Inspection on 16/09/05 for The Chestnuts

This inspection was carried out on 16th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 13/01/09

The Chestnuts 02/01/07

The Chestnuts 07/02/06

The Chestnuts 28/01/05

The Chestnuts 23/09/04

The Chestnuts 29/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE The Chestnuts The Avenue Ross-On-Wye Herefordshire HR9 5AW Lead Inspector Wendy Barrett Unannounced Inspection 16th September 2005 09:45 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 DS0000024734.V251613.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000024734.V251613.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address The Avenue Ross-On-Wye Herefordshire HR9 5AW 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) 01989 562031 01989 567608 caring@chestnutsha_freeserve.co.uk Chestnuts The (Ross-On-Wye) Housing Association Ltd Mrs Julie Caroline Powell Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28 January 2005 Brief Description of the Service: The Chestnuts (Ross-on Wye) Housing Association Limited (also a charitable organisation) has operated this home since 1991. The provider leases the building from Herefordshire Council and must carry out the maintenance and any improvements to the property. The home is registered to accommodate up to thirty people aged at least sixtyfive. Service users may require care due to a range of care needs arising due to the ageing process, including physical disability, dementia or a mental health disorder. The Chestnuts comprises of a large Victorian house, set in private grounds, and is situated in a residential area within a reasonable walking distance of Rosson-Wye town centre. The property was converted to a care home many years ago and an extension was added to the original house in the 1960s, which has been totally upgraded within the last few years. All of the bedrooms are single, sixteen of them having en-suite facilities, and are located on three floors with two shaft lifts provided. The bedrooms on the upper floor in the original part of the building are not easily accessible for service users with restricted mobility although those in the extension are suitable to accommodate wheelchair users in respect of the space available and their accessibility. The home offers two sitting rooms, a separate dining room and a sun terrace as communal space for the service users. The garden is reasonably sized and provides a very pleasant and easily accessible area for service users and their visitors. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that was carried out between 9.45am and 3.30pm. The Care Manager was at work and a considerable amount of the time was spent with her clarifying the current situation and developments since the last inspection. Staff and residents were seen around the home. One resident was interviewed in the privacy of his bedroom. Staff interviews were not conducted on this occasion. However, feedback questionnaires were sent out prior to the inspection for staff to submit their views on the service. Four replies were received. The focus of the visit was on reviewing compliance with previous inspection requirements, checking whether action has been taken in response to recommendations from visiting representatives of the Provider, and gaining a general overview of the service at the point of this inspection. Some records and documentation were inspected during the visit, and the Commission’s own records of contact with or from the service since the last inspection were referenced. What the service does well: There is written information available for prospective residents to find out what the home offers and what the service costs. Staffing levels are good and the health care needs of residents are well met. Residents benefit from a programme of regular social events at the home but they can also follow a more individual lifestyle if they wish. The Provider and Care Manager keep the Commission well informed about the situation at the home in between inspections. There have been no complaints made to the Commission about the service. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 DS0000024734.V251613.R01.S.doc Version 5.0 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 the following standard(s): 1 There is literature available to prospective residents that describes the service and will help them decide if the home would suit them. EVIDENCE: There has been a previous recommendation to revise the home’s Statement of Purpose and Service User’s Guide so that it contains all the required information. The Commission received a new copy of a Residents Handbook during this inspection. A copy of a Charging Policy was also received. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 the following standard(s): 7 and 8 Residents are looked after well in respect of their personal and health care needs. The quality of record keeping is improving and should continue to be developed so that it fully reflects the quality of the care being given. EVIDENCE: A sample of care records identified an appropriate process of assessment, care planning and review. The care planning system has been subject to ongoing development e.g. nutritional screening has been introduced since the last inspection. This development work should continue to ensure that staff have clear and up to date guidance on the actions they should take to meet each resident’s needs. This is particularly important where there are areas of potential risk. The Assistant Care Managers review each plan on a monthly basis and key workers contribute through a monthly report. Fourteen staff were due to attend a training session on continence management, and four staff had attended a study day on dementia care in February 2005. The home has purchased two additional pressure-relieving mattresses at the end of last year in response to increased frailty of residents. The Care Manager and senior staff are complying with a regulatory requirement to notify the Commission of accidents/illnesses etc. occurring at The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 10 the home. These reflect thorough and prompt attention to emerging health care needs and appropriate referral to other health care professionals when necessary. A care assistant was observed attending to a minor injury. This was done in a respectful but cheerful manner. Hygiene considerations e.g. wearing protective gloves were addressed. There is a system at the home of colour coding cleaning cloths as part of infection control. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 the following standard(s): 12 and 14. Residents are encouraged to keep control over their lives so that they can continue to live in a way that suits them. EVIDENCE: A report of a visit to the home by the Provider’s representative referred to an interview with a resident. At this point the resident felt unhappy at the home. He was interviewed in the privacy of his bedroom during this inspection. He was much happier now and described how he was adjusting and finding he could maintain control of his daily routine with some support from staff when needed. There were examples of recent social events e.g. nine residents had been on a trip to ‘Horseworld’ the previous week, there had been an outing to Brecon railway the previous month, and a country and western evening had been held on 20th August. A resident had recently returned from a cruise holiday, escorted by a friend. Another resident regularly goes out into the local community. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 the following standard(s): 16 There is a commitment to take complaints seriously and to make sure appropriate action is taken if this is necessary. EVIDENCE: There is a complaints procedure that provides guidance for staff in dealing with complaints. There is also a complaints policy for the information of residents and their relatives/representatives. No complaints have been made to the Commission about the service at Chestnuts. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 the following standard(s): 19 and 26 The accommodation is receiving maintenance attention although there are some areas in need of redecoration. The home is kept clean but there needs to be more careful attention to identifying potential health and safety hazards around the building. EVIDENCE: The home was clean and tidy when this unannounced inspection took place. There were no bad smells in the building. There are examples of ongoing attention to the upkeep of the accommodation e.g. decoration, arrangements for additional storage space, refurbishment of vacant bedroom in readiness for new occupant. Some paintwork is chipped (probably caused by wheelchairs) and a section of wallpaper was falling off the office ceiling. The ceiling of a first floor corridor needs attention to water damaged paintwork. A professional Fire Safety consultant was due to help the Care Manager with risk assessing the use of door wedges. This work has been subject to The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 14 regulatory requirement at two previous inspections, and must now be addressed promptly. Bedroom door closures are not linked to the fire alarm system and there was an example of a door that did not close securely. Some bedroom doorframes did not have intumescent strips to ensure an effective firebreak. The risk assessment should identify what further work may be required to contribute to the fire safety of the building as a whole. A previous recommendation advised that bath water temperatures should be checked and recorded on a regular basis. This practice confirms that the automatic controls are working effectively. There has been no action taken in response to this recommendation and it is now subject to a requirement. The Care Manager felt that the arrangements for legionella control were satisfactory. The process for this assessment should be recorded. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 There is a satisfactory level of staff employed. The way staffing is arranged should be reviewed because some staff feel they are not able to get their work done. New staff are not always being recruited in a way that will best assess their suitability to work with vulnerable adults. The staff are receiving the type of training they need to develop their competence. EVIDENCE: A good level of supervisory, care and ancillary staff supports the Care Manager. Three of the staff feedback questionnaires indicated inadequate levels of staff employed on direct care and weekend laundry duties. The Care manager described pressures on her time in addressing previous inspection requirements and recommendations. This picture suggests that there is a need to consider whether staffing arrangements need further review to ensure they are being used to best effect. A related recommendation is made. There are examples of further attention to staff training programmes e.g. involvement in N.V.Q., health and safety, professional practice instruction. Two staff files were inspected. One record reflected a thorough recruitment process that complies with regulatory requirements. The second staff file was less positive. Portable references are no longer acceptable and ‘open’ references should not be accepted. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 There is good oversight of and support for the service from the Provider. Staff at the home promote the health care of residents. There needs to be more attention to the overall safety of the premises and essential services. EVIDENCE: The Provider had responded promptly to a suggestion from its visiting representative and the Care Manager was now able to order skips to remove large items of rubbish. The Commission is receiving reports of visits by the Provider’s representative. Notifiable events are also being reported appropriately. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 17 Evidence included under the ‘Environment’ section of this report suggests that there is unsatisfactory attention to premises health and safety factors. An electric lead was trailing across the walkway in the office. This could present a tripping hazard. The Care Manager explained that this had resulted from the recent installation of a new piece of computer equipment. Covering the wire with tape would have improved the situation until the office furniture could be re-organised. This advice was given to the Care Manager during the inspection visit. There are records of kitchen risk assessment exercises. The records indicate that the risk assessments need to be more regularly reviewed to ensure they are kept up to date. The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 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 x x x x N/A 2 x x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x 1 The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 19 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement All recruitment must be processed in line with substituted Schedule 2 to the Care Homes Regulations 2001 (9th July 2004). Care staff must receive appropriate induction training. The induction programme introduced by the home must be in accordance with relevant specifications and be fully implemented. (Not fully reviewed. Carried over with revised timescale) A risk assessment must be undertaken regarding the wedging open of service users’ bedroom doors and included in the home’s written fire risk assessment. (Previous timescale of 31st March 2005 not met). Water temperatures (particularly in baths) must be checked regularly and this recorded to ensure that thermostatic controls remain effective. There must be a recorded system of regular auditing of the DS0000024734.V251613.R01.S.doc Timescale for action 15/10/05 2 OP36 18 31/10/05 3 OP38 13 and 23 15/10/05 4 OP38 13(4) b 15/10/05 5 OP38 13(4) 30/11/05 The Chestnuts Version 5.0 Page 20 6 OP38 13(4) c premises and facilities (with action taken when indicated) to maintain the safety of residents and staff. There must be a record of risk assessment in respect of legionella protection, with details of any action taken to monitor the water supply arrangements. 31/10/05 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 The development of the care planning system should continue to ensure that care records and plans clearly show that all individual service users’ care needs have been assessed and how they have (or should) be addressed by care staff. The Provider should review the way that the Care Manager and staff share out the work in the home. This exercise should include consultation with staff and residents. 2 OP27 The Chestnuts DS0000024734.V251613.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 DS0000024734.V251613.R01.S.doc Version 5.0 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!