Inspection on 09/10/07 for Chestnuts Nursing & Residential Care Home (The)

This inspection was carried out on 9th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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... 17/01/07

Chestnuts Nursing & Residential... 11/05/06

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 9th October 2007 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.V353166.R01.S.doc Version 5.2 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.V353166.R01.S.doc Version 5.2 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 Lianne Marie Humphries Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 51 17th January 2007 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 £454.00 and £900.00 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.V353166.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which started at 10am and took place over seven hours. The inspection was undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. The manager was available throughout the visit to aid the inspection process. This was a key inspection in the inspection programme for 2007/2008. Discussion took place with the manager; several members of nursing and care staff; the head chef; maintenance person; activities co-ordinators, and the home’s administrator. The inspectors spoke to residents where possible; and they were asked to give their views on the service and their experience of living in the home. Nursing and care staff were asked about the care that residents receive and were also observed carrying out their duties. A tour of the premises, including all communal areas and the main kitchen was undertaken. The files of several residents were case tracked, together with the examination of other staff and home records. This included medication administration; activity programmes; training records,; maintenance records; complaints; accidents/ incidents and staff recruitment procedures and files. Information was taken from an Annual Quality Assurance Assessment (AQAA), which was completed by the manager. This is a self-assessment process, which all providers are required to complete once a year. Additional information relevant to this inspection was also obtained from monthly Regulation 26 monitoring reports and Regulation 37, notification of events. As part of the inspection process the views of several community health and social care professionals who provide a service to the home were sought, and are commented on in this report. Surveys were sent out to the home prior to the inspection. Twenty surveys were sent to residents and eighteen were returned. Twenty surveys were sent to staff and only two were returned, which is a disappointing response. All of the surveys returned by residents indicated that they were satisfied with the care they were receiving in the home. Several resident were asked how people living in the home wished to be referred to. The majority expressed a wish for the term resident to be used, as it is their home. This is reflected accordingly in the report The inspector would like to thank the residents, staff and visitors for their input during the inspection, and to those people who completed surveys. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Care plans should be seen as working tools, which provide staff with up to date information pertaining to residents changing needs. If used in this way it will ensure that all care needs are being understood and met on a daily basis. Care plans must also be more specific with regards to the recording of outcome Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 7 around the cultural and religious care needs of the individual. This will mean that staff understand and are able to meet such needs. Whilst staffing levels are satisfactory, residents would benefit from a more effective deployment of nursing and care staff, so that residents do not have to wait unnecessarily for staff support and attention. All staff involved in the administration of medication must view medication records as key to the efficient management of health care matters. The home is clean and generally the physical environment meets the needs of the people living in the home. However, in many areas of the home the decoration and furnishings, including carpets in the communal areas, are now being to look ‘tired and worn’. These areas are now in need of redecoration and refurbishment, which will be to the benefit of all current residents and any prospective residents. 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. The summary of this inspection report can be made available in other formats on request. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 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.V353166.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 4 People using the service experience good quality outcomes in this area. This judgement has been made using all available evidence including a visit to this service. A pre-admission assessment is undertaken for all prospective residents. Care plans are drawn up from the information in this assessment ensuring that the needs of the residents are identified, understood and met. The home does not offer intermediate care. EVIDENCE: Individual records are kept for each resident and a number of files were examined. All records examined had assessment information recorded and the information had been used to continue assessment following admission to the home. The records showed that residents, where possible and their relatives/ representatives are involved in the assessment process. Where appropriate, information provided by the placing authority was also included. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 10 The inspectors were satisfied that a full assessment of need is undertaken prior to service users moving into the home, and that the manager would not admit a new resident unless she was sure that the assessed needs could be met. The manager was provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. This sets out what information care home providers need to include in the Service User Guide regarding fees and terms and conditions, and is in a format that is easy to understand. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents health and personal care needs are set out in individual care plans. The care plans are generally detailed but need to be more specific with regards to the recording of outcomes for residents around the cultural and religious care needs of the individual. Care plans must be used as a working tool and provide all staff with up to date information pertaining to residents changing needs, to ensure that all care needs are being understood and met on a daily basis. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the recording of medication, which may result in unsafe practices. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 12 EVIDENCE: New care planning has recently been implemented and nursing staff have received training in its use. Individual care plans were available for each resident and a total of nine residents were case tracked and their care plans and related documentation inspected. Care plans were generally detailed, but need to be more specific with regard to the recording of outcomes around the cultural, religious and social care needs of residents. For example residents religion is recorded but there was no evidence on the care plans as to the impact of a person’s religion on the method and type of care provided. Although care plans made brief reference to a resident’s religion or culture, there were no further references in the care plans to the implications of this on either care, health/social needs or dietary needs. Staff need to have a knowledge of what a persons religion and culture means in terms of care and activities. There was evidence that care plans were being reviewed at least monthly, but not all care plans examined had up to date information around changes in care needs. One resident who had had conjunctivitis had received appropriate treatment for this but there was no indication in the care plan that the necessary infection control methods had been identified and implemented. Another resident’s care plan stated that she wore glasses, but during the inspection it was apparent that this resident did not have her glasses. When discussed with the manager, the inspector was told that she refused to wear them, but this was not indicated in the care plan. The documentation/ health records relating to wound management; management of insulin dependant diabetes; catheter care and a recently admitted resident were examined. The records for these residents were generally found to be detailed and being adequately maintained. Two of the residents who were case tracked were insulin dependant diabetics, and it was evident from their files that care plans around the management and treatment of the diabetes were in place and being followed by the nurses and care staff. Generally the care plans for wound management were good, and advice and input from the tissue viability nurse had been sought. However, one of the residents who was case tracked did have an abrasion to the right hand but there was no record of this in the care plan, nor of any treatment being given. Risk assessments are routinely undertaken on admission around nutrition, manual handling, risk of falls, and pressure sore prevention. It was evident that residents were being weighed on admission and then generally on a monthly basis with fluctuations in weight being monitored. Where necessary referrals were being made to either a dietician or a nutritionist. Monitoring charts such as fluid intake/ output; turning regimes, and blood sugar monitoring, were up to date and being adequately maintained. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 13 Staff were observed to interact well with residents and to treat them with kindness and respect. However, it is important that residents who remain in their bedrooms either through choice or for health reasons, are not forgotten by staff who may be busy with other residents in the lounges. The inspectors visited several residents in their bedrooms, during the morning, where the curtains were still drawn. When the residents were asked if they would like their curtains pulled back they all said “yes”. Keeping curtains drawn can, for a resident who remains in their room from either choice or necessity, add to them feeling even more isolated. The new care planning documentation now includes specific night care and end of life care plans. However, in the majority of the care plans viewed staff have made ‘standard’ statements. For example “ensure always supervised”, but with the current staffing levels it is not possible to fulfil this statement. If there are residents who need to be constantly supervised then the management must review the current staffing levels to ensure that these identified needs can be met. It is essential that the care plans, in all aspects, reflect the individual needs of each resident and that staff refrain from using standard statements. There has been some development of care plans around ‘End of Life’ wishes and needs. The inspector was able to evidence information in some care plans where discussions had taken place with residents and relatives around end of life care needs. From discussions with staff and viewing cards/ letters received from relatives, it was apparent that staff dealt with a person’s dying and death in a sensitive and understanding manner. One relative had written: “A heartfelt thanks for the love and care you gave Dad. We never had to worry about him which was a relief”. Staff in the home routinely support relatives following the death of a resident through sympathy cards, floral tributes and support for staff to attend funerals. If care is to be delivered effectively, care plans should be a working document for all members of staff, that is nurses and care staff. However, during this inspection it