Inspection on 18/12/08 for The Chestnuts

This inspection was carried out on 18th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Chestnuts 11/12/07

The Chestnuts 22/08/06

The Chestnuts 21/03/06

The Chestnuts 24/10/05

The Chestnuts 01/03/05

The Chestnuts 24/08/04

The Chestnuts 04/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chestnuts 57 Bargate Grimsby North East Lincs DN34 5AD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kate Emmerson     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Chestnuts 57 Bargate Grimsby North East Lincs DN34 5AD 01472345513 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cleethorpes Care and Nursing Ltd Name of registered manager (if applicable) Marie Rose Land Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: That the occupant of the room must have no significant mobility problems Date of last inspection Brief description of the care home The Chestnuts is a well established home situated in a pleasant central location of Grimsby. It has access to local amenities and public transport. The building is Victorian in style with a modern extension providing care for up to 26 residents. The home caters for the needs of residents with the problems of old age and mild to moderate dementia. The home consists of three storeys serviced by stairs and a passenger lift. There are twenty single rooms, of which nine have en-suite facilities and three shared rooms. The home has registered a room on the first floor which has conditions applied due to configuration limitations. There are bathroom and WC facilities located on each floor. Care Homes for Older People Page 4 of 29 care home 26 Over 65 26 26 0 0 Brief description of the care home There is one lounge, a conservatory and dining room, all of which are located on the ground floor. The home has pleasant front and rear gardens with ample parking to the side of the property. The current scale of fees are £329- £367 per week. Additional charges include activities, chiropody, hairdressing, newspapers and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was unannounced and took place on the 18 December 2008. The last key inspection was conducted on 21 January 2007. We examined the written documentation in the home including care plans, medication records, staff recruitment, staff training and health and safety records. We conducted a tour of the building and viewed a random selection of bedrooms. We spoke to some of the people living at the home to see if it was helping them to meet their needs and provide them with a happy and comfortable environment to live in. Surveys were also sent to the home and we received three completed surveys from the staff group. Care Homes for Older People Page 6 of 29 The owner, manager and members of staff on duty were spoken with. We also spoke to a district nurse and a community psychiatric nurse during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: A copy of the assessment of peoples needs should be held. These should be signed and dated on completion to evidence that they were agreed by the person using the service and completed before admission. Care Homes for Older People Page 8 of 29 Peoples care needs and associated risks must be set out in detail on the care plans. To ensure staff have complete information to meet peoples care needs safely and consistently. They should ensure that the care plans and risk assessments are discussed and signed by the person using the service or their representative. The medication policy and procedure should be further developed to include procedures for disposal of medication and the action to take in the event of a medication error. A training plan should be developed to identify all the mandatory training needs and how these are to be met over the next year. The manager should make sure that all the staff have completed mandatory training in the past year in moving and handling and protecting vulnerable adults. Where the home is managing money on behalf of residents they must maintain accurate records and receipts for all transactions. Records of fire system checks must be kept up to date and audited regularly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs had been assessed and care plans had been developed, this meant that staff had information to be able to meet peoples needs. However they had not always made records of the assessments and they had not always dated or signed the assessments to evidence that these had been completed before people were admitted to the home. Intermediate care is not provided. Evidence: Six care files were checked. There was evidence in the files examined that the home had undertaken an assessment of peoples needs in most cases. In one case there was no record of an assessment as in the other care files but a reasonably detailed care plan was in place to inform carers of the persons care needs. In another the home was working from the placing authorities care plan as this had been an emergency Care Homes for Older People Page 11 of 29 Evidence: admission. The assessments were not always dated or signed by the person completing them to evidence that the information was gathered prior to the person being admitted to the home. Assessment before admission is important to ensure that peoples needs can be met in the home. The assessments that had been completed were well-presented and linked clearly to individuals care plans. The assessments included information from people who used the services and their representatives and health professionals. This evidenced that the home worked in partnership to ensure full information about peoples lives and care needs was recorded. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs were generally met and people felt they were treated with respect. However care plans did not always reflect peoples needs which may lead to their care needs not being met. Evidence: Five care files were examined. The home was in the process of transferring information onto new care plan formats and these were not as detailed as the previous care plans and there were some inconsistencies and gaps in the these care plans. For example in one care file where the person was at risk of pressure sores there was no care plan developed to show the care required to minimise this risk but in two other care plans this was recorded. In another case where where a person had specific dietary needs this was well recorded but in another where the person had had a weight loss this was not followed up and a plan of care had not been devised. Where bed rails were required risk assessments had been completed in one case but not in another. Care Homes for Older People Page 13 of 29 Evidence: The home had developed good links with health professionals. A visiting district nurse and community psychiatric nurse (CPN) spoke highly of the care provided in the home and of the management and staff. A chiropodist regularly visited the home and records showed assistance was given to attend other health care appointments such as the optician and dentist when required. The home had developed links with the dietetics department at the local hospital and staff had attended training. Staff demonstrated, when asked, that they had a good working knowledge of peoples needs. One person living in the home said that the care was excellent. Not all the care plans or risk assessments were signed by the individual or their representative to show that these had been discussed and agreed. The home demonstrated that it administered medication appropriately by keeping comprehensive and fully completed records. This included controlled drugs. Medication was stored appropriately and the temperature of the room and cabinets were monitored. Records and discussions with staff confirmed that those who administered medication had been trained to do so. The medication policy and procedure did not include procedures for disposal of medication or the action to take in the event of a medication error and this should be further developed. One person had been prescribed a medication to manage their behaviour on an as required basis. Records did not support the reasons for administering this medication, for example there were no records of incidents or changes in the persons behaviour to explain the decision to administer the medication. It is recommended that a care plan be developed to ensure a consistent approach to managing this persons behaviour and administration of this medication. People spoken with said that staff treated them with respect and were polite. Staff were constantly alert to peoples needs and positive, lively and supportive interactions were observed between individuals and staff. A number of people said that the staff were nice and kind to them. Staff were observed to speak to people appropriately and use peoples preferred term of address. In discussion with staff about respecting peoples privacy, staff were able to demonstrate that they understood the need for sensitivity when carrying out personal care tasks. Staff were observed to knock on peoples doors prior to entering and people said that their privacy was respected. Care Homes for Older People Page 14 of 29 Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good facilities were provided for people to experience activities and community and religious involvement of their choosing and maintain contact with their relatives and friends. Meals were nutritious and balanced, offering a healthy and varied diet. Evidence: Although social needs and preferences were not always identified on assessment and care planning in this area was very minimal peoples lifestyle in the home satisfied their social, cultural religious and recreational needs. This was evidenced from talking to people living in the home and staff. A range of weekly activities was offered in the home including bingo, reminiscence, board games, baking and arts and craft. Staff were observed to positively encourage and assist people with activities. Religious services were regularly held in the home and people were able to attend church services in the community if they wished. Contact with family and friends was promoted by the home. People were positive Care Homes for Older People Page 16 of 29 Evidence: about being able to see their friends and family when they wished. A number of people in the home commented about the food and how good it was. comments about the food included very good and excellent. Menus were balanced and varied. The menus indicated that a choice was available at every meal. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident that complaints would be listened to and taken seriously. Procedures and staff training were available to protect people from abuse. However there was a lack of clarity and poor record keeping in the management of peoples finances which did not offer people protection in this area. Evidence: The home had a clear complaints procedure in place and this was displayed in the home. People spoken to said that they were were very happy and had no complaints about the home and felt confident to raise issues of concern if they arose. The relationships between staff and people who live in the home were observed to be open and inclusive. There had been no complaints since the last visit to the home. The home had a policy in place to protect people from abuse. Staff spoken with were clear about reporting procedures should anyone make an allegation of abuse. All staff had received training in this area via the local council. This subject was also covered in supervision sessions and questionnaires were also used. There were some gaps in the training records and the manager was advised to review records to ensure all staff had received refresher training in last twelve months. There had been no allegations of abuse in the home. However we made a referral to the Local Authorities safeguarding team following the inspection of peoples financial Care Homes for Older People Page 18 of 29 Evidence: records.(see management and administration section) Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, hygienic and well maintained and suitable for the people accommodated. Evidence: The facilities that the home provides for people were of a high standard. The home was regularly decorated and a planned programme of maintenance was in place. The toilet and bathing facilities for people were maintained to a high standard. At the last inspection the hot water temperature in one bathroom was too high at 48 degrees centigrade. The manager stated that this had been attended to and weekly checks of water temperatures were now completed, records of the checks were examined and showed water temperatures to be within acceptable limits. The bedrooms were personalised and well decorated. Picture signs were provided to help people identify the bathrooms and toilet facilities. The home was very clean and tidy throughout. A bedroom which had been very odorous at the last inspection had had a new carpet fitted which had resolved the problem. The home were very committed to managing and preventing cross infection in the home. Staff had received training and were observed to practice appropriately to avoid Care Homes for Older People Page 20 of 29 Evidence: the risk of cross contamination. The home had been involved in piloting the infection control Safe and Clean project with the hospital and had joined the Tracking Health Care Associated Infections project. The home had a laundry, which was suitable to meet the needs of the home and people using the service. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Well-trained staff looked after people in the home. However there was lack of forward planning to ensure all mandatory training was kept up to date. Recruitment procedures offered protection to people living in the home. Evidence: The home was staffed appropriately. Three care staff were on duty throughout the day, which included a senior member of staff. The manager assisted on am shifts in the week. A further member of staff was provided at weekends on the early shift and a teatime assistant was provided for three hours, 7 days a week. Two members of staff were on duty from 8pm to 8am with a staff member on call. Of the fourteen care staff employed, nine had achieved NVQ level 2. The staff recruitment files evidenced that all checks with regard to references and POVA first check (Protection of Vulnerable Adults) had been obtained prior to employment. A training plan was in place and a record of training received by staff in the home was available for inspection. The staff confirmed that they received a wide variety of Care Homes for Older People Page 22 of 29 Evidence: training in the home which was relevant to their role. The training plan did not identify all the mandatory training needs and how these were to be met over the next year. This meant that moving and handling training had not been provided for some staff as due. The management provided written information to advise us that this training would be completed in early January 2008. Training in working with people with dementia was provided and ongoing for all staff. Throughout the inspection the staff showed that they were very skilled in working with people with dementia. Staff said that the course was excellent and they had changed and improved practice as a result. Staff had received an induction to skills for care standards once employed by the home. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of peoples finances and lack of consistent fire system checks may have put peoples health safety and welfare at risk. Staff supervision had been provided at the required frequency to ensure support and future development for staff. Evidence: The manager has been in post for 5 years and has achieved the registered managers award and NVQ level 4 in care. Staff and people living in the home said that the manager is approachable and supportive. The home operated a quality assurance system that sought the views of people living in the home and staff on a regular basis. This has been further developed to seek the views of health professionals and other stakeholders. Very positive responses had been received on the returned questionnaires. There was a monthly audit system in place that looked at key areas aimed at improving standards although this had not Care Homes for Older People Page 24 of 29 Evidence: been maintained in all areas. The home had achieved the Investors in People award in October 2008. Where the home looked after the personal monies of people living in the home records of transactions were maintained. These were checked with the money held. There were some discrepancies, in two cases the records did not balance with the cash held, multi buy savings had not been given appropriately to the resident and receipts for purchases of toiletries from the home were not held. We referred these issues to the Local Authorities safe guarding team for further investigation. Formal one to one supervision had been provided and they were on target to achieve at least six sessions per year. Generally the appropriate safety checks were carried out within the specified time frame and policies were in place for safe working practice. However the fire system checks had not been completed as required in November when there had been a change of handyman. The manager assured us that these had been completed by the groups other handyman but had not been recorded. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Peoples care needs and associated risks must be set out in detail on the care plans. To ensure staff have complete information to meet peoples care needs safely and consistently. 01/04/2009 2 8 13 Where monitoring records 01/04/2009 show people have had a weight loss or gain follow up action must be recorded. To evidence that appropraite action has been taken to ensure that peoples health is maintained. 3 8 13 Where people are identified as being at risk of pressure sores a care plan must be developed. To ensure that the risk of pressure sores is minimised. 01/04/2009 4 35 17 Where the home is managing money on behalf of residents they must 01/04/2009 Care Homes for Older People Page 27 of 29 maintain accurate records and receipts for all transactions. To safeguard peoples money 5 38 17 Records of fire system checks must be kept up to date and audited regularly To ensure that fire system checks are completed. 01/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 A copy of the assessment of peoples needs should be held. These should be signed and dated on completion to evidence that they were completed before admission. The care plans and risk assessments should be discussed and signed by the person using the service or their representative. The medication policy and procedure should be further developed to include procedures for disposal of medication and the action to take in the event of a medication error. People’s preferences in regards to social activities should be recorded to ensure that suitable activities are arranged. The manager should review records to ensure that all staff have received safeguarding training in the last twelve months. A training plan should be developed to identify all the mandatory training needs and how these are to be met over the next year. 2 7 3 9 4 5 12 18 6 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 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. 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!