Inspection on 14/01/06 for The Chestnuts

This inspection was carried out on 14th January 2006.

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

The Chestnuts 23/08/07

The Chestnuts 20/09/06

The Chestnuts 23/09/05

The Chestnuts 10/08/04

The Chestnuts 18/05/04

The Chestnuts 06/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Chestnuts 9 Lodge Road Yate South Glos BS37 7LE Lead Inspector Karen Walker Unannounced Inspection 14th January 2006 09:30 The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 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 DS0000003402.V276116.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000003402.V276116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address 9 Lodge Road Yate South Glos BS37 7LE 01454 227252 0117 9709301 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Miss Michaela Jane Spray Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd September 2005 Brief Description of the Service: The Chestnuts is registered to accommodate up to eight service users with learning disabilities. The Home is run by Aspects and Milestones Trust and is divided into two segregated units called Woodland and Meadow View, which are managed as one. The Home is situated in a quiet lane with few other residential buildings nearby. The centre of Yate is about a mile away. The Trust is in the process of building bed-sit accommodation on a plot next door. The property consists of a large, extended Victorian house set in its own grounds and with a well kept garden and patio area. The Home has two cars for the use of service users and public transport can also be accessed a short distance from the Home. Parking is available at the front of the premises. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of this inspection was to ensure good practice recommendations and requirements made at the last inspection have been met. The standards not assessed at the last inspection have also been assessed. Residents were case tracked and care documentation was examined in respect of them. Records relating to health and safety and the general running of the home were also examined. The inspector met with a limited number of residents at the home due to them carrying out previously arranged activitities. A senior staff member gave information relative to this report and a resident helped with a tour of the building. What the service does well: What has improved since the last inspection? This is the first visit carried out by this inspector however it was noted that all of the requirements made at the last inspection had been met. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 6 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 DS0000003402.V276116.R01.S.doc Version 5.1 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 DS0000003402.V276116.R01.S.doc Version 5.1 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): 2,3,4,5 Residents are confidant that their assessed needs will be met and that they will receive terms and conditions of occupancy. It would be beneficial to ensure these terms and conditions were accessible to all residents either in picture or audio format. EVIDENCE: Residents’ case tracked were in receipt of the ‘statement of terms and conditions of occupancy’ which had been signed by a staff member as being read and explained to them. The statement would benefit from being in a format more suited to each individual’s communication skills and understanding, which greatly differ from person to person. The admission procedure was seen which made it clear that prospective residents would not be admitted before an assessment had taken place. The admission is a staggered process where the resident can visit for a meal and gradually progress to an overnight stay. A staff member said ‘this can carry on until we are sure the person will fit in and we can meet their needs’. It was noted that the original assessment fed information into the Essential Lifestyle Plan (ELP), care plans and risk assessments this ensures continuity of support. Support information was reviewed. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 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 Residents are confident that their assessed needs and associated risks are reflected in the care plan and that they can make their own informed decisions on service provision. EVIDENCE: It was noted that care plans and associated risk assessments were in place to ensure assessed needs can be met. One folder had good clear information on supporting someone with complex communication needs. It included a description of the person’s behaviour, what the staff think it means and how they should respond. One example noted is ‘he pushes you away. This means he’s not interested or happy with you. Leave him alone’. Positive reputations are recorded and plans concentrate on skills as well as need. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 10 Staff confirmed that residents have monthly meetings and every Saturday there is a communal meal where the two houses get together and discuss any ideas or concerns. Staff attend training on the use of ‘makaton’ and use ‘objects of reference’ to support communication. Records show that residents are empowered to make decisions about their own lives and about the running of home. There are plans to change one bedroom into a ‘flat incorporating a kitchen and bed-sit to encourage the development of new skills and independence. It was seen that this was also identified on the annual business plan for the home. Risk assessments are comprehensive and evidence was seen that staff are working hard to encourage residents to be as independent as possible within the parameters of their risk assessments. Risk assessments were varied and include aspects of daily living as well as the management of ‘behaviours which may be described as challenging’. It was noted that one risk assessment stated that ‘staff must be trained in ‘PRT’. This was discussed with the senior staff member on duty who confirmed that no form of restraint was used and the training referred to the theory behind diffusing potentially difficult behaviours and situations. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 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): 16 The daily routines and house rules promote independence and individual choice. Any restrictions in choice or movement are recorded and risk assessed. EVIDENCE: Staff were observed knocking on residents doors and speaking to them respectfully but in a friendly manner. It was evident that residents are supported to be as independent as possible within a risk-assessed framework. The kitchen in the ‘woodlands’ is accessible to residents and staff members confirmed residents are supported to make snacks and drinks. Some residents are not able to open and understand their own mail so they are supported by the staff members. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 12 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): 19,20,21 Residents are confident that their health care needs will be met and that medication prescribed will be reviewed appropriately. Residents will soon have information relating to their wishes in the event of their death added to their care plans assuring their likes, dislikes and final wishes can be carried out. EVIDENCE: The homes medication practices were assessed. Medication was stored appropriately and each unit had a separate drugs cabinet. The monitored dosage system is used and one staff member said the chemist provide medication training to all staff. This is in addition to the competency tests set by the qualified nursing staff at the home. It was noted that there is rectal diazepam in stock. This was signed in and out of the home where necessary and it was confirmed that all staff had received training in its administration by the district nurse. The senior staff member on duty said individual Strategy plans were in place so that staff knew exactly when to use rectal diazepam, if and when to administer a second dose and when to contact the emergency services. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 13 The medication administration record sheets were in place and in good order. There was a picture of each resident and a brief summary of how the person likes to take their medication. This is good practice. There was written evidence in the care planning folders examined that the consultant psychiatrist reviews the medication every 3 months and liaises with the general practitioner. It was noted that the appropriate healthcare professionals were accessed where necessary and records show input from the speech therapist, occupational therapist, chiropodist, dentist, general practitioner and opticians. Whilst it was noted that two care planning folders did not contain information relating to the ‘residents wishes in the event of death’ it was confirmed by a staff member that a form had been sent to relatives to gain their views and this information had not yet been returned. This is used where residents are not able to make their views known. Staff that know residents well are still able to contribute to the plan by adding for example a known piece of favourite music or favourite flowers. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 14 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): X EVIDENCE: These standards were assessed and met at the last inspection. It was noted however that a system for dealing effectively and efficiently with complaints is in place. Procedures for the protection of vulnerable adults are well established. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 15 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): 27,29,30 Residents live in a clean tidy environment that is suited to their assessed needs. EVIDENCE: One resident was observed to pull down the curtains from the hall area. It was noted that Velcro held the curtains in place so that at a later time they could be re-hung without distress to the resident. There were grab rails positioned appropriately in the bathrooms and by toilets to maximise independence however no hoists or lifting equipment is currently needed. There were adequate toilet and bathing facilities. One bedroom was bare of pictures or ornaments and the curtain had been removed. A covering had been put over the bottom part of the window to support privacy. The staff member explained how this was the resident’s choice and was maintained to avoid unnecessary distress and anxiety. A tour of the environment took place and it was noted that each room was clean and tidy. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 16 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): 34,36 Residents can feel confident that they are protected by a sound recruitment system. This is reinforced by regular supervision for staff where policy and procedure is discussed. EVIDENCE: It was noted that all staffing records are held at the Trust HQ. The senior staff member on duty confirmed that all other records relating to the staff were kept in a lockable facility and were unavailable in the manager’s absence. The recruitment policy was examined and it was noted that it made reference to ‘police checks’. This needs to be updated to include the Criminal Record Bureau (CRB) checks and the Protection Of Vulnerable Adults (POVA). It was noted however that information on CRB checks was made available in the policy file. The organisation will take action for this update. The policy detailed the recruitment process from start to finish including the seeking of references and seeks to ensure the safety of residents. Residents are further protected by a number of in-house policies relating to staffing including, the duty rota, the covering of shifts, the communication book and its use, the role of the shift co-ordinator and the mentor system where a new staff member receives a mentor for the first two week of employment. This is good practice. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 17 There is easy access to the job descriptions and person specifications of all staff to ensure staff are aware of their roles and responsibilities within the home. staff confirmed regular formal supervision. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 18 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): 40,43 Residents views are taken into account and residents benefit from accountable management. Residents’ rights and best interests are safeguarded by the homes policies and procedures. EVIDENCE: There is a 2005/06-business plan in place covering key-issues such as; staff training and development, person centred planning, communication, leisure and recreation, service development and the environment. There is an action plan detailing how and when the changes will be made. Regular ‘regulation 26’ visits take place to ensure the home is providing a quality service to residents. The visits were confirmed by staff members and are unannounced. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 19 The home has one vacancy and is operating within their conditions of registration. The home has adequate liability insurance. At the last inspection it was noted that residents are consulted wherever possible about how the Home is run and how they feel about any possible changes to routine. Quality monitoring systems are now in place to measure how successful the home is at achieving its aims and objectives. Staff awaydays have been held to underpin this monitoring and evidence was seen of staff and resident meetings that fed into this process. There are a number of organisational policies and procedures in place all readily accessible to staff members. There are also a number of in-house policies and procedures devised to meet the needs of the resident group at the Chestnuts. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 20 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 X 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 3 X X X 3 X X 3 The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 21 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 Refer to Standard YA5 Good Practice Recommendations Ensure residents’ contracts are provided in an accessible format. The Chestnuts DS0000003402.V276116.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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