was evident that care plans appear to be the domain of the nurses, and that care staff have very little input, and in some instances have not seen the care plan. It was possible to talk to several residents, one of whom said: “The carers are really kind and so are the nurses”. Another resident told the inspector that she “was generally happy at the home, and had been tested for osteoporosis and was now receiving medication, but had not had this for approximately two weeks”. This was case tracked as part of the medication audit. An audit was undertaken for the handling and recording of medicines within the home and a sample of Medication Administration Record (MAR) charts were examined. There are clear medication policies and procedures for staff to Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 14 follow and medication audits are undertaken by the manager on a regular basis. All MAR charts examined were in order with the exception of one. The home’s GP had arranged for the health monitoring of residents in respect of identifying those residents requiring supplements for osteoporosis. As a result of this several residents were prescribed a specific supplement. For one resident the amount of medication supplied for the interim prescription had ran out and it appeared that nursing staff had not re-ordered. The inspectors brought this to the attention of the manager who took immediate action to address this. She made immediate contact with the GP, who gave assurance that there would be no ill effects to the residents health, by the omission of this medication. Subsequently the manager met with the GP to discuss changes to the ordering of interim prescriptions, met with nursing staff and changed the home’s systems to ensure that this situation does not occur again. The inspector is satisfied that the manager has taken appropriate and adequate action to address this issue. All nursing staff involved in the administration of medication must view medication records as key to the efficient management of health care matters. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Residents are given the opportunity to take part in a variety of activities and the lifestyle within the home matches the preferences of residents with regard to their social and recreational interests and needs. EVIDENCE: Through observations, discussions with some service users, the two activities co-ordinators and the manager, the inspectors were satisfied that service users do have individual care plans around activities. Some of these activities are individual and some group, and care staff are also now more involved in undertaking some activities with residents, such as sitting and talking to them, or reading a newspaper with them. During the inspection some of the residents were taking part in a quiz. The manager has written to all relatives to advise them that an essential part of care is to compile a life history for each of the residents. Where relatives Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 16 have co-operated and provided relevant information, photographs and other materials staff are now working with individual residents to complete this work. Where residents have a degree of confusion or short term memory loss, such life history books are essential as part of reminiscence work with the individual resident. Privately purchased massage is available from an external provider and some service users do take advantage of this. A hairdresser also visits the home on a regular basis. Residents are encouraged to maintain contact with family and friends, and both the manager and the activities co-ordinators are clear that residents will be encouraged to build and maintain community contacts. Books are available within the home and these are on loan from the local library. One resident told the inspector “I like to go out at least once a week, and a member of staff takes me to the local shops which I really enjoy.” She went on to tell the inspector “I like being in my bedroom and I have a door onto a small patio area where I am growing tomatoes. I also like feeding the squirrels and two of them actually come into my room to collect nuts.” The majority of residents are white British and of a Christian persuasion and religious services take place within the home. However, some of the residents are Jewish and the proprietor ensures that they participate in the Friday evening service (Shabbat) in preparation for the Sabbath. Another resident is Muslim and a carer has been allocated as her key worker who speaks the same language and is also a Muslim. Two of the communal areas have been re-designated as dining rooms and this provides a variety of rooms for residents who choose to use them. Tables were seen to be being nicely laid with tablecloths, cruets and cutlery. It was evident during the inspection that residents had easy and frequent access to drinks, and those residents that needed assistance were being given this by care staff. There are four meals a day, but drinks and snacks are available throughout the day: Breakfast – from 8a.m. Lunch – from 12.30p.m. Tea – from 5.30p.m. Supper – from 9p.m. From discussions with the cook, from a visit to the kitchen, viewing the menus and conversations with some residents, the inspectors were satisfied that the residents receive a varied, appealing wholesome and nutritious diet which is suited to individual requirements. For instance Kosher and Halal foods are Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 17 available for those residents who require this. Fruit platters are prepared daily for the residents, and they do seem to enjoy this. Custards, porridge and milk drinks are made with full cream milk. The cook is also aware of the birthday of each resident and makes sure that there is always a celebration cake. 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 inspectors had no concerns with regard to the management of the kitchen area. Residents are encouraged to personalise their bedrooms, and many of the residents had chosen to do this. On visiting residents in their bedrooms the inspectors were pleased to note that all had their emergency buzzers within easy reach. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager and staff make every effort to sort out any problems or concerns. Residents and their relatives can be confident that their complaints and concerns will be listened to and acted upon. Staff working in the home have received training in safeguarding adults to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The home has a written complaints policy and procedure for dealing with complaints, and staff spoken to were aware of the complaint procedure and how to deal with complaints or concerns made to them. The complaints log was inspected and indicated complaints received, details of investigation, action taken to resolve and the outcome for the complainant. The manager was clear that any complaints received by the home would be responded to in writing and in accordance with the home’s complaints procedure and stated timescales. There are also concerns/ complaints/ compliments forms at reception and on each floor of the home, available for any resident or visitor to complete. Those residents spoken to were aware of how to complain and to whom. No complaints have been received by the Commission since the last inspection. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 19 All staff working in the home have received training in safeguarding adults and this is included in induction training for all staff. This was evidenced on staff files and the training programme. Those staff spoken to were conversant with the action to be taken if they had concerns about the safety and welfare of residents or if they witnessed any suspected abuse. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 24 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is clean and generally the physical environment meets the needs of the people living in the home. However, in many areas of the home the decoration and furnishings are now being to look ‘tired and worn’, and are in need of redecoration and refurbishment. EVIDENCE: The building was toured by the inspectors, accompanied by the manager, at the start of the visit, and all areas were visited again later during the day. Although the housekeeping staff are constantly deep cleaning carpets, these are now showing signs of staining and it is not always possible to alleviate offensive odours. With the exception of the communal areas on the top floor, Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 21 decoration and furnishings in other areas of the home are now looking ‘tired and worn, and in need of redecoration with some carpets and furniture requiring replacement. Although one lounge was redecorated last year, some residents commented that they did not like the colour. Other residents commented that the décor in the Garden Room is very dark, with very little natural light. On the day of the inspection several residents were eating their midday meal in this room. The carpet and dining chairs were noted to be stained, and a total of eleven wheel chairs were being stored along one side of the room. Whilst the residents had chosen to eat in this room, it did not provide a very congenial setting, and residents left the room as soon as their meal was finished. As the Chestnuts is the home of the residents, it is essential that they are consulted and involved in the choice for redecoration and refurbishment materials for their home. Also since care plans indicate that some residents have complaints such as asthma, breathing problems and C.O.P.D. (chronic obstructive pulmonary disease), it is essential that the environment be kept as dust free as is possible. The manager is advised to ensure that where there are heavy curtains, that these are vacuumed and cleaned to ensure that they remain dust free. The registered persons have recently submitted an application to the Commission to admit up to twelve residents with a diagnosis of dementia. The planned unit is on the top floor and the scheduled works are near completion. The inspectors visited the communal areas and were very impressed with the changes that have taken place. The manager has referred to good practice guidance in dementia care, and this is reflected in the décor and signage. The communal areas were very bright, well decorated and designed. Fire doors were closed and fire extinguishers were not obscured by items of furniture or hoists. A maintenance person is employed and there is an effective system in place for staff to report items requiring minor repair or attention. Sanitisers were located in each bedroom and these were filled with the necessary liquid. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. The laundry was visited but the person in charge was not present. However, the laundry was found to be clean, with soiled articles being stored appropriately, pending washing. The manager has received information and is fully aware of the recent legislation regarding smoking in care homes, which came into effect on the 1st July 2007. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 22 The rear garden was well maintained and the fishponds were clean and the fish visible. The home recently won an award from the London Borough of Redbridge ‘Redbridge in Bloom’ competition. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. Whilst staffing levels are satisfactory, residents would benefit from a more effective deployment of nursing and care staff, so that residents do not have to wait unnecessarily for staff support and attention. The procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: Staff rotas were inspected and the staffing levels and skill mix of qualified nurses and care staff was sufficient to meet the assessed nursing and personal care needs of the residents. However, the deployment and supervision of care staff must be more efficiently managed by the nursing staff. Particular attention must be given to busy times of the day, and to those residents who remain in their bedrooms either by choice or for health reasons, so that they are not forgotten by staff who are occupied with other residents in the lounge. The full time receptionist has left and there are no current plans to fill this position. All staff, including nurses and care staff, at various times of the day, have to respond to the telephone and the front door. The registered persons Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 24 must keep this situation under review to ensure that this does not unduly impact upon staff in carrying out their care duties with residents. A record is maintained of staff training and records showed that staff have undertaken training in essential areas such as infection control, safeguarding adults, food hygiene, health and safety, first aid, moving and handling, and fire safety. Other training undertaken has included, bereavement, dementia care, palliative care, continence management and nutrition in the elderly. On the day of the inspection kitchen staff where undertaking training around COSHH (Control of Substances Hazardous to Health). The AQAA completed by the manager stated that 80 of care staff are qualified to National Vocational Qualification (NVQ) level 2 or above. A discussion took place with the manager around the recently introduced Mental Capacity Act 2005, and the impact it will have upon the delivery of care to vulnerable people. It is essential that all staff working in the home receive adequate and appropriate training in this important area. The files of the three most recently employed staff were inspected and these were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. The Chestnuts, employs a workforce from diverse cultures and backgrounds. It was apparent that the ethnicity of the majority of the staff team is not generally reflective of that of the residents group. However, in discussion with the manager and staff they were able to demonstrate an awareness and understanding of the importance in appropriately meeting the needs of all residents, wherever possible around equality and diversity issues. It is important that the manager continues to reinforce this issue through staff training and supervision. This will ensure that the spiritual, cultural, sexual and any other diverse need of residents at The Chestnuts is met through meaningful ‘person centred’ care. The manager had made provision for Muslim staff working through Ramadan, by identifying a suitable quiet room for prayer. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using all available evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken regularly by the proprietor of the home to monitor and report on the quality of the service being provided. EVIDENCE: The registered manager has the qualifications and experience to manage the home and is able to demonstrate a clear understanding of the needs of the residents. Ms Humphries is very resident focused and works continuously to improve the service and provide an increased quality of life for residents. She Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 26 is committed to build on the skills of staff and develop a skilled, confident and competent staff team. The proprietor undertakes Regulation 26 monitoring visits on a monthly basis to monitor and report on the quality of service being provided in the home. A copy of the report is sent to the Commission. An annual quality assurance questionnaire is undertaken, and the manager uses the feedback from this to gain the views of people who use the service or have an involvement in the home, and make changes to improve the service. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by their relatives/ representatives. Secure facilities are provided for the safekeeping of money and valuables, if held on residents behalf. A wide range of records were looked at including fire safety, gas and electrical certificates, portable appliance testing (PAT), hoist and lift maintenance/ service, and accident/ incident reports. All these records were found to be in good order, up to date and accurate. Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 27 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 2 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 12 & 15 Requirement The registered persons must ensure that care plans provide staff with up to date information about residents care, to ensure that care needs are being understood and met on a daily basis (Timescale of 28/02/07 not met) The registered persons must ensure care plans are more specific with regard to the recording of religious and cultural needs. The registered persons must ensure that all staff involved in the administration of medication adhere by the home’s policies and procedures. Nursing staff must abide by the Nursing and Midwifery Council (NMC) Standards for the administration of medicines. The registered providers must ensure that there is an ongoing programme of decoration and refurbishment for all parts of the home. This will ensure that residents live in a wellDS0000025950.V353166.R01.S.doc Timescale for action 30/11/07 2. OP7 12 & 15 30/11/07 3. OP9 13(2) 09/10/07 4. OP19 OP20 16 & 23 31/01/08 Chestnuts Nursing & Residential Care Home (The) Version 5.2 Page 29 5. OP22 23(2)(l) 6. OP27 18 maintained environment, which meets their individual and collective needs. The registered persons must ensure that suitable provision is made for the storage of wheelchairs and other mobility aids. The registered persons must ensure that staff are effectively deployed, so that residents do not have to wait unnecessarily for staff support and attention. 30/11/07 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnuts Nursing & Residential Care Home (The) DS0000025950.V353166.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V353166.R01.S.doc Version 5.2 Page 31 - 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. 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