Inspection on 11/05/06 for Chestnuts Nursing & Residential Care Home (The)

This inspection was carried out on 11th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Chestnuts Nursing & Residential... 09/10/07

Chestnuts Nursing & Residential... 17/01/07

Chestnuts Nursing & Residential... 21/02/06

Chestnuts Nursing & Residential... 22/08/05

Chestnuts Nursing & Residential... 01/02/05

Chestnuts Nursing & Residential... 23/07/04

Chestnuts Nursing & Residential... 14/01/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

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

CARE HOMES FOR OLDER PEOPLE Chestnuts Nursing & Residential Care Home (The) 63 Cambridge Park Wanstead London E11 2PR Lead Inspector Ms Gwen Lording Unannounced Inspection 11th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.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 Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chestnuts Nursing & Residential Care Home (The) 63 Cambridge Park Wanstead London E11 2PR Address 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) 0208 989 3519 0208 530 6211 thechestnutscarehome@yahoo.co.uk Ms Avril Stein Louise Hulme Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (45), Physical disability (6) of places Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service can only admit people in the category of PD (Physical disability) who are 55 years of age and above. 21st February 2006 Date of last inspection Brief Description of the Service: The Chestnuts is a care home registered to provide accommodation with personal care and nursing for up to fifty-one residents, including six places for residents over 55 years who have a physical disability. The registered provider is the sole proprietor. The large property is situated in its own grounds with a large secluded garden to the rear. The majority of rooms are single and all have en suite facilities. There are two passenger lifts, with access to all floors. The home is set well back on a busy main road in Wanstead, in the London Borough of Redbridge. The home is well served by public transport and close to shops and other local amenities. On the day of the inspection the range of fees for the home was between £426.00 and £790.00 per week. A copy of the Statement of Purpose and Service User Guide to the home is made available to both the resident and the family. There is a copy of the guide in each bedroom and is also provided on request. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 10.00 am. It took place over seven and a half hours during the late morning and afternoon. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The registered manager was available throughout the visit to aid the inspection process. This was a key inspection visit in the inspection programme for 2006/2007. Discussion took place with the registered manager, several members of nursing and care staff, the head cook, maintenance and administrative staff. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. The inspectors spoke to a number of residents and relatives. Where possible residents were asked to give their views on the service and their experience of living in the home. All parts of the home were visited and a number of staff, care and home records were looked at. An Immediate Requirement Notice was issued for action to be taken to address an urgent maintenance issue to a bath in a downstairs bathroom, which posed a health and safety hazard for both residents and staff. The Commission is aware of an adult protection matter that is subject to ongoing investigation. The registered persons are working co-operatively with the Commission and the local authority to address this matter. As part of this investigation one of the placing authorities will be undertaking reviews of all residents they currently have responsibility for. As part of the inspection process there was consultation with representatives of the London Borough of Redbridge, Commissioning Authority and representatives of the Primary Care Trust (PCT). They currently have no specific concerns about the care of residents they are involved with, apart from the ongoing adult protection issue. Consultation with a senior nurse from Newham PCT, who has recently undertaken a continuing care nursing assessment on a resident in the home, has expressed serious concerns about the quality of nursing care being provided in the home and the competencies of the nursing staff. Correspondence has been sent to the home, with a copy to the Commission, detailing the required action to be taken. A large number of requirements made at the last inspection have not been met and have therefore been restated in this report with a new timescale for action. Unmet requirements impact on the welfare and safety of service users. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 6 Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. The inspectors would like to thank the staff and residents for their input and assistance during the inspection. What the service does well: What has improved since the last inspection? What they could do better: There are ten outstanding requirements from the last inspection, which have not been complied with. These unmet requirements have been restated with a revised timescale for action which must be complied with. In addition a further seven requirements have been made following this visit. A number of serious concerns were discussed with the manager and these must be addressed by the registered persons as a matter of urgency. From observation throughout the inspection and from discussions with the manager it was evident that the home is not being run in the best interests of residents. The current deployment, competence and number of staff available is not sufficient to meet the high dependency levels and complex nursing needs of residents being accommodated in the home. The Commission cannot be confident that all staff have the training and competence to meet all residents needs. Generally the standard of care plans viewed was very poor and there was little evidence to show that residents’ individual needs were being met on a day-today basis. Nutritional screening must be undertaken for all residents on admission, and thereafter on a regular basis. Any weight gain or loss must be recorded with appropriate action being taken and recorded. Nursing staff are still not complying with correct procedure in relation to the administration, recording and management of medication. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 7 The management of the care home is a joint responsibility between the registered persons to carry on the home with care, competence and skill. 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 Nursing & Residential Care Home (The) DS0000025950.V294530.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 Nursing & Residential Care Home (The) DS0000025950.V294530.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): Standards 1, 2, 3 and 4 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide is made available to all residents and their relatives. Whilst privately funded residents have a statement of terms and conditions, residents funded by a local authority are not always provided with such details. This means that neither residents nor their relatives are given clear documentation as to the terms and conditions of placement at The Chestnuts. Appropriate assessments are undertaken prior to admission to the home, and care plans are drawn up from some of the information in this assessment. However, this does not mean that all residents, and their relatives/ representatives can be sure that all their needs will be met by the home. The home does not offer intermediate care. EVIDENCE: Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 10 Although there was no evidence on the residents’ files inspected, following discussions with the manager it was apparent that prospective residents and/ or their relatives are provided with a copy of the statement of purpose prior to admission to the home. A welcome pack is also placed in each bedroom and this contains a copy of the service users guide. The manager must record on each service user’s file that such information has been given to him/ her or their relatives. Several files were viewed and whilst those residents who are privately purchasing their care are given a statement of terms and conditions at the point of moving into the home, this does not appear to be the case for those residents who are being supported by a local authority. There is either an umbrella contract between the local authority and the provider, or there is an individual contract, specific to a resident, between the local authority and the provider. This was discussed with the manager who must ensure that each resident and/ or their relative are given a statement of terms and conditions at the point of moving into the home, and that this is signed by all parties and a copy is retained on the resident’s file. It is essential that the provider ensures that residents are given clear documentation as to the terms and conditions of placement at The Chestnuts. A total of ten residents files were examined; and included people who had been resident in the home for some years and people who had been admitted to the home more recently. A full assessment of need is undertaken prior to a resident moving into the home. Some of the information had been used to continue assessment once the resident moved into the home, and to develop written care plans, but the Inspectors were not able to evidence this in all files case tracked. The day-to-day practice in relation to the care plans is commented on in the next section of the report, Health and Personal Care. The evidence to support Judgement 2 is also detailed in the next section of the report, Health and Personal Care. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in an individual plan of care, but this does not mean that these needs are met on a day-to-day basis. Nursing staff are still not fully complying with correct procedure in relation to the administration, recording and management of medication. This has the potential to result in residents being put at risk. EVIDENCE: The Inspectors case tracked the residents who were the subject of the most recent Regulation 37 notifications sent to the Commission by the home. Therefore the care plans and related health documentation of 10 residents was case tracked. The style of care planning documentation used in the home is a standardised format, which then needs to be individualised to address the specific elements of an individuals care. However, from the case tracking undertaken there was Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 12 evidence to show that this is not happening for all residents. For example, there may be a standard sentence “to meet personal hygiene needs” but there are no specific details as to what these needs are for the individual and how they will be met. Generally the standard of care plans viewed was very poor. Needs were being identified but from reviews and daily records there was often little evidence of how the identified needs had been or were being met. Entries in daily recordings did not always relate to the specific care plans and entries made gave very little indication of the actual care being given. Comments made included: “Satisfactory day. Due care given”. Met her needs and care. All due care”. The following examples were highlighted and discussed with the manager: • Several residents were identified as having a catheter in situ, but there was no catheter care plan for one resident and only one entry that a catheter flush had been done. For another resident the catheter care plan was neither accurate nor up to date. Two residents were identified with pressure sores but there were no wound care management plans. In one instance a resident had been identified with a grade 1 pressure sore and there was no further reference to this in daily records. One resident had been identified as having a non-isolated infection but although there was a care plan, there was no evidence that this was being complied with by staff. Although residents were being weighed on a regular monthly basis there were no nutritional care plans, and whilst monthly weights were being recorded there was no evidence that any variations in weight were being acted upon. For example, one record showed the weight of a resident in March 2006 as being 68kgs, and in April 2006 as being 54kgs. There was no evidence that