Inspection on 13/10/05 for The Chestnuts

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

The Chestnuts 20/10/04

The Chestnuts 20/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 The Chestnuts The Chestnuts Vines Lane Hildenborough Tonbridge Kent TN11 9LT Lead Inspector Helen Martin Unannounced Inspection 13th October 2005 03:00 The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 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 DS0000024012.V258364.R01.S.doc Version 5.0 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 DS0000024012.V258364.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Chestnuts 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) The Chestnuts Vines Lane Hildenborough Tonbridge Kent TN11 9LT 01732 834178 01732 834178 The Avenues Trust Limited Mrs Judy Morgan Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: The Chestnuts provides personal care and accommodation for up to four adults with a learning disability, some of whom may also have a physical disability. The home is owned by Avenues Trust Limited. The Chestnuts is located in a rural area on the outskirts of Hildenborough (a few miles from Tonbridge) some distance from local shops and other general amenities. The home has four single bedrooms, a kitchen, lounge, dining room and utility room. There is a secluded garden. Car parking is available in a small drive and by the roadside to the front of the house. The home has a vehicle for the benefit of residents. The registered manager is a trained nurse (RNMH) and has completed the Registered Managers’ Award. The home employs care staff, working a roster, which gives 24-hour cover. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Helen Martin, Inspector for the CSCI, undertook this unannounced inspection on the 13th October 2005 between 15.00 and 18.00. The visit included talking with residents, staff and the manager. Some judgements about the quality of life within the home were taken from observations and conversation. Some records were looked at. In addition, a tour of the home and garden was undertaken. The home currently has four residents and no vacancies. What the service does well: 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 The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 6 contacting your local CSCI office. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 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 DS0000024012.V258364.R01.S.doc Version 5.0 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, 5 Prospective residents and their representatives receive sufficient information about the home before they decide to move in. EVIDENCE: The home has adequate pre-admission information. A Statement of Purpose and a Service Users Guide are available for prospective residents and their representatives. These give details about the home and the service provided. This is to enable a decision about the suitability of the home for the prospective resident. Residents are helped to understand the information, as it is presented in a suitable format. The home has the capacity to meet the assessed needs of individuals with high dependency needs. All residents’ have a contract with the home. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 9 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, 8, 9, 10 Residents’ are supported to make their own choices with their goals and preferences reflected in their care plans. EVIDENCE: Following initial assessment to determine the suitability of the home for a potential service user, an individual written care plan is begun. Each resident has a detailed care plan. This is added to as on-going reviews of residents’ needs require and particularly every six months after major reviews involving care managers and others. Care plans give clear guidance for staff about the actions to be taken to meet the health and welfare needs of residents. Their changing needs, individual goals and preferences together with procedures for challenging behaviour and specialist input are reflected. Care plans contain risk assessments and any restrictions on residents’ choice and freedom. These provide guidelines for staff regarding action that can be taken to reduce the level of risk for residents. Risk assessments include daily and specific activities. Residents are encouraged to make choices. Where residents are unable to make informed judgements staff are supportive and caring. Residents receive The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 10 continuity of care by having individual key workers. Residents participate as much as possible in all aspects of life within the home. Known preferences and views are taken into account. Residents are unable to manage their own finances due to their disabilities and appropriate assistance is given. Because of their higher dependency needs, residents do not generally have the capacity to undertake household and personal tasks, although staff encourage them to be involved as much as possible. Information about residents (the main information is kept in each residents’ bedroom) is held in a confidential and secure way. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 11 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): 11, 12, 13, 14, 15, 16, 17 Residents enjoy individual lifestyles with opportunities for social, educational and recreational experiences. EVIDENCE: The home helps residents towards the maintenance and development of social and communication skills. Residents are treated as individuals who have different interests and preferences. Opportunities are provided accordingly. Members of staff support residents to become part of the local community and to have access to leisure activities. Residents’ activities and access to the community is recorded in their care plans. The general lifestyle of residents was discussed. Examples of activities offered to residents include Aromatherapy, hand and foot massage and DVDs. Sensory equipment is available. The home has it’s own vehicle and outings are organised, such as Hydrotherapy, meals out, cinema and theatre trips, parks and steam trains. One resident enjoys shopping for clothes. Residents are very much part of the local community. Residents are encouraged to maintain relationships with their friends and The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 12 families. They are able to see their family and friends as often as they want to. Residents’ relatives and friends are invited to join in activities within the home. Because of their higher dependency needs, residents do not generally have the capacity to undertake household and personal tasks, although staff encourage them to be involved as much as possible. Some residents are able to go on holiday, whilst others who don’t have the capacity are offered days out. Some residents are going abroad this year for a holiday and days out. Funding is available for holidays, although residents are sometimes asked to contribute if the price is expensive. Residents are encouraged to be as involved in shopping and cooking, as they are able. Staff are aware of residents’ likes and dislikes. At the time of inspection, they were clearly looking forward to a pork stir-fry. The meal looked appetising and generously sized. Residents’ nutritional needs are monitored and special diets can be provided where necessary. In the case of a service user with deteriorating health, the home provides protein drinks (obtained on prescription), a soft diet and assistance at mealtimes. Residents enjoy privacy in their rooms and staff respect this. Staff talk to residents in a friendly and polite way. