Inspection on 15/06/05 for The Chestnuts

This inspection was carried out on 15th June 2005.

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 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 31/05/07

The Chestnuts 09/11/05

The Chestnuts 17/11/04

The Chestnuts 22/07/04

The Chestnuts 20/10/03

The Chestnuts 28/01/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Chestnuts Lavric Road Aylesbury Bucks HP21 8JN Lead Inspector Caroline Roberts and Guy Horwood Announced 15th June 2005 9:30am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address Lavric Road, Aylesbury, Bucks, HP21 8JN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01296 414980 Heritage Care Mr Satyanarain Lutchmiah Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (64), Physical disability over 65 years of age (0), Sensory impairment (0) The Chestnuts Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 That staffing levels on the dementia care groups are reviewed 3 monthly to ensure staffing is sufficient to meet Service Users needs. the outcome of each review is to be documented and maintained in the home. Date of last inspection 17th November 2004 Brief Description of the Service: The Chestnuts is a purpose built care home situated on the Southcourt estate in the market town of Aylesbury, which has a variety of shops. The Chestnuts is registered to accommodate sixty-four service users, thirty two of whom have dementia care needs. All bedrooms are single with en-suite facilities. The home is devided into four groups, each with its own lounge, dining room and small kitchen. The home has two shaft lifts and a variety of moving and handling equipment. The home has its own mini bus which makes access to Aylesbury town centre much more accesible. The Chestnuts Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the announced inspection carried out at The Chestnuts on the 15th June 2005, between 9.30am and 4.30pm. The lead inspector was Mrs Caroline Roberts who was accompanied by Mr Guy Horwood (Inspector). The inspection consisted of meeting with Residents and staff, viewing records and documents pertaining to the provision of care and the running of the home. The inspectors toured the building, gaining permission from a number of residents to enter their bedrooms and viewing a further number from the doorway. The inspectors met and discussed the inspection findings with the manager, Mr Lutchmiah, and the deputy managers, before leaving. The inspectors found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspectors would especially like to thank the residents for their time and for allowing the inspectors into their home. What the service does well: The standard of the environment within this home is good providing residents with a clean, attractive and homely place to live. The home is equipped with pressure relieving devices and moving and handling equipment, thus enabling staff to meet specific health care needs. Residents have access to a variety of health care services external to the home. Residents appeared well cared for, and the inspectors had the opportunity to speak with a number of residents during the visit. Comments received included, “The food is good”, “The staff are kind”. Residents are able to choose where they spend their time, and to furnish their bedrooms with personal belongings. The providers are pro active in the refurbishment and on-going maintenance of the home, creating a homely and pleasant environment. The Chestnuts Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Chestnuts Version 1.10 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The admissions procedure is not followed consistently; therefore residents may be inappropriately admitted to the home. EVIDENCE: The home has an admissions procedure, which includes meeting potential residents prior to admission. The records for the four most recent admissions were viewed. Information is obtained from social services prior to the assessment-taking place in the form of a care service order. The assessments viewed were not consistent in the level of detail they contained. The Chestnuts Version 1.10 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9. The home has a care planning system in place, however, those care plans viewed were inconsistent in the level of information recorded, therefore residents needs are not clear, or up to date and do not enable staff to provide the most appropriate care. The home has developed good working relationships with external healthcare providers; therefore ensuring residents have access to a variety of healthcare services. The systems for the administration of medication require review, to ensure that residents are not placed at risk. EVIDENCE: A random selection of care plans were viewed, some of which pertained to recent admissions to the home. These care plans included moving and handling, tissue viability, continence and individual risk assessments. Records of visits undertaken by healthcare professionals were insufficiently detailed. These assessments were incomplete in several of the care plans viewed. The Chestnuts Version 1.10 Page 10 The documentation pertaining to daily well being was found to contain inappropriate comments pertaining to the behaviour of residents by staff. The use of tippex was noted in several records. These issues were discussed with the manager at the time of the inspection. During the inspection, care plans and residents care needs were discussed with individual staff members. Through these discussions staff were able to demonstrate a much better knowledge of residents and their personal care, health and social needs than was recorded within the related care plans. Due to this lack of detail contained within care plans, it would appear that should staff who were unfamiliar with the residents be charged with their care, (for example agency care staff), the residents would not be guaranteed the same level of care provided by regular staff employed at the home. It was noted that the home accommodates some residents with specific healthcare needs, (for example Diabetes), and through discussion with staff members ascertained that in some cases their knowledge of these conditions was limited. It is strongly recommended that the manager include training pertaining to these specific healthcare needs within the existing staff-training programme. All residents are registered with a local General Practitioner surgery, partners of which visit the home in order to undertake monitoring and review of residents. The home has equipment for the provision of specific healthcare needs. This includes pressure relieving devices, moving and handling equipment, weighing scales and nutritional supplements. The practices relating to the handling, storage and administration of medications within the home were viewed. Storage of medication is satisfactory. This was not the case with regard to recording and administration. It was noted that: • • • Staff hand write