Inspection on 15/03/07 for The Chestnuts

This inspection was carried out on 15th March 2007.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Chestnuts 24/10/05

The Chestnuts 18/04/05

The Chestnuts 09/11/04

The Chestnuts 04/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE The Chestnuts Wrotham Road Meopham Gravesend Kent DA13 9AH Lead Inspector Marion Weller Key Unannounced Inspection 15th March 2007 09:30 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 DS0000024032.V332955.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 DS0000024032.V332955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address Wrotham Road Meopham Gravesend Kent DA13 9AH 01474 812152 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) Mr Michael Knowles Banks Mrs Patricia Banks Mr Michael Knowles Banks Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residential care for two Older Persons with a Dementia condition DE. To `admit persons under the age of 65 years from time to time`. Date of last inspection 24th October 2005 Brief Description of the Service: The Chestnuts is a privately owned care home for older people. The home is a large detached property standing in its own grounds, which has undergone substantial conversion. It is registered for twenty-nine residents who are over 65 years of age. To the rear of the property there is a large and attractive garden with seating for residents use. Residents’ accommodation is located on the ground and first floor, with the second floor of the home being used for administration purposes. There is a Stannah stair lift and a separate passenger lift serving the first floor, which gives step free access throughout. The home is situated in the village of Meopham and is close to local shops, a Post Office and is on a main bus route. There is a main line railway station in the village. There is ample parking for visitors to the front of the building. The home employs care staff working a roster, which provides 24-hour cover. Current fees range from £380 to £456 according to assessed personal need. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 09:30 am and 4:45 pm. During that time the inspector spoke with some residents, the owner/ manager, his wife and daughter and some of the staff on duty. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. In addition a tour of the building was undertaken. Responses from residents indicated they were very satisfied with the standard of care the home provided. Statements made during the site visit included: “I feel satisfied with the choice (of home) I made and I feel safe here. I am well taken care of” “The staff are so good, very caring and they helped me to settle in. I was sad to be leaving my own home” AND “It is a comfortable home that you can’t really find fault with, – what more can you ask” The manager and staff gave their full co-operation throughout the site visit. What the service does well: The Chestnuts provides a welcoming, friendly and homely environment for residents. Information about the home is easily accessible and staff are effective in helping new residents settle in. Residents’ health needs are well met and medication is given correctly and regularly reviewed. The home enjoys good relationships with other health care professionals. Staff members were seen to be kind and caring. Residents clearly benefit from the ethos, leadership and management approach of the home. Residents enjoy a wholesome and varied menu of meals. Residents’ relatives and friends are always made welcome when they visit. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 123456 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People accessing and using this service have the information they need to make an informed decision about whether the service is right for them. The personalised pre admission assessment means that residents’ needs are clearly identified and planned before they move into the home. Residents are given a written statement of the terms and conditions of their residency that clearly tells them about the service they will receive, the fee to be charged and the room they will occupy. EVIDENCE: The home has a Statement of Purpose and a Service Users Guide. Residents are given their own copies, which are presented, in a leather ‘hotel style’ folder, which is kept in their bedrooms. The information in the folder clearly outlines the facilities and services provided in the home. In addition to this, The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 9 the owner/ manager speaks with prospective residents or their representatives in order to answer any remaining questions they may have. The owner/manager stated that the home’s information documents are reviewed annually or more frequently if there is a need. The documents were clear, easy to read and informative. They would however benefit from a further minor review. The Dept of Health has changed regulatory requirements recently to clarify in more detail the type of general information about fees and related services that care home providers must include in information documents. The home needs to review the current content of information documents to ensure they continue to meet the demands of regulation. The home has recently completed building work to add a further three bedrooms to the current accommodation. Information documents may need further minor review to reflect the additional number of places registered with the Commission. The owner/manager stated that the three bedrooms are not yet furnished or ready to be offered for occupation however this work is in hand. The home has a clear process for undertaking pre admission assessments. The owner/manager or a member of the senior care staff visits the prospective resident to make a decision about whether the home can meet the person’s needs. Information is also obtained from other parties, including relevant health care professionals and forms the basis for the care the home provides. Residents or their representatives are able to visit the home before moving in and some residents said staff had been very helpful in assisting them to settle in. Each resident or their representative was provided with a contract or statement of terms and conditions between the home and themselves. The documents are comprehensive with fees to be charged in evidence and the room number allocated to individuals. The home’s contracts clearly state the responsibilities of the home and the rights of the resident. Intermediate care is not offered at The Chestnuts. The Chestnuts DS0000024032.V332955.