessary measures had been taken prior to the appointment but the home had not conducted a police and POVA check via the Criminal Records Bureau or taken up two references. These checks were conducted subsequently. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 16 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, 35 and 38 The registered manager is experienced and has some relevant qualifications which demonstrate her commitment to running the home in the best interests of the service users. The home has the necessary arrangements in place to safeguard service users’ financial interests. Service users’ welfare is not fully protected as a consequence of shortfalls with some aspects of the management of health and safety. EVIDENCE: Both Mr Stewart-Hall, registered provider, and Ms Bodzon, joint registered provider and registered manager, have several years experience of running a care home for older persons. Ms Bodzon has completed the registered manager’s award. She has yet to undertake a care qualification that equates to NVQ level 4. She is an NVQ assessor and she keeps up-to-date with
Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 17 training courses that relate to operating a care home and to the care of older persons. All service users have a relative or other representative to assist them with their finances, where necessary. The home has no formal involvement with service users’ financial affairs. Small amounts of cash are held on behalf of a few service users; records are made of transactions and receipts are kept when purchases are made on behalf of service users. The home keeps a record of all accidents and a detailed audit of accidents has been completed for the period 2/7/05-24/2/06. The manager has obtained information and a format for the carrying out of risk assessments and has begun work on the topic. A risk assessment has not yet been conducted in respect of hot water outlets to wash-hand basins, a matter which has been outstanding for a year now. The programme of fitting guards to radiators in communal areas has been completed and this has made an important contribution to the safety of the environment. The servicing of the fire precaution system and the gas boiler/central heating system is carried out on a regular basis. The stair lift has been installed relatively recently and has not yet been serviced. There is no servicing arrangement for the bath hoist, although it is checked by a Company representative in the event of a problem occurring. The fire officer has made a requirement that the home produce an up-to-date fire risk assessment. Fire instruction to night staff is now overdue. Staff receive training in topics that relate to health and safety. The home’s health and safety policy was not available for inspection. Other policies/procedures, e.g. regarding infection control and the safe-keeping of cleaning materials and other chemicals (COSHH) were in place. A bottle of bleach was located in the first floor bathroom; although this room is not currently in use as a bathroom cleaning materials that may be detrimental to health should be stored safely. Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 x x 1 Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13(4) Requirement 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. This requirement has been partially addressed; previous timescale of 30/11/05 not met. 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. Previous timescale of 31/12/05 not met. A care plan must be drawn up within five days, following the admission of a service user on an emergency basis. The current procedure for administering medicines must be
DS0000026781.V286147.R01.S.doc Timescale for action 30/04/06 2. OP7 15(1) 31/05/06 3. OP7 15(1) 31/03/06 4. OP9 13(2) 31/03/06 Chestnuts Version 5.1 Page 20 reviewed and risk assessed. Previous timescale of 30/11/05 not met. An assessment of the premises must be undertaken by an occupational therapist or professional of similar standing. Previous timescales not met, most recently 31/10/05. 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 timescales not met, most recently 31/10/05. The registered persons must not employ a person to work at the home until a POVA FIRST check has been completed, two satisfactory references have been received and suitable supervisory arrangements for the person in question have been implemented. There must be a written health and safety policy which is available for staff to read at all times. Cleaning materials which pose a hazard to health must be stored securely, in accordance with the homes’ own policy relating to COSHH. Night staff must receive fire instruction at quarterly intervals. The registered person must ensure that the home complies with the relevant regulations with respect to the servicing and inspection arrangements for the lifting equipment, i.e. the stair lift and the bath hoist.
DS0000026781.V286147.R01.S.doc 5. OP22 23(2) 30/09/06 6. OP25 13(4) 30/04/06 7. OP27 19(1)(5) 15/03/06 8. OP38 13(4) 30/04/06 9. OP38 13(4) 31/03/06 10. 11. OP38 OP38 23(4) 13(4) 30/04/06 31/05/06 Chestnuts Version 5.1 Page 21 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 OP1 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. This recommendation is made for the second time. There should be a manual handling assessment for each service user which documents what assistance service users may require when transferring. This recommendation is made for the second time. 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). This recommendation is made for the second time. The work to the laundry room should be completed so that the walls are readily cleanable and impervious to liquids. The registered manager should attain NVQ level 4 in care. 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 fifth time.
Chestnuts DS0000026781.V286147.R01.S.doc Version 5.1 Page 22 2. OP7 3. OP9 4. 5. 6. OP26 OP31 OP33 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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