such a major weight loss had been questioned, or that a referral had been made to a dietician or a nutritionist, or that the weighing equipment had been checked for any possible malfunction. Weight variations were evidenced when case tracking other residents and again there was no records to show that any action to be taken, had been identified. Appropriate aids such as a hearing aid had been mentioned on the initial assessment, but there was no specific care plan to ensure that the hearing aid was fitted each morning, regularly checked to ensure that it was clean and that the battery was still in working order. • • • • Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 13 Whilst touring the home two residents who were visited in their bedrooms had drinks left for them, which were out of their reach. Another resident’s spectacles were also not within her reach but if they had she could not have seen through the lenses since these were extremely dirty. The alarm call was also situated beyond her reach. There are policies and procedures for the handling and recording of medications. An audit was undertaken of the management of medications within the home and a random sample of Medication Administration Record (MAR) charts were examined. The following issues were discussed with the manager and the nurses in charge on the day of the visit: • • • • • Insulin in current usage was being stored in the medicine fridge and not at room temperature in line with directions and the product license. A number of cartons of nutritional supplement drinks being stored in the treatment room, had exceeded their use by date. Hand written entries on MAR sheets must be signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP, registered nurse. When directions for administering medications are variable e.g. one or two tablets, then the dose give is to be entered on the MAR chart. There were a number of unexplained omissions on the MAR charts. A number of fluid intake/ output charts and turning/ positioning charts were examined. This included recordings for the day of the visit and the preceding two days. At 14.25 hrs on the day of the visit the last recorded entry on some charts was 09.00h hrs. On examination of charts from the preceding day there were significant gaps in the recording of fluid intake e.g. 13.00 hrs and the next recording being 09:00 hrs the following day. Another fluid chart recorded 20:00 hrs and the next recording being 09:00 hrs the following day. For some residents this may indicate that fluids had not been given for a period of some twenty hours and thirteen hours respectively. This concern was raised with the nursing staff and they indicated that the completion of these charts was the responsibility of the care staff. If the recordings of fluid intake are indicated for a resident then this must be considered a clinical record and must be monitored by nursing staff. It is essential that all monitoring records for individual residents are maintained accurately and up to date. Discussion with staff suggested that residents were receiving fluids but that staff were failing to record this on each occasion. The Inspector also observed fluids being given to residents during the inspection. It would be very difficult to confirm that residents are always treated with respect since the inspectors observed very little interaction between staff and residents. One resident was noted by an inspector to be continually rubbing one of her eyes which appeared extremely sore, but although there were three Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 14 care staff sitting in the lounge not one of them appeared to notice this. This was discussed with the manager. There was no evidence on files to confirm that neither residents nor their relatives had been consulted with regard to end of life matters. During a tour of the home approximately five residents were in bed, and these residents appeared to be very poorly. However, the inspectors were not able to observe staff attending to the needs of such residents since the care staff appeared to remain within the lounges generally just sitting watching residents, and nursing staff were not generally in evidence. Also the residents did not always appear to be well groomed, and some male residents were observed to be unshaven. On the day of the inspection the external temperature was approximately 24 degrees centigrade, but in the home it seemed even hotter. There were no working thermometers available to gauge the actual temperature within the home. However, the heating was on and very few fans were in use although more were available but were not being used by staff for the benefit of the residents. The inspectors were able to talk with visiting relatives who also commented on how hot the bedrooms were, and had asked for a jug of water to be provided for the service user they were visiting. This was discussed with the manager who was also advised to ensure that there was a “heat wave contingency plan” in situ for a possible hot summer, and that this was complied with by all staff members. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 15 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): Standards 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle matches the expectations and preferences of some residents, but others need support to exercise choice and control over their lives within their individual capabilities. The meals in the home are good, offering both choice and variety for residents living in the home. EVIDENCE: Through observation, and discussion with some residents and the manager, the inspectors were able to evidence that residents do have individual care plans around activities. Some of these activities are individual and some small group activities. However, it would seem that the activities are left mainly to the remit of the two activity co-ordinators and that care staff do not really participate and continue these activities when the co-ordinators are absent. Privately purchased massage is available from an external provider and some residents do take advantage of this. There is a new occupational therapy Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 16 service being offered by an external provider and the registered person