CARE HOMES FOR OLDER PEOPLE
The Chestnuts 169 Norwich Road Wisbech Cambridgeshire PE13 3TA Lead Inspector
Don Traylen Key Unannounced Inspection 8th December 2006 14:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 169 Norwich Road Wisbech Cambridgeshire PE13 3TA 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) 01945 584580 Arnas Mauremootoo Arnas Mauremootoo Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 3rd October 2005 Brief Description of the Service: The Chestnuts is registered as a care home for up to eighteen people over 65 years of age. An increase from 17 to 18 places was approved by the CSCI on the 26th September 2005. There are no conditions of registration recorded for this service. The home is situated in a residential area in the town of Wisbech and is close to local amenities and has good road links to the cities of Cambridge, Ely, Peterborough and the town of March. The home is an integration of an older two- story house and an adjacent bungalow. A ground floor extension has been added. The building has been adapted and extended to provide accommodation for older people. There are sixteen single rooms and one double room. All bedrooms have wash hand basins and twelve rooms each have a toilet. One room has full on suite facilities. A stair lift allows easy access to the first floor. The home has two separate lounges, a dining room, a spacious entrance hall, a conservatory and a hairdressers room. The garden and grounds to the front and rear of the home are pleasant. The driveway has parking facilities for approximately six cars. At the time of inspection fees charged by the home were £340 per week. This is a standard fee asked by the home that represents the ‘benchmark’ amount determined by Cambridgeshire County Council and Cambridgeshire Primary Care Trust for funding service users. The home charges the same fee to all service users, regardless of whether they are private and self- funding, or are partially financed by a local authority or PCT. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Prior to the visit to the home, consideration was given to the level and content of the documentation and of activities reported by the home since the previous inspection in October 2005 and of their previous inspection report in October 2005. This ‘key’ inspection of the home lasted 3.5 hours and was conducted by one inspector and included a tour of the home and discussions with service users, both in groups and individually to determine their views and opinions about their care, as well as observing aspects of their care. The registered manager and the deputy manager and two care staff were spoken to. Care plans and medication records and policies were read. The assistant manager was available throughout the inspection and feedback and discussion about this inspection was given to her. What the service does well:
In the previous inspection the home was judged to have provided a safe, friendly and relaxed atmosphere for service users. On the cold and damp day of the inspection the home was a warm and comfortable and well-lit environment. Service users were occupying the different areas of the home and were seated in small groups and stated they had chosen where they wished to sit. Service users were seen to be are treated with respect and were spoken to in a natural, kindly manner. Service users stated that friendly and attentive staff cared them for. Overall, the care that was observed was person-centred and the re-assuring impression was given that each person is important. It was stated in the last inspection report that the registered provider, Mr Mauremootoo, has made improvement to his service and he continues to aspire to make further improvements in the future and made this plans known to the inspector during the inspection. The management example set by the registered provider (who is also the registered manager) is very open and inclusive of staff and of service users and community based care and health professionals. The management of the home is shared by the registered provider and the assistant manager and is effective in that it is strongly principled in striving to provide good care and is quietly determined to ensure that improvements can be made to the home. Staff recruitment is rigorous and ensures that service users are protected as much as possible as a result of this process.
The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The reader is asked to refer to the previous report to consider the home’s continuous improvements. The home has come to a juncture in their approach to achieving improvements after a frenetic period of improvements. The manager explained that they are now better able to consolidate their staffing structure. The home has increased their staffing numbers and the manager explained they are now looking to retain staff and intend to provide further training and encouragement to their staff and to improving the quality of care. The manager stated that the objective is to identify and train care staff whilst considering the realistic prospects of developing their potential for a career in care. Staff training is encouraged and a variety of courses have been made available for care staff. The home has provided care to their maximum number of places for service users and has therefore managed to increase their numbers of service users (and respite provision) and thereby has brought about an improved financial outlook to the business. The large trees at front of home have been lopped and some have been cut down and this has allowed much more natural light into the front of the home and allowed more visitor parking spaces. The home had demonstrated they are protective of service users by appropriately reporting their concerns about the potential harm that may have been experienced by a service user. New chairs for the main lounge have been purchased, as has a pressurerelieving cushion and slide sheets for assisting service users to move and a chair, weighing machine has also been purchased and used to record weights of service users. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good. Service users and their representatives are offered all the information they would like and every opportunity to asses the home prior to deciding if they would like to live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users and relatives spoken to assured the inspector they were provided with sufficient information about the home and the fees and were given the opportunity to visit and assess the home prior to deciding whether to live there. The home has clear and straightforward contracts signed by service users or their representatives. The homes Statement of Purpose confirmed the above approach by the home. Intermediate care is not provided by the home. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good. Service users living in this home are treated with respect and their dignity is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six service users and two visiting relatives confirmed on the day of inspection they were treated respectfully by care staff whom they stated were, “helpful” and “ they are there for you when you want them” and “the home is good”. Outcomes are good for service users living in this home. Care plans showed a full range of needs are identified and planned for. Further clarity to locate the sections of the care plans are recommended and the elements of care that have been reviewed should be made easier are clear what are the current ways of providing to meet service users’ needs that have changed. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 11 Medications records were checked and found to accurate records of the amounts of medication and had been well maintained. Insulin that had been prescribed by injection for one service user is given daily by a District Nurse, but the amounts of insulin stored by the home had not been recorded by the home, although a record was maintained by a District Nurse. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. The home’s service users experience a good quality of daily life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users who spoke of their experiences of their care confirmed they were satisfied with their lifestyle and that contacts with families and friends was encouraged and facilitated by the home. Visiting relatives indicated they could visit at any time, within reason, and they had been enabled to stay in the home at a time of poor health and an anticipated death. A record of meals provide is maintained and service users stated their food was satisfactory. One service user said the food was, “tip-top”. Service users are monitored for their food intake and their weight is regularly checked and recorded in their care plans. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. Service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home maintains a complaints log. Service users are regularly consulted and asked for their opinions in an informal daily approach that was observed during the inspection. Service users were given adequate opportunity to raise a complaint and some service users stated they would complain to the manager should they so choose. All service users spoken to knew the manager by name and said it was easy for them to speak to him about any matter. The home has a whistle blowing policy and a written abuse policy to protect service users. All staff bar two recently recruited have undertaken, ‘Protecting Vulnerable Adults from Abuse’ training provided by Cambridgeshire County Council trainers. The manager is undertaking a key practitioners’ training course provided by the Cambridgeshire County Council. One member of staff confirmed her understanding of her responsibility to immediately report any allegation or suspicion of abuse. The home has recently demonstrated they support the procedures and guidelines concerning the protection of vulnerable adults that has been published and recommended by Cambridgeshire County Council.