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. This judgement has been made using available evidence including a visit to this service. Residents’ health and social care needs are set out in their care plans ensuring that these needs will be met. They would benefit further from a single system of care planning being adopted by the home to ensure consistency of approach and to avoid any confusion. Residents are largely protected by the home’s policies and procedures regarding medication. They can be confident that where shortfalls exist the home will review its arrangements and facilities in light of good practice advice to secure their safety and protection. Residents’ privacy and dignity is considered important and their independence is promoted. EVIDENCE: Residents care plans were seen to be individually maintained in the home and were made available to staff for guidance. Some were inspected closely. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 11 Content covered health; personal and social care needs of residents. Written daily records maintained by staff had improved since the last inspection and work continues to make sure they always reflect the demands of individual care plans. It is in the home’s interests to be able to show what they have done, along with providing the evidence on which to base a resident’s monthly review and to record that they are following the individuals’ assessment of needs. The home currently uses a traditional Standex care planning system and one, which is computer, based. Staff can report work completed with individual residents directly to the electronic system for recording, using hand held devices. The owner/ manager appeared keen to rationalise the care planning systems in the home and to eventually remove the traditional hand written Standex system. Both systems have some shortfalls inherent in their composition and use. The situation was discussed at length to ensure that future plans safeguarded residents. Should the computer based electronic system be fully implemented, the home should remain mindful that electronic records must provide sufficient detail in relation to the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the individual are met. Any system used must also be able to evidence a resident’s involvement in, and their agreement to, the plan of care formulated by the home. The individual or their representative must sign the document, as the standard requires. A residents care plan must be in a format and style that is accessible to them or their representatives and they must also be informed of any changes made to it. This information should be shared and evidenced when the plan is reviewed on a monthly basis at the home to reflect changing needs and the current objectives for health and personal care. The home must evidence that staff are fully trained in the use of the electronic system and are known to be competent in its use. They must have access to information that tells them how to care for a resident with ease. Electronic records must be backed up to ensure there is no possibility that entries can be lost or changed by any individual who may have access to the system. The home stated their intention to take these matters into consideration when making their final decision. Residents said they receive all the assistance they need. Care workers were observed assisting residents in a way that was consistent with that described in care plans There was evidence that showed that residents’ doctors are called promptly when there is a concern about an individual’s health. Plus appointments are The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 12 made with other visiting medical professionals – Optician, Dentist, Chiropodist, etc Residents said that care workers are pleasant, kind and friendly in their manner towards them, while at the same time being respectful of their individual preferences. It was noted on several occasions during the site visit that care workers varied their approach according to what they knew to be residents’ different expectations of them. For example, some people wanted to spend quiet time in their bedrooms, while others wanted to be in the company of others in the lounge or to walk alone in the garden. Medication is largely managed well in the home. The home use’s a Monitored Dosage System for administration and staff follows the home’s medication policy and procedure. Other advisory documents, such as The Royal Pharmaceutical Guidelines were in evidence to further inform and guide staff. There are some minor areas regarding medicine storage that could be improved upon. The home does not have a dedicated lockable medicine fridge for cold storage of medicines, where it is necessary. They use a locked box in the main domestic fridge. Whilst it is important to be proportional, the home is increasing in size and this resource should now be included in the home’s forward planning to meet best practice demands. Domestic fridges have on occasions to be adjusted to achieve the correct temperature range for medicines requiring cold storage. Medication administration sheets were being completed well, with no obvious gaps. Second signatures were in place for handwritten entries to ensure accuracy of transcription. The home has a small lockable box in the main medication trolley for the storage of Controlled Drugs, which is not best practice. They do use a Controlled Drugs register. The manager said that no residents were currently prescribed Controlled Drugs. It is recommended the storage of controlled drugs is reviewed and best practice advice followed. Residents are given the choice of self-medication within a risk assessment framework and have lockable facilities in their rooms for the storage of the medicines retained by them. No residents self-administer medicines currently. The local Pharmacist visits the home regularly and advises on medication issues. Only a minimum number of staff was seen to have received external medication training and this was some years out of date. This issue was discussed. The owner/ manager stated the intention to arrange medication training, and to formulate a procedure for checking and recording medication administrators on going competency in the administration of medicines. The privacy and dignity of individuals in care practice and the handling of privileged information is currently sound. The home carefully considers end of life care and the manager is proposing to develop care plans still further in this direction. This standard was not comprehensively inspected on this occasion. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. Social activities and opportunities for mental stimulation are regularly offered to residents. These diversions provide some variation and interest. Residents are enabled to exercise choice in their everyday lives and receive a varied and healthy diet. Residents are enabled to maintain contact with friends and family who are made welcome in the home. EVIDENCE: Residents benefit from a suitable range of activities provided by the home and are encouraged to maintain their independence and exercise their right to choice and control. Someone from the local church visits regularly and those wishing to take Holy Communion can do so. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 14 There is a very pleasant and large garden at the rear of the home and two residents were seen outside ‘taking the air,’ as one explained. People are free to come and go as they wish. Residents maintain contact with their family and friends who are made welcome in the home. There are three separate lounge areas in the home that residents and visitors can use to achieve some privacy, as well as being able to use the resident’s bedroom. The dietary needs of residents are well catered for offering both variety and choice. The home purchases mainly pre prepared food, which necessitates little food preparation time for staff. On the day of the site visit there were two main meals and two desserts on the menu for residents to choose from. Care staff all takes turns to cook as part of their normal caring role. There is no ancillary catering staff employed. The system appears to work well and staff stated that they are very careful to pay attention to infection control measures. For instance, the person detailed for cooking the meal will not also take on personal care duties during that time. The system ensures that the home is not short of people who can cook. The dining room was attractively laid up for lunch. The owner/ manager stated that the home was able to offer special diets. Residents said they are regularly offered refreshments and snacks if they so wish. There was evidence of residents exercising choice. For example, people said that they decided for themselves when to got up and when they went to bed and how to spend their day. Residents’ personal choices and likes and dislikes were recorded on care plans. One resident said she would like staff to spend more time talking with her, but she realised this was not always possible. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Residents have access to a clear complaints procedure which they or their representatives understand and know how to use. They further benefit from having their views and concerns listened to and acted upon without delay. Residents would be further protected if all staff were trained in Adult Protection issues. EVIDENCE: The home has a clear complaints procedure in place, which explains how residents and their representatives can make a complaint about any aspect of the facilities and services provided in the Home. A Copy of the complaints procedure is included in the information folder provided to residents and kept in their bedrooms for ease of access. It was noted that the complaints procedure viewed evidenced an outdated title for the regulator. This should be amended to avoid any confusion for residents or their representatives wishing to contact the Commission at any stage of a complaint. Residents spoken with said that they were confident that any matter they raise will receive serious attention and if possible will be addressed. One resident stated that she felt very safe and secure in the home, much more so than when she was living on her own and that was a huge relief to her. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 16 Information provided by the home prior to the site visit recorded that one formal complaint had been received since the last inspection. This had been responded to appropriately by the provider and records were on file showing clear outcomes. The owner/manager is evidently very proactive in resolving any concerns raised and genuinely wants people to be satisfied with the service they receive. They home could not evidence that they record minor concerns raised with them to inform quality assurance or the home’s business planning. This issue was discussed and it was confirmed that this aspect of the quality assurance process would be addressed in future. The owner/manager and staff had a sound understanding of what constitutes good care practice. As part of this, they are aware of the need to be alert to instances, which might jeopardise the well being of a resident. They are aware of the various agencies external to the home to which reference can be made, should they become concerned. The home could evidence a copy of Kent & Medway’s Adult Protection Policy. It was stated that they use this as the basis for their own safeguarding practice. The recommendation issued at the last inspection to obtain a copy and review the home’s policy and procedure to ensure it was in line with the lead agencies document, has been met. The home’s Adult Protection Policy is included in staff induction procedures. Evidence was seen that one member of staff had been trained by the local authority as a trained trainer for Adult Protection matters. Unfortunately the staff member had recently been absent from the home and training had not been completed for staff as intended. This and other staff training requirements were discussed. The owner/manager stated the intention to address these shortfalls as quickly as possible. This must now be a priority. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 17 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 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in a safe, well maintained, and clean environment in which good standards of décor and furnishings are maintained. EVIDENCE: Residents said that they were comfortable living at The Chestnuts and that they consider the accommodation to be very homely and welcoming. A tour of the building was undertaken with the owner/manager. No defects in the general presentation of the accommodation were found. The home was seen to be clean, odour free and well maintained. The home has recently increased the size of the accommodation offered by adding three bedrooms. These new rooms were seen. All have been The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 18 completed to a high standard and registered by the Commission. The owner/ manager stated these rooms are not yet ready to be occupied, but that work to furnish them is in hand. There was an adequate number of shared use toilets and bathrooms to enable residents to access these facilities without having to wait or otherwise to be inconvenienced. There were various items of equipment in place to assist staff meet the needs of residents who experience a measure of reduced mobility. These include items such as hoists and banister rails along