is currently endeavouring to identify funding for this provision. Residents are able to maintain contact with their family and friends but it was not evident that residents are involved in local community groups or that such groups visit the care home. Following discussions with the manager, some residents and observations by the inspectors, it was not evident that residents are helped to exercise choice and control over their lives in all aspects. As previously stated the majority of residents are washed and dressed in the mornings and taken to one of the lounges. Generally this is where they stay for the main part of the day. Occasionally one or two may be taken out into the garden for activities with a larger group of residents. They do not appear to be given the choice as to whether or when they rise in the mornings, or where to have breakfast, that is in their bedrooms or in the lounge or the small dining areas. From discussions with the cook, from a visit to the kitchen, viewing menus and conversations with some residents, the inspector was satisfied that the residents receive a varied, appealing, wholesome and nutritious diet, which is suited to individual requirements. Fruit platters are prepared and on the day of the inspection fresh melon was one of the items available for supper. However, although the menus appear to be wholesome and nutritious this cannot be evidenced through the care plans since nutritional screening and monitoring is not taking place. The majority of residents receive their meals in the lounge areas whilst remaining sitting in the same chair with a small tray table in front of them. There are two small dining areas one of which is the garden room, which appears not to be used as a dining area. It is essential that the manager review the provision for the taking of meals to ensure that residents are given real choice as to where they take their meals, and that these are taken in congenial settings. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 17 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): Standards 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a complaint policy/ procedure however, not all residents would have the capacity to use a formal process. Not all complaints or expressions of concern or dissatisfaction with the service are currently being recorded. This means that residents and relatives cannot be confident that their complaints are being listened to or acted upon. EVIDENCE: The home’s complaint record was examined and since the last inspection only two written complaints had been recorded with the action taken. The Inspectors discussed with the manager as to what constituted a “complaint” to be logged, as it would appear that neither verbal complaints nor concerns are being recorded in the complaints book. All complaints made whether, written or verbal via telephone or face-to-face, or expressions of concern or dissatisfaction with any element of the service must be recorded. Unless all concerns or complaints, however made, are accurately recorded together with the action taken, the manager will not be able to ensure that residents, relatives and friends will be confident that they will be listened to and taken seriously. Concerns/ complaints/ compliment monitoring should form part of the quality assurance systems of the home to ensure that the needs of residents are being met. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 18 Since the last inspection new staff have been recruited, but there was no evidence that such staff had received training in adult protection as part of their induction training. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 19 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): Standards 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. Generally the home was clean, but the environment does not always meet the residents’ needs and does not provide people living in the home with a safe or well-maintained environment. EVIDENCE: A tour of the premises was undertaken by both Inspectors at the start of the visit and individually throughout the visit. There were no offensive odours in the home. Generally the home was clean and cleaning was being undertaken on the carpet in the Princess Diana dining room (which is not actually used as a dining room). However, the décor looked quite “tired” in some areas with chipped paint and marked walls. Although the bedrooms had been personalised some of these needed some maintenance and carpets that needed cleaning. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 20 During the tour of the premises the inspectors noted several fire doors being propped open with fire extinguisher; fire extinguishers obscured by either artificial plant/ flower arrangements or equipment such as hoists or fans; and fire exit signage was not clear and apparent on all corridors and exits. There is a balcony to the front of the home but this was not being used on the day of the inspection even though it was hot and quite a pleasant day. The majority of the residents were left sitting in the various lounges. Two or three residents were sitting in the rear garden with a member of staff. The rear garden has been laid out as a sensory garden but again there was no evidence that residents were being encouraged to use this as a sensory garden. Two small ponds contained stagnant water and the fountains were not in use. This is a health hazard and will encourage flies and mosquitoes. The laundry area is to the rear if the sensory garden and at the time of the inspection a washing machine had broken and was being repaired. However, there was laundry both inside and outside the laundry room because of the small floor area of the laundry. On either side of the laundry room was discarded items of equipment such as window frames and other rubbish. It was noted that hoists, wheelchairs and other sundry items of equipment were being stored in bathrooms. An Immediate Requirement Notice was issued with regard to the bath in Bathroom “B”. The bath was free standing and fixed by plumbing only. The bath had no floor or wall fixtures and could be easily moved from side to side. This was considered a health and safety hazard for both residents and staff. As previously stated in this report, although the external temperature was approximately 24 degrees centigrade, the internal temperature felt much higher and the heating was on in the home. It is apparent that the majority of residents would not be able to independently control the temperature in either their bedroom or the communal areas due to their frailty, and staff appeared to be unaware, or made no effort to ensure that the temperature was controlled to a level tolerable to residents. The kitchen was very clean, food in the refrigerators was in date order and clearly labelled, as were the dry goods and fresh foods. The Inspector had no concerns with regard to the management of the kitchen. Sanitizers were located in each bedroom and these were filled with the necessary liquid. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 21 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): Standards 27, 28, 29 and 30 Quality in this outcome is poor. This judgement has been made using available evidence including a visit to this service. The current deployment, competence and number of staff available is not sufficient to meet the high dependency levels and complex nursing needs of residents being accommodated in the home. The Commission cannot be confident that all staff have the training and competence to meet all residents needs. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: During the inspection staff were generally observed sitting in the lounges “watching” residents but with no activity or interaction taking place other than assisting residents to the toilet and assisting with feeding when necessary. Nursing staff were not in evidence either in the lounges, nor in individual bedrooms, nor supervising care staff. Those residents who remained in their bedrooms appeared to receive very little supervision. Evidence to support this has been included elsewhere in this report. Health and personal care needs were discussed with both nursing and care staff, and some staff were observed carrying out their duties during the visit. A number of concerns around training and the competency of staff in the Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 22 provision of health and personal care to residents were discussed directly with the manager. These concerns have already been detailed in this report. (See Standards 7-11 Health and Personal Care) The registered persons must ensure that staff individually and collectively, have the required skills, experience and training to deliver the service and care which the home offers to provide. From reviewing Regulation 37 notifications it is apparent that there is a significant incidence of residents sustaining injuries through unobserved falls, for example in their bedrooms. In addition there is a high incidence of residents being re-admitted to hospital, sometimes within one to two weeks of admission to the home. This would indicate that either the deployment of all staff, both care and nursing, or staffing levels must be urgently reviewed. The manager stated that approximately 48 of care staff are qualified to NVQ level 2 or above. However, an additional 9 members of care staff are currently working towards this qualification. An examination of the files of four staff employed since the last inspection, showed that the home is undertaking necessary checks to ensure the protection of residents. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 23 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): Standards 31, 32, 33, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst there is a qualified manager who is registered with the Commission, she appears to still have no day-to-day authority to increase staffing levels according to changing needs of residents. Nor does she appear to have the authority to commit expenditure for the maintenance of fixtures and fittings, to ensure the care and protection of residents. Although the manager has a clear vision in which she wishes the home to develop, currently this does not appear to have been embraced positively by either the nursing or care staff. This is to the detriment of residents and staff and is inhibiting the progression of the standard of care. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 24 EVIDENCE: Since the last inspection the only progress appears to be that the manager has now been allocated the staff training room as an office. However, privacy is still an issue, as other staff require access to a storeroom situated to the rear of this office. There was no clear indication of where staff training would now take place. The manager has still not been equipped with a working budget and all expenditure has to be agreed with either the finance director or the proprietor. Through observation throughout the inspection and from discussions with the manager it is evident that the home is not being run in the best interests of residents. For example, the home appears to operate for the benefit of staff routines and staffing levels and not for the benefit of residents. The manager stated that an additional member of staff is now employed for one and a half hours in the morning, following the night shift, to exclusively sit in the large first floor lounge to observe residents whilst other staff are still engaged in getting residents up. Very few residents appear to be given the option to exercise choice as to the time they are got up in the morning or to have breakfast in their room. During discussions with the manager she was clear that she had given instructions for certain residents to be left in bed until later in the day but these instructions had not been carried out by nurses and care staff. This was also evidenced through case tracking, as some residents appeared to be quite poorly and were sitting uncomfortably in chairs in the lounges. Staff were not visible in the home other than in the lounges and when meals where being served. From Regulation 37 notifications sent to the Commission and case tracking individuals during the visit, it was evident that recent admissions have been to the higher end of dependency levels with complex nursing needs but there has been no corresponding increase in either nursing or care staff. The manager is responsible under the Care Homes Regulations to ensure that the assessed needs of all residents are met at all times. Following a recent adult protection investigation members of the strategy meeting had commented positively on the manner in which the manager had dealt with the situation and actively addressed concerns and areas highlighted for action. This is an indication that demonstrates that when the manager is enabled to discharge her responsibilities she does so competently and in an effective way. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 25 The registered manager must be allowed to communicate a clear sense of direction and leadership, which staff understand and are able to relate to the aims and purpose of the home. A wide range of records were looked at, including fire safety, portable appliance testing, accident/ incident records, lift testing/ maintenance, and gas certificates. These records were detailed, up to date and accurate. Residents meetings are held regularly and there has been some discussion around arranging meetings for relatives. The home is also in the process of sending out satisfaction questionnaires to residents and relatives. A newsletter is produced and provided to residents and their families on a regular basis. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 26 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 2 2 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 1 2 X 3 1 2 STAFFING Standard No Score 27 1 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X 2 2 1 Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 27 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 OP14 Regulation 12 Requirement The registered persons must conduct the home as to maximise residents’ individual capacity to exercise personal choice. Any such decisions made to limit this must be based on a risk assessment of the individual’s vulnerability with evidence of regular reviews. (Timescales of 31/03/05 and 30/09/05 and 31/03/06 not met) Suitable provision must be made for the appropriate storage of aids and other equipment. (Timescale of 30/09/05 and 31/03/06 not met) All staff must implement an individual’s specific plan of care to ensure the resident receives a consistent quality of care.(Timescale of 31/03/06 not met) All aids to hearing and seeing must be managed so as to promote residents independence DS0000025950.V294530.R01.S.doc Timescale for action 30/06/06 2. OP22 23 30/06/06 3. OP7 15 30/06/06 4. OP8 12 11/05/06 Chestnuts Nursing & Residential Care Home (The) Version 5.1 Page 28 and protect the individual.(Timescale of 31/03/06 not met) 5. OP9 13 All nursing staff must abide by the home’s medication policies/ procedures; Misuse of Drugs Act 1971; and the Nursing and Midwifery Council (NMC) Standard for administration of medication.(Timescale of 21/02/06 not met) All records of complaints and incidents must be maintained robustly, up to date and in a secure manner.(Timescale of 21/02/06 not met) 11/05/06 6. OP16 13,22 & 37 11/05/06 7. OP19 13,16 & 23 11/05/06 The registered persons must ensure that: All parts of the home to which service users have access are so far as is reasonably practicable free from hazards to their safety. Any activities in which service users participate are so far as is reasonably practicable free from avoidable risk. Unnecessary risks to the health or safety of service users are identified and so far as possible eliminated.(Timescale of 21/02/06 not met) 8. OP19 23 The registered providers must review the use of all communal facilities in the home to utilise them to the best advantage of residents and to make them accessible and safe.(Timescale of 30/04/06 not met) The registered persons must review the staffing levels and ensure that there are sufficient DS0000025950.V294530.R01.S.doc 30/06/06 9. OP27 18 30/06/06 Chestnuts Nursing & Residential Care Home (The) Version 5.1 Page 29 staff on duty at all times to meet the assessed needs of all residents.(Timescale of 31/03/06 not met) 10. OP31 10 The registered persons must ensure that the home is operated and managed in a manner to ensure sufficient care, competence and skill, according to the numbers and needs of residents.(Timescale of 31/03/06 not met) Where the record of fluid/ food intake, turning regimes etc; is indicated for a resident, these recordings must be accurately maintained and up to date. Staff individually and collectively must have the required skills, experience and training to deliver the service and care which the home offers to provide and to ensure the health and welfare of all residents. The manager must ensure that each service user is provided with a statement of the terms and conditions of placement at Chestnuts. Nutritional screening must be undertaken for all residents on admission, and subsequently on a regular basis. A record must be maintained of nutrition, including any weight gain or loss, and appropriate action taken. The manager must ensure that heating and ventilation in both residents’ rooms and communal areas; meet the relevant environmental health and safety requirements and the needs of individual residents. Soiled articles, clothing and linen must be managed effectively in the laundry to ensure that there DS0000025950.V294530.R01.S.doc 30/06/06 11. OP8 12 11/05/06 12. OP4 12 & 18 30/06/06 13. OP2 5 (1) (b) (c) 31/07/06 14. OP8 12 11/05/06 15. OP25 23 11/05/06 16. OP26 16 11/05/06 Chestnuts Nursing & Residential Care Home (The) Version 5.1 Page 30 17. OP19 23 (4) are systems in place to control the spread of possible infection, in accordance with relevant legislation and published professional guidance. The manager must ensure that fire doors are not propped open; fire extinguishers must not be obscured at any time; and that fire exit signage is clear and apparent on all corridors and exits. 18/05/06 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 OP31 Good Practice Recommendations It is strongly recommended that the registered proprietor identify and designate suitable office accommodation for the registered manager. This will enable the manager to maintain a high profile within the home. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Chestnuts Nursing & Residential Care Home (The) DS0000025950.V294530.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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