Inspection on 13/11/06 for The Chestnuts

This inspection was carried out on 13th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Chestnuts 24/05/07

The Chestnuts 25/05/06

The Chestnuts 16/01/06

The Chestnuts 07/06/05

The Chestnuts 30/09/04

The Chestnuts 21/07/04

The Chestnuts 08/03/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Chestnuts (Welcome House) Watts Avenue (10) Rochester Kent ME1 1RX Lead Inspector Mary Cochrane Unannounced Inspection 13th November 2006 09:30 The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 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 The Chestnuts (Welcome House) DS0000028336.V314283.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 Adults 18-65. 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. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts (Welcome House) Address Watts Avenue (10) Rochester Kent ME1 1RX 01634 842084 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) Dr Toqeer Aslam Post Vacant Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th May 2006 Brief Description of the Service: The Chestnuts provides accommodation for up to 15 people with mental health needs. The home is a large detached property with accommodation over two floors. Communal areas include a large lounge, a dining room and kitchen. The home is close to Rochester town centre and has a selection of local shops and services nearby. The current fees for the service at the time of the visit were £540.00 per week. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the 2nd unannounced key inspection to The Chestnuts since April ‘06. Two inspectors did the site visit to the home. All the key standards were looked at. Focus was given to the areas identified at the previous visit which required attention and improvement The following methods of inspection and information gathering were used: one-to-one discussion with and service users staff, observing interactions, care interventions and activities, reading and discussing individual support plans, risk assessments, selected policies, medication charts, training matrix and training programmes. Evidence was also gained from a pre inspection questionnaire completed by the home; comment cards from service users, family, and care managers; and a site visit to the home. . . Comment cards received from the service users were generally positive. Some said that they would like to more involved with the decision making within the home and others said that they would like to do more activities. All the residents said that they were happy living at the home and enjoyed the company of the other service users. What the service does well: The small staff team are committed to caring for the service users. The interactions between staff and service users are good. The residents get on well together and are supportive of each other. Those who wish to, remain in contact with their family and friends. The home provides a friendly and homely atmosphere where people can relax and feel comfortable. The residents reported that the food at the home was good and they enjoyed mealtimes. The bedrooms are individualised and reflect the personalities of the residents. Each service user has a written and signed contract with the home. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information contained in the Statement of Purposed and Service Users Guide does not give a true reflection of the service the home provides. The home does have an admission procedure to ensure the needs of potential service users can be assessed and meet. Prospective service users have an opportunity to visit and to “test-drive” the home. Service users places at the home are protected. EVIDENCE: The home does have as Statement of Purpose and Service Users Guide in place, however they contain exactly the same information. There is no distinction between the 2 documents. The service users guide is not written for prospective service users and does not contain the required information The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 9 detailed in the national minimum standards. The first paragraph of the guide states that further information, which is too bulky to be stored in the guide can be found at the reception area of the home. The manager could not find this information. Both documents continue to state the home provides long-term, short-term and respite care. Previous reports have required the management to define the purpose of the home. (Inspection report 16th January ’06) They cannot continue to have a ‘catch-all’ statement. It is considered bad practice to operate a respite service alongside a long-term service. The history of The Chestnuts suggests this home is a long-term service. This is what the Statement of Purpose needs to reflect. Prospective service users and their representatives cannot make an informed choice unless they are given clear information about the home. The Chestnuts must decide what service is being offered at the home, and change their statement of purpose and service user guide to reflect a true and up-to-date picture of the purpose of the home. The language in the statement of purpose contains sentences of negative and emotive language. An example of this is: ‘Persons in our care with past or present mental illness are ordinary people who have been unfortunate enough to be stricken with often a chronic illness….’ We found no evidence (apart from menus) to support the following statement within the Statement of Purpose ‘We hold a firm belief of user empowerment, and our service users take an active role in helping us shape the services that we provide and we are committed to ensuring that service users are fully consulted about matters which are significant in the running of the home or about matters which might affect their well being or quality of life. Managers and staff are available to listen to the views of service users at any time’. The home has reviewed its assessments procedures since the last inspection and new documentation is in place. Since the last visit a new resident move to the home. There was evidence in place to demonstrate that an assessment taken place. Relevant information had been gathered from the service users’ previous placement to form the basis of a care plan. However, the care plan had not been reviewed or up-dated to reflect the changing needs of the service user. The care plan from the previous home was being used. The manager of the home had undertaken the assessment and was able to make an informed decision that the home would be able to meet his needs. The new service user reported that he was involved with the assessment process from the start and he was able to make the decision as to whether or not he wanted to move to the home. He also said that he had the opportunity to visit the home on several occasions prior to making the decision to move in. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 10 All the service users have contracts and terms and conditions of residency on file. There is information about the fees charged. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users cannot be sure that the information on how to meet their needs is used on a daily basis. There are shortfalls in implementing care for the assessed and changing needs of the service users. Service users are able to make decisions about their lives but their participation is limited in the way the home is run and by staff shortages. The home cannot ensure the safety of the service users, as risks are not minimised. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 12 EVIDENCE: A sample of care plans were looked at during the visit. The manager has done a great deal of work transferring and developing the care plans onto the new format. They are written to a satisfactory standard and contain all the information to meet the individual needs of the service users. However there was evidence to show that the care plans are not used as a daily working tool by the staff. The plans are not reviewed and kept up to date to reflect the changing needs of the service users. There are sections for aspirations and goals, in some plans. These have been identified but have never been followed up to find out if they have been achieved. The home has systems where information on service users in kept in various files and books. There is a daily hand over sheet, which contains basic information, for example if a service users has had a bath or shower. Personal information about the service users is recorded on the same sheet. Daily record notes are not completed on a daily basis and are kept together in a separate file. Evidence of activities undertaken is erratic and not individualised. The out come is that there is no clear picture about how individual service needs are meet on a daily basis. There is no record about how service users spend their time. There is no evidence to show what support and encouragement they have been offered to achieve aspirations and goals. There are individual risk assessments at the home. They do not give staff the necessary information on how to manage risks. All areas of risk need to be identified and robust risk assessments need to be developed to ensure that staff have all the necessary information and training to keep risks to a minimum while allowing service users to live a fulfilling and active life as possible. The home does need to develop a more person centred approach to care. Key working needs to be developed and promoted. To do this effectively the home needs more staff who have the skills and knowledge to undertake the role effectively. Some of the service users reported that they are able to make decisions on how they live their life’s and this was seen on the day of the visit. They said that they receive allowances weekly or monthly depending on which they prefer. Monies can be paid directly into their bank accounts or they can have cash. Some of the service users can come and go as they please and there are no restrictions in place. Others said that if they do make decisions about what they want to do they are unable to achieve them, as the home does not have the available staff to give the support and assistance that they need. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 13 The service users spoken to said that they are not really involved in the decision making on how the home is run. They was evidence to support that there is involvement in menu planning but apart from this residents or staff could not think of any other area. Records inspected indicated that service users meetings are held and are chaired by the service users. Minutes are kept however there was no evidence provided to indicate if the minutes had been actioned and out-comes achieved. The acting manager produced questionnaires completed by service users rating the service provided. There was no indication of what if anything was done with the information that these provided. The manager needs to ensure that the service users are consulted and participate in all aspects of life at the home. They need to be involved in the daily running of the home and their choices and preferences need to be acted on. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not provide all the service users with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Service users are part of the local community. Service users have limited support to engage in leisure activities. Service users have opportunities to develop personal relationships though have limited support to do so. Service users’ basic rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 15 EVIDENCE: As identified in the last inspection report there was no evidence to show that the home provides any activities or leisure pursuits. The format for developing activities programmes is in place. In some cases completed but there is no evidence to show that it is being implemented. Most of the plans centre on household chores. On the day of the inspection it was identified that a service users activity was to hoover the lounge but a staff member was doing the task. When asked why she was doing it she said she could do it quicker. The service users had not been asked or encouraged to undertake the task. Service Users do not know what is written in their activities plan. Residents reported that nothing happens in the home and when they are in the house they just sit around watching television. Service users said that they would like more in-house activities. Some of the service users living at the Chestnuts are able to undertake activities independently and require little support to do so. However many of the service users do need assistance and support and there is not enough staff employed at the home to facilitate this. One service users said that she is not going out at the moment due to a recent accident, which has left her feeling vulnerable. She stated that ‘I would go out if there were more staff’. Service Users also expressed the wish to meet people from out-side the home. Another stated that he does not go out much due to a decline in his mobility and unstable condition. His only outing is to the cash and carry with the manager, and a coffee and sandwich while they are there. Occasionally he will go for a short walk. He would be able to go out more if there was staff available to support him. Service users reported they would like to participate in more community activities such as the day centre or visiting friends. Some of these activities require taxis and many of the service users do not have enough money to afford this. The home does not provide transport. In the home’s statement of purpose and service user guide, they say the following: ‘Our home actively encourages residents to maintain all forms of social contact that they enjoyed before moving into our home. We will assist residents to maintain contact if requested’. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 16 Neither in the Statement of Purpose or Service Users Guide is it stated that the home does not support its service users with transport. On the notice board in the office the current fees are stated. Underneath ‘not included’ section it says ‘transport’. Under the title of ‘social activities’ in the Statement of Purpose it states; ‘our home is able to provide a variety of ways that service users can engage in the enjoyment of social activities, hobbies and leisure interests. Resident’s individual wishes regarding involvement in activities will be respected. Little evidence that the home adheres to the above statement was found. Service users spoken to say that they did not get the support that they needed when they went out. Some said that they would like support with shopping for personal items but felt that there was not enough staff on duty to assist them. Service users did report that they often have to rely on their social workers to help them do this therefore it did not happen very often. A day trip to Dymchurch was organised since the last inspection. This was in conjunction with other homes within the company. This was reported to have been very successful. At the time of the visit he service users had a sing-along in the lounge with service users playing the piano and guitar. Service users reported that this usually happens about once a week. Service users reported that staff and other service users are respectful of their privacy and knock before coming into their rooms. Residents had a key to their room and those who wish now have a key to the front door. Those who are physically able come and go from the home as they wish and are able to decide how they spend their time. Service users receive their own mail and open it themselves. When they had time care staff involved service users in conversations. Staff and service users communicated well and effectively. Service users are able to spend time in their rooms or in the communal areas of the home; the choice is theirs. Service users who illnesses lead to isolation and withdrawal are monitored and encouraged to spend time with others. Menus follow a three weekly cycle. Care Staff prepare all the meals. Service users reported that they now involvement in planning the menus. A service user now goes out with the manager to buy food. The menus indicated that the home provides a varied and nutritious diet for the service users. There was evidence to show that the home provided a choice if a service user did not like what was on the menu The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 17 There is no record kept of the dietary intake of the service users. There was a good supply of dry store and frozen food. Service users reported that are not involved in the preparation of meals. Service users confirmed that they could prepare drinks for themselves. The kitchen is now locked at 7.30p.m. A kettle and drinks are available in the dining room area so service users have access to hot drinks after this time. All the service users spoken to said that they enjoyed the meals provided by the home and they had enough to eat. The majority of the service users eat in the dining area. Those who did not wish to eat at this time were able to have their meal later. Service users can choose not to eat in the dining room and can eat in private if they wish. The kitchen was clean and tidy. Food was stored at the correct temperatures. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal support service users receive is adequate during the day. Service users cannot be sure they will receive the support at night if they need it. Service users will not always have the choice to be supported by a carer of their own gender. Service users healthcare needs are being met. The home’s procedures for dealing with medication were inadequate in terms of protecting service users. EVIDENCE: The Chestnuts now employs a male member of staff but he only works part time at the home. There are still days when male service users do not have the option of receiving care from a member of staff of their own gender. Some male service users require a degree of assistance with bathing. This was identified at the last inspection. All the Service users spoken to said that they choose their own clothes and can wear what they want. Service users did The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 19 report that they now have a hairdresser coming into the home. Staff were observed assisting service users in a flexible and supportive manner and were seen treating the service users with respect and understanding. Service users receive the help and support they need with their personal care during the day but at nights there is no waking night staff on duty to give assistance. Service users reported that they received appointments with dentists, opticians, and chiropodists and the homes records now support this. There are systems in to ensure that all the service users received the specialist support that they need. Contact and visits from care managers and CPN’s are recorded and monitored. The manager of the home encourages and supports service users to attend health care appointments and closer monitoring and observation is kept on those who attend independently. Feedback from Healthcare professionals indicated that there is an improved working relationship with the home. Communication has improved and that they are contacted promptly if there is any deterioration in their clients health. Professional reviews are undertaken at the necessary intervals. The medication is stored in a locked cupboard in the hall. The home uses a monitored dosage system, which is delivered monthly from Boots. Some medications are not supplied in MDS, and these are kept in separate named boxes. The medication cupboard was extremely warm. The thermometer in the cupboard registered 26oC. Most of the medication in the cupboard should be stored at 25oC or lower. The manager stated that the hot pipes run below the cupboard, and that it is likely that throughout the winter period this temperature is likely to rise. An immediate requirement was made for the home to purchase a medication trolley, and that this is securely stored in an area that does not reach temperatures above 25oC. One service user is prescribed a controlled drug. This is included in the MDS and is not stored separately. This medication should be stored in a controlled drugs cupboard. Furthermore, the homes own policy, and Regulation states that a controlled drug should be administered by an appropriately trained staff member and witnessed by another trained member of staff. Inspection of the controlled drugs record evidenced that one member of staff administers the medication, and witnessed (and countersigned) by the service user receiving the drug. This is unacceptable. MAR sheets for the day of inspection were read. Several 9am medications were not signed for. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 20 The medication file was unacceptably messy. One service user did not have a front sheet detailing his medication, allergies, date of birth or photograph. All other service users did have a front sheet with all the above information on. However, they contained several crossings out regarding prescribed medications, and some did not contain any information about allergies. Protocols for the administration of medication to be administered when required were inspected. Evidence gathered pointed to significant shortfalls with the home’s current practice. These need to be reviewed. The home needs to have individual guidelines in place to give direction to staff on when to administer when required medication to service users. One service users administers his own medication there was no risk assessment in place to show that the service users was able to do this safely and that all risks were minimised. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel that their complaints will be listen to and appropriate action taken. Service users cannot be sure that they will be protected from self-harm, abuse and neglect. EVIDENCE: Service users spoken to said that they knew how to complain within the home. Service users explained that they would report any concerns to the manager and then to the registered provider though were not sure where to go after this. A copy of the complaints procedure was on display, which incorporated all the necessary details. One complaint had been made since the time of the last inspection and these have been dealt with appropriately. The home has established procedures to protect service users from abuse. The procedures state that all staff should read and sign that they have understood them. Records indicated that this had been done. Staff training in adult protection has taken place. However when staff were asked about adult abuse they were not able to demonstrate that they had any depth of knowledge about what constituted abuse. The registered person needs to ensure that staff have understood and taken on board what they have learnt and read and check competency. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 22 There have been no incidents requiring referral to adult protection since the last inspection. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s premises are suitable for its stated purpose and meet service users’ individual and collective needs in a comfortable and homely way. EVIDENCE: The Chestnuts is suitable for its stated purpose and provides a homely, friendly and safe environment. The premises are in keeping with the local community and the communal areas are accessible to all the service users. The premises are in line with the statement of purpose. The location of the home near to the centre of Rochester puts it in close proximity to local amenities, shops and transport links. Furnishings and fittings were in keeping with providing a homely environment. It was reported that a handy man visits when necessary. There is a stair lift installed though it has been decommissioned. There is an electric bath hoist. The records for the hoist showed that it has now been serviced. The home needs to have a planned renewal and maintenance The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 24 programme in place for the fabric and redecoration of the premises. Records need to be kept. Bedrooms are personalised and service users can bring in their own furniture and buy extras for their rooms. They can also decorate their rooms to their own tastes. The majority of rooms were decorated and maintained to a reasonable standard. Overall the home was clean and free from unpleasant odours. One bedroom did have an unpleasant odour. This was discussed with the manager. Service users are encouraged to keep their own rooms clean and tidy and have access to housecleaning equipment to do so. One service user said that they are given assistance and support from staff if they need it. Laundry facilities are adequate. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An effective staff team does not support Service users. Service users cannot be sure that staff supporting them are appropriately trained. Service users can be confident they are protected by the home’s recruitment policy and practices. There are not enough staff on duty to met the needs of the service users The staff have a good understanding of the needs of the service users. This is evident from the positive relationships between staff and residents. EVIDENCE: At the time of the inspection duty rota stated that the home employs 3 full time members of staff, 2 part time staff, and 1 staff member who works occasional shifts. This staff member had not worked any shift in the past month. A new member of staff had started at the home on the day of the inspection and she was shadowing. The manager had only been informed a few days The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 26 before that a she would be having a new member of staff. She was not involved in the recruitment or interview. Residents are never involved in the recruitment of staff. The home does have an induction programme in place, which new staff complete. A sample of staff files were looked at all checks were in place and 2 references received. The management need to ensure that a full employment history is obtained and staff have pictures on file. Due to our visit the manager arranged for the staff member who works sleepin nights to work on the floor so there would be 2 members of staff available. The manager and three staff take on the multiple tasks to deliver the service to residents. All service users spoken to said that they thought there was not enough staff on duty day or night. Service users said that staff were very busy all the time and were not able to spend any time with them. Staff on duty cook, clean, assist some service users with personal hygiene needs, administer medication, complete administration tasks, write reports, and do shopping. This was observed on the day of the visit. Staff were continually rushing around from one task to the next. The duty rota showed that on most of the morning shifts there are 2 members of staff on duty from 9 am until 5p.m after this there is only one member of staff. The sleep-in night staff also covers daytime duties. The sleep-in night staff lives and sleeps in a flat on the top floor of the house. At weekends there is only one member of staff per shift. There is not enough staff employed by the home to meet the needs of the service users at any time of the day or night. This has been highlighted throughout this report and was also highlighted at the previous 2 inspections. Little has changed with regards this. The outcome is that service users needs are not met and service users are at risk at night. Service users spoke about their concerns about the staff situation. One service users said he was worried about being cared for during the night. When asked about access to the sleep in staff member, he said ‘it worries me, I can’t get up them stairs’. Service users do not know how they would summon help should he need to during the hours of 10pm and 8am. One service users does have bell to alert the night staff this was installed after the last inspection. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 27 Another service users said that if they needed to contact the sleep in staff member. She told me she could not get up the stairs and would try to wake up another service user. 50 of the staff have achieved NVQ level2 or above. Not all staff are up-to date with mandatory training, and there is very little specialist training provided. This is of particular concern considering the diverse and complex needs of the of the service user. The training needs of all staff must be addressed. The service users reported hat they have developed good relationships with the staff. One service users said “ the manager was brilliant and they felt safe when she was around”. Another said, “they dreaded when she went on holiday as you did not know what was going to happen” Service Users reported that the staff do the best that can but there is not enough of them. It was observed that the staff are approachable and helpful towards the service users. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Considering the number of staff on duty the home is well run on a day-to-day basis. The manager needs to demonstrate her fitness by undertaking the necessary qualifications and becoming registered Quality assurance and monitoring needs to be further developed to ensure the aims and objectives of the home are being met and the views of the service users/representative are acted on. Gaps in staff training potentially leave service users and staff at risk. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 29 EVIDENCE: The acting manager of the home has now decided to apply to the CSCI to become the registered manager of the home. She is commitment to providing care and support to service users at the home and works beyond her duties to provide this. She is knowledgeable about their needs and has the skills to deliver care. The manager needs to evidence her competency and knowledge by under taking the NVQ4/RMA training. Evidenced gathered during the inspection indicated that service delivery is compromised because of insufficient staffing, and inadequately trained staff. Service users are not receiving adequate care or support to lead valued and fulfilling lives. The company has a dedicated person to undertake effective quality assurance and quality monitoring systems. The aim is to look at managerial effectiveness, improve paper work and highlight any deficits so they can be addressed. Views of the service users relatives and other stakeholders are sought. This now needs to move to the next step. The information needs to be collated and the strengths and weaknesses of the home identified. From this information the home needs to improve the service that it provides to the residents. This will ensure that the aims and objective and statement of purpose of the home are being met. Not all mandatory training is up-to-for the care staff. This needs to be on going and up-dated as required. Regular maintenance checks take place and certificates viewed were all up to date. Fire checks are undertaken at the required intervals. The bath hoist has been serviced since the last inspection. The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 1 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 2 X 2 X X 2 X The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 31 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4(1)a,b,c 5(1) a,b,c,d,e,f. Timescale for action The registered person needs 28/02/07 to review and amend the homes Statement Of Purpose and Service Users Guide to comply with the regulations and to reflect an accurate picture of the service the home offers. The service users guide needs to be separate document and contain the information listed in National Minimum Standard 1.2 (Outstanding requirement from inspection dated 16/01/06. Timescale not met). The registered person shall ensure that the assessment of the service user’s needs is kept under review; and revised at any time when it is necessary to do so having regard to any change of circumstances. The registered person shall DS0000028336.V314283.R01.S.doc Requirement 2. YA2 14(2), b 28/02/07 3. YA6 15(2)a,b, c,d 28/02/07 Page 32 The Chestnuts (Welcome House) Version 5.2 make the service user’s plan available to the service user; keep the service user’s plan under review; where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and notify the service user of any such revision. (Outstanding requirement from the previous 2 inspections. Time scale of 28/08/06 not met) 4. YA9 13(4)(b)13(4)(c) The registered person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Outstanding requirement from the previous 2 inspections. Time scale of 28/07/06 not met) 16(2)(n) Each service user requires an individual activities programme arranged by or on behalf of the care home that is tailored to meet individual needs. These programmes need to be implemented. To make arrangements for the service users to engage in local, social and DS0000028336.V314283.R01.S.doc 28/02/07 5. YA12 28/02/07 6. YA13 16(2)(m) 28/02/07 The Chestnuts (Welcome House) Version 5.2 Page 33 community activities 7. YA14 16(2)(n) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. All staff need to have the competencies and qualities required to meet service users’ needs The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (Outstanding requirement from the previous 2 inspections. Time scale of 28/07/06 not met) 28/02/07 8. YA20 13(2) 13/11/07 9. YA32 18(1)(a) 28/02/07 10. YA33 18(1)(a) 28/02/07 11. YA35 18(1)c(i) 18(1)c(ii) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users (c) ensure that the persons employed by the registered person to work at the care DS0000028336.V314283.R01.S.doc 28/02/07 The Chestnuts (Welcome House) Version 5.2 Page 34 home receive training appropriate to the work they are to perform; and suitable assistance, including time off, for the purpose of obtaining further qualifications appropriate to such work. (Outstanding requirement from inspection dated 16/01/06. Timescale not met). 12. YA39 24 (1)(a)(b) (2)(3) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. Mandatory training must be provided to ensure that all staff are up to date. 31/03/07 13. YA42 12(1)(a) 13(4)(c) 5,6,7 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations Service users need the support and assistance from staff to support them their decisions. Service users decisions need to be acted on. Staff support service users to maintain friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). The registered provider should ensure that a male member DS0000028336.V314283.R01.S.doc Version 5.2 Page 35 2 YA15 3 YA18 The Chestnuts (Welcome House) 4 5. YA18 YA23 of care staff is on duty in the home. Personal support needs to be available to all service users day and night. The registered person of the home needs to ensure staff are aware of and understand the homes adult protection policies and procedures. Staff competency need to be checked. The home needs to have a maintenance plan in place with timescales. It will need details of work done and work that will need to be undertaken to ensure the home is kept to a good standard. All areas of the home need to be free from any offensive odours. The manager and service users at the home need to be involved in the recruitment of new staff. The home needs to obtain a full employment history. An up to date photograph needs be kept on each staff file. The manager needs to achieve NVQ4/RMA and become registered with the CSCI. 6 YA24 7 8 YA30 YA34 9 YA37 The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Chestnuts (Welcome House) DS0000028336.V314283.R01.S.doc Version 5.2 Page 37 - 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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