hallways. There is a passenger lift installed and a stair lift that one resident was seen using unaccompanied. Care workers said that enough provision had been made to enable them to safely undertake all aspect of their work and to support residents to maintain their independence. The home has an infection control policy. This was seen to be adhered to. Particularly in relation to the carers extended role in the home, in that they prepare and cook residents’ meals as well as providing their personal care. The laundry room was clean with suitable resources for laundering residents’ clothes. One resident stated “My clothes are always returned to me smelling fresh, clean and ironed. That is important to me.” There is a call bell system installed in the home. This means that there are call points in most areas from which residents can summon care workers should their assistance be required. Residents like their bedrooms. They said that they have enough facilities in them to use them as bed sitting areas in the manner envisaged by the Standards. The inspector had the opportunity to see several bedrooms and these were noted to be very comfortable and pleasant spaces, which reflected the preferences and interest of their occupants. The home has a large and pleasant garden at the rear of the property which residents regularly access. The home’s kitchen was clean and orderly. Cleaning schedules were in evidence. The Environmental Health Officer had visited the home. No problems were noted or recommendations made during that visit. The home commendably provides a visitor’s bedroom with ensuite facilities if it should be required. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 19 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. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by a dedicated staff team who are well supported and supervised. The home continues to train and develop its staff to ensure residents’ needs are met at all times however, there are areas of staff training that need prompt attention. Residents would further benefit from the home formulating a training matrix that gives a clear overview of staff training needs. EVIDENCE: There was sufficient staff on duty during the day of the site visit to meet residents needs. The owner/ manager discussed the possibility of an increase to current staffing levels when three new bedrooms, recently added to the accommodation are occupied. Staff appeared unhurried on the day of the inspection and residents were clearly having their needs met. Residents spoke highly of the staff. They said they found them very capable and had confidence in them. There are clear levels of responsibility in the home. In discussion it was found that staff had no issue with catering as well as caring and felt they had The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 20 sufficient time to undertake all tasks. Domestic staff are employed but contracts and job descriptions state their role as domestic/carers. The owner/ manager believes this approach provides for greater flexibility and enables the home to fill vacant roster hours, thus ensuring residents’ needs are always met. The carer responsible for cooking the meal does not also care for residents during preparation and dishing up and there is sufficient staff on duty to facilitate this. Staff spoken with were very aware of maintaining good infection control measures in the home due to the innovative way staffing is approached. Suitable staffing rosters are in place, which take account of busy times. The owner manager stated that staff are very dedicated and committed to the home and will always offer to work additional hours to cover vacant shifts. No agency staff is used in the home. The home evidenced a very effective staff team, who have the residents at the heart of their work. Staff files inspected met the requirements of regulation. Staff files held training records, certificates gained, supervision and appraisal notes. The home’s application form needs further review to ensure it meets the demands of regulation. The owner stated the intention of revising the document. CRB and POVA Checks were in evidence in staff files to ensure the protection of residents. The owner/ manager stated that staff supervision and appraisal take place on a regular basis now to meet the standard required of at least six times a year. The requirement issued at the last inspection to facilitate regular staff supervision has been met. The manager uses a template that records staff training completed. An overview of staff training to date, training planned and updates due, would benefit the home and would give them a clearer overview of staff training needs. A recommendation to this effect will be made. In the respect of qualified staff, three staff holds an NVQ Level 2 & 3 in Care. A further staff member has a NVQ Level 3. There is five staff with a Level 2. Three staff are currently in the process of gaining the qualification and two staff are on modern care apprenticeships. The home has 26 staff in total and therefore falls just short of the requirement for 50 of trained staff. This will be met however when those in the process of gaining their qualifications have completed their assessments. The home uses a staff induction package supplied by a professional training organisation. The owner/ manager was of the opinion that the contents met the Skills For Care standards. The organisation was said to have recently updated the induction book. Contents were seen to be comprehensive. The owner/ manager stated the intention to check content against the Skills for Care website. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 21 It was noted on pre inspection information sent to the Commission that some staff training is overdue and is now a priority. The home has suffered some disruption recently due to the absence of some senior members of staff. It has been necessary for the owner to take on the operational management of the home in the absence of a Registered Manager. These issues are receiving attention and the home is currently in a transitional stage. There are some mitigating circumstances for current shortfalls. However, a requirement to address staff training will be made as a consequence of this inspection to ensure the home can evidence it’s usual good practice. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 22 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 33 35 36 38 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service. Residents’ benefit from the home being managed by someone who is experienced, competent and resident focussed. Residents’ financial interests were protected and their welfare promoted through regular maintenance and equipment safety checks. Residents’ benefit from a staff group who receive formal supervision and regular support however there are areas of staff training that need prompt attention to ensure that a consistent high standard of care continues to be delivered. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 23 EVIDENCE: There are various arrangements in place to promote effective teamwork in the home. These include handover meetings at the end of each shift and the completion of records in relation to each resident. Daily records have improved since the last inspection. Periodic staff meetings are held. These enable staff to meet and to discuss their work and to receive instruction, guidance and support. There are clear lines of accountability and everyone spoken with understood their role. Residents and staff said they found the owner/manager approachable, supportive and knowledgeable. The atmosphere in the home was calm and pleasant, residents spoken with were happy, contented and felt well looked after and cared for. The owner/ manager and his wife, who co owns the home, have a sound understanding of how it operates in practice. Both are very experienced and resident focussed. Residents spoken with said that the home is run without there being any intrusive rules or routines. This means that they continue to experience a normal home life of their choosing. The home has suffered some disruption recently due to the absence of some senior members of staff. It has been necessary for the owner to take on the operational management of the home in the absence of a Registered Manager and for another experienced family member to assist with the home’s administration. The home is currently in discussion with family stakeholders who are seeking a solution to address some of the issues. It is therefore in a transitional stage and there are mitigating circumstances for the current shortfalls in some areas, particularly staff training and the qualification requirements for the manager. A requirement to address staff training will be made as a consequence of this inspection to ensure that a consistent high standard of care continues to be delivered. The owner/manger operates a system by which residents and their representatives are invited to comment about their home. Information received as a consequence of quality assurance processes are collated. Any issues of dissatisfaction are investigated and dealt with promptly. The owner / manager said that all items of equipment in use remain in good working order and are regularly serviced. Maintenance certificates seen were current. The home now has a file that evidences all of the required documents/ certificates necessary to confirm residents’ welfare is being promoted through regular maintenance and equipment safety checks. The requirement issued at the last inspection has been met. The Registered Provider continues to maintain a suitable system which is designed both to prevent the occurrence of a fire safety emergency and to The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 24 manage one effectively should the need arise. The owner/manager stated that requirements raised by the Fire Officer during the building of the home’s new accommodation wing have all been met. The Commissions Central Registration Team have now completed their work and issued a revised Certificate of Registration to the home. The home’s policies and procedures had been reviewed regularly in line with good practice advice and current legislation and records were stored securely in locked cabinets in a room on the second floor, which is kept locked when unoccupied. All staff spoken with knew how important it was to maintain residents’ privacy and confidentiality Small amounts of cash are kept for residents in the home. The money is kept securely; Records show balances and checks made to ensure accuracy. The home encourages relatives and representatives to support residents with their finances. Staff supervision and appraisal now takes place regularly. Records were seen on staff files inspected. The Requirement from the last inspection is now met. The home notifies the Commission in a timely manner of any issue that affects the welfare of residents. The owner’s wife, herself a trained nurse, will now undertake official visits monthly and prepare a report on the conduct of the home. The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 25 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 X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Timescale for action The registered person shall make 01/08/07 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. • In that: Staff must receive suitable training and be regularly assessed for competency to administer and manage medicines. The registered person shall make 01/08/07 arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. • In that: All staff must undertake training in the protection of vulnerable adults. 01/08/07 Requirement 2. OP18 13 (6) 3. OP38 OP30 18 (1) (c) The registered person shall (i) having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that staff employed by the care DS0000024032.V332955.R01.S.doc The Chestnuts Version 5.2 Page 27 home receive training appropriate to the work they are to perform. In that: All staff must receive mandatory training and update training on all safe working practice topics. Appropriate courses should be undertaken by staff or booked for individuals to attend by the timescale given. • 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 OP7 Good Practice Recommendations It is recommended that a single system of care planning being adopted to ensure consistency of approach and to sufficiently evidence good practice in the care planning process. It is recommended that residents or their representative’s sign their care plan to evidence both their involvement with the documents formulation and their agreement to the plan. It is recommended that the manager fulfil the stated intention of reviewing the medication administration practices and storage facilities in the home in line with good practice advice to secure residents safety and protection. It is recommended a training matrix be used to readily identify staff training needs. It is recommended that the Registered Person undertakes up to date qualifications relevant to the care the home is providing or appoints a manager willing to undertake the qualification. 2. OP7 3 OP9 4 5 OP30 OP31 The Chestnuts DS0000024032.V332955.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © 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 DS0000024032.V332955.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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