instructions on medication administration records without evidence of the original prescription, Eye drops were not dated when opened, A member of staff had not received accredited training in the handling and administration of medication, yet was tasked with administering medication within the home. The Chestnuts Version 1.10 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The dietary needs of residents are well catered for, with a balanced and varied selection of food available that meets with residents tastes and choices. EVIDENCE: A number of residents were spoken with and everyone who commented on the food said it was good. The menus were viewed and found to offer variety. The kitchen was visited and the head chef spoken to. The chef was in the process of cooking the day’s meal, and this appeared appetising and to be cooked with diligence and skill. A variety of fresh produce and known brands were noted in the kitchen store. Lunch was sampled and was found to be well cooked, very tasty and well presented, residents are offered second portions if they so wish. The chef confirmed that specialist diets could be catered for upon request. Throughout the day it was noticed that hot and cold drinks were offered to residents on a regular basis. Supplementary drinks were noted to be available where required. The Chestnuts Version 1.10 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed at the time of this inspection. The Chestnuts Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,26 The standard of the environment within this home is satisfactory, providing residents with a clean, attractive and homely place to live. EVIDENCE: The Chestnuts is a modern purpose built care home situated in a residential area of Aylesbury. Residents are accommodated in single bedrooms, all of which have en-suite facilities. The organisation employs maintenance and gardening staff. The grounds appeared accessible to residents and provide a secure area for the residents. It was noted at the time of the inspection that some attention is needed to the garden areas to make them appear more appealing. The home has a variety of lounges, all of which are a good size and are decorated in a homely style. Furnishings are domestic in character and meet The Chestnuts Version 1.10 Page 14 the needs of individual residents. Individual bedrooms contained personal belongings reflecting the character of the occupant. The home has disabled bathing facilities in addition to en-suites. The home was found to be clean and tidy on the day of the visit. The laundry was of an adequate size, with suitable equipment provided. The laundry assistant said that she had sufficient time to perform her duties. The sluice on Cedar group, was noted as needing a good clean. The Chestnuts Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Residents needs appear to be met by the numbers and skill mix of staff. Residents are protected by the homes recruitment policy and practices. EVIDENCE: At the time of inspection the home appeared to be adequately staffed to meet residents needs. The usual staffing levels within the home were discussed with the manager, and staff numbers on duty at the time of the visit appeared to mirror those depicted within the staffing rota. The recruitment files of four recently appointed members of staff were viewed, and these contained the required information as per Regulation 19 and Schedule 2 of the Care Homes Regulations 2001. The Chestnuts Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,38 The homes manager has the skills, knowledge and experience to discharge his duties fully; therefore residents live in a home, which is well managed. The home has not been proactive in ensuring that potentially harmful items are stored appropriately, which potentially places residents at risk of significant harm. By the use of door wedges the health and safety of residents, staff and visitors is compromised. EVIDENCE: The homes manager, Mr Satyanarain Lutchmiah, is a qualified nurse, possesses a suitable management qualification, and has many years experience as a homes manager. The manager presents as competent and experienced to manage the home. The Chestnuts Version 1.10 Page 17 The management structure within the home provides a good role model for care staff and their provision of care. The manager and his deputies were open, co-operative and courteous throughout the visit, and this was also the case with all staff spoken with. At the time of the inspection, the inspectors noted the use of wedges to hold open several fire doors. This practice is unacceptable as poses a risk to the health and safety of residents and staff. The manager was able to provide all records that were required for the inspection. These were well maintained, up to date and generally subject to review. Records were stored securely where required. Moving and handling equipment was present, and this appeared to have received regular servicing. Window restrictors were fitted to all first floor windows. During the tour of the premises, prescription creams and latex gloves were found in bathrooms and en-suites. Due to the category of Residents accommodated by the home, it is not safe for these items to be on display. The homes accident reports were viewed. documented. These were appropriately The Chestnuts Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 4 3 x 3 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 4 x x x x x x 2 The Chestnuts Version 1.10 Page 19 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. 1. 2. Standard 3 7 Regulation 14(1) 15(1) Requirement Accommodation must not be provided to residents unless their needs have been fully assessed. Care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Residents care plans must be kept under regular review. All staff are to be adequately trained in the handling and administration of medications. Handwritten instructions within medication administration charts are to be supported with evidence of the original prescription. Prescription creams, lotions and laytex gloves must be stored appropriately. Doors are not to be held open unless with approved hold open devices following discussion with the fire officer. An immediate requirement was served on the day of the inspection. Timescale for action 01.08.05 01.09.05 3. 4. 9 9 12(1), 13(2) 12(1), 13(2) 01.10.05 01.08.05 5. 6. 38 38 13(4) 13(4), 23(4) 15.06.05 15,06.05 7. The Chestnuts Version 1.10 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. Refer to Standard 7 8 9 Good Practice Recommendations The use of tippex within care plans should cease immediately. It is strongly recommended that training is provided to staff with regards to diabetes care. It is strongly recommended that eyedrops be dated when opened. The Chestnuts Version 1.10 Page 21 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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 Version 1.10 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!