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 13 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, 20, 21 Residents benefit from good support which meets their individual personal and healthcare needs. EVIDENCE: Residents are given the personal support they need, while respecting their dignity and privacy. Staff have a good understanding of the preferred routines of each resident. Residents’ personal and care needs are met by a flexible and responsive staff approach. Designated key workers are in place. Each resident has access to a GP, care manager, dentist, optician and other healthcare professionals and services. They also visit a chiropodist and a hairdresser as necessary. Service users are supported to attend appointments. Community nurses visit the home on a regular basis and provide Epilepsy training for staff. Liaison with a speech and language therapist takes place. All appointments with health professionals and others are recorded in residents’ care plans. No residents keep their own medication. Residents are protected by the arrangements in place for the storage and administration of medication. Records are kept of all medicines received, administered and leaving the home. Staff who administer medication are trained and their competency is checked. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 14 The home can support residents who have serious illness and such a service is currently being provided. Members of staff have experience in helping residents and their families. Members of staff are able to obtain the support of additional social and healthcare services. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 15 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, 23 Residents’ views are listened to and acted upon. Residents are protected from potential abuse, although this could be enhanced by an external appointee. EVIDENCE: Residents are listened to and their views are taken seriously and acted upon. The manager said that the home has not received any complaints, only letters of compliment. If any complaints were received, these would be recorded. The procedures available within the home protect residents from potential abuse. There is a written policy available. Adult protection training for staff is to be provided in the near future. The home keeps cash on behalf of residents who all have their own bank accounts. Records of all transactions and receipts are kept. One resident’s cash was checked, which tallied with the amount shown in the records. The manager is an appointee for three residents, as they said no other party is available. The company regularly audits financial accounts. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 16 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, 25, 26, 27, 28, 29, 30 Residents benefit from living in a clean, comfortable and homely environment which meets their needs. EVIDENCE: The building fits in with the local community and has a style and atmosphere that meets individuals’ needs. At the rear is a well-maintained secluded garden, which includes a sensory area and gazebo. Residents are able to go anywhere in the house and garden. A garage/utility room houses the laundry facilities, which are domestic in nature. A maintenance schedule has been agreed with the owners of the premises (West Kent Health Authority) via Kelsey Housing Association. Residents benefit from living in a clean, tidy, well-maintained, comfortable and homely environment. Adequate recreational, dining, toilet, bathing and individual accommodation are available to residents. All residents have their own rooms, on the ground and first floor, which are highly personalised. Furnishings are suitable for residents’ individual needs. Residents benefit from the provision of aids and adaptations. Their safety is maintained by chained and coded external doors and gates. A hoist is available. One resident has sensory equipment in their room such as mirrors, The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 17 lights and music. Special lighting for a resident with the SAD condition is provided. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 18 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): 31, 32, 33, 34, 35, 36 The number of staff provided meets residents’ needs. Residents are supported by an effective staff team, although additional NVQ training would enhance this. EVIDENCE: Staff showed a good understanding of residents’ needs and the homes philosophy and values. Residents benefit from good support and interaction. All staff have job descriptions that are kept on file. Staff training appropriate to meet the health, safety and welfare needs of residents is provided. New staff can be provided with induction and foundation courses. Staff have been trained in food hygiene, Dementia, manual handling, the management of aggression, health and safety and first aid. The manager is a qualified trainer and is able to provide some courses for the rest of the staff team. They have recently updated their qualification and are shortly to provide adult protection training. Examples of certificates were seen. No staff have obtained an NVQ qualification, with the exception of the manager. Two staff are currently in the process of undertaking NVQ level 3. It is planned that another will undertake NVQ level 2. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 19 At the time of inspection, the number of staff provided met residents’ needs. The home provides two support workers for four residents during the day. One member of staff sleeps in at night, with an on-call rota of local managers and senior staff. There is a stable and permanent team, with some individuals having worked within the home for several years. Two bank staff are used to cover any absences. Support workers also undertake cleaning and cooking, they aim to involve residents with these tasks wherever possible. No ancillary staff are employed by the home. The manager said that no new staff had been recruited for some time and many had been working at the home since it’s opening in 1994. All staff have undertaken a Criminal Records Bureau check and samples were seen. Residents are protected by appropriately supervised staff. Regular 1 to 1 supervision takes place, which includes the identification of training needs, goals and the role of keyworking. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 20 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): Residents benefit from a well run home and their health, safety and welfare are protected. EVIDENCE: Residents benefit from a well run home. The manager is a trained nurse (RNMH), has obtained the Registered Managers’ Award and is also a qualified trainer and aroma-therapist. They have extensive experience of managing care for people with learning and physical disabilities. The manager has a rota for working with the direct care of residents and management tasks. It was said that sufficient time was allowed for the management of the home. A small core of staff, consistent over the years, has helped to produce a settled atmosphere at the home, helping residents feel confident and secure. Residents feel comfortable spending time with staff. The manager has a three-year business plan. This is updated quarterly to reflect responses to quality assurance questionnaires. These are sent to residents’ relatives, care managers and healthcare professionals. The owning The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 21 company undertakes audits for residents’ finance, care planning and health and safety. Records seen were completed appropriately and were kept in a manner that preserved confidentiality. The relevant maintenance and safety checks are undertaken for systems and equipment within the home. Examples of records were seen. Risk assessments are carried out in relation to individuals, procedures and the premises. Staff training appropriate to meet the health and safety needs of residents is provided. The Chestnuts DS0000024012.V258364.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 3 3 4 3 LIFESTYLES Standard No Score 11 4 12 3 13 4 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Chestnuts Score 4 4 3 4 Standard No 37 38 39 40 41 42 43 Score 4 3 3 X 3 3 X DS0000024012.V258364.R01.S.doc Version 5.0 Page 23 No 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard YA23 YA32 Good Practice Recommendations The manager is appointee for three residents. It is strongly recommended that a review should be undertaken to confirm that no other viable options are available. It is strongly recommended that an action plan should be developed to ensure that a minimum of 50 of the staff team obtain an NVQ qualification as soon as possible. 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