The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,23,24,25,26, Quality in this outcome area is good. The environment is clean and warm and meets service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was warm and very well furnished and kept clean and bright. New chairs have been purchased for the main lounge. Room number 15 was propped open with a chair and did not have an operative fire closing devise, as did other bedroom doors. Some rooms did not have service user’s names on and rooms did not have lockable safe storage places for service users money. The front exterior area of the home has been made lighter by the removal and lopping of branches of large trees.
The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. Service users are protected by the home’s safe recruitment policies and the This judgement has been made using available evidence including a visit to this service. EVIDENCE: The process for recruiting staff meets the Care Homes regulations and is rigorously applied. The home has a satisfactory recruitment policy and procedures. Two staff and an assistant manager and the registered manager are usually working for five days of each week and one night care staff is on duty. One of the 18 service users commented that the home is sometimes short of staff. It is recommended the home review their staffing levels to ensure that service users needs are always adequately met. The observations of staff and service users interactions revealed they are capable of providing good personal care and attention. A range of adequate and appropriate training course are made available to staff. However, training in Dementia care had not been provided to staff and it is considered that this training is essential for staff to be better prepared and capable of meeting service users’ needs. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38, Quality in this outcome area is good. The management of this care home is in safe and competent hands and focuses on the best interests of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager and the assistant manager work very well as a team and share the same philosophy and enthusiasm for promoting good care for their service users. The registered manager/ provider holds an NVQ level 4 management award and has had previous experience of management tasks in a care home. The deputy manager also holds an NVQ level 4 award in management and is an NVQ Assessor and holds NVQ level 3 in teaching. She is a competent deputy with nine years experience of NVQ assessing and is capable of managing the home. She has had 11 years in a management position prior to working at the Chestnuts in January 2004.
The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 17 Discussions with staff and a tour of the building showed that care staff did not have any dedicated area for their breaks and did not have a staff room, or a resource room, where they might have access to literature and other types of information about care practices to enable them to further their knowledge of the care and the care industry. The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 3 The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2), & Schedule 3, (3)(i) Requirement The registered person must ensure that any supplies of insulin kept by the home and the injections administered by a District nurse, must be recorded and the amounts of insulin must be accounted for by the home. The home’s medication policy must include a section dealing with the procedures for handling, administering and managing ‘PRN’ prescribed medication and with the management and storage of insulin when administered by a District Nurse. The registered person must request a Fire Safety Officer to assess service users’ bedroom doors for the suitability of the self-closing fittings. Service users’ rooms must be provided with a safe and lockable cabinet so they may safely store their money or valuables. The registered person must ensure that care staff are trained in dementia related care. Timescale for action 31/01/07 2 OP9 13(2) 28/02/07 3 OP19 23(4)(a) 31/01/07 4 OP24 23(2)(m) 28/02/07 5 OP30 18(1) (c[i]) 31/03/07 The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 20 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 3 4 Refer to Standard OP7 OP7 OP27 Good Practice Recommendations The home should continue with their intention to record Care Plans in a person- centred manner. Care Plans should be indexed and should make reviewed plans and current instructions easier to identify and should avoid unnecessary repetition. It is recommended the registered person review the home’s staffing levels to ensure that service users needs are being adequately met. Staff should be provided with a dedicated private area or room, where they can relax and eat when they are taking a break from their duties and the room should be equipped with whatever essential reading and health and care journals and books and information, such as a code of conduct, the manager and staff may agree to have access to. The registered person should consider the use of the internet as a manner for staff to access a range of relevant information in regard to their work. The managers and assistant managers office should be rearranged in a style that allows care staff easier access urgent and vital information and contact details whenever they might need them. OP32 5 OP32 The Chestnuts DS0000059065.V323146.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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