Inspection on 02/01/07 for The Chestnuts

This inspection was carried out on 2nd January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Chestnuts 13/01/09

The Chestnuts 07/02/06

The Chestnuts 16/09/05

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 Chestnuts, The The Avenue Ross-On-Wye Herefordshire HR9 5AW Lead Inspector Wendy Barrett Unannounced Inspection 10:00 2 January 2007 nd 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 Chestnuts, The DS0000024734.V317768.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. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnuts, The 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 (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 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. One of these places is currently registered to accommodate a named individual who is under 65 years of age. 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. An up to date copy of a Residents’ Handbook was available at the home. It included details of the home’s charging policy. Each resident receives a copy of the handbook when they are admitted to the home and a copy is also offered to any potential residents. In November 2006 the fees ranged from £339-50pence to £421-00pence per week. There were additional charges for hairdressing, chiropody, transport to local G.P. surgery and hospital appointments, newspapers, private telephone bills and personal toiletries, confectionary, alcohol and soft drinks. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report for was written with reference to information held on the Commission’s service file, feedback comments from residents, relatives and involved professionals and the content of a pre-inspection questionnaire completed by the Provider. An unannounced inspection visit to the home was also undertaken to gather additional evidence. What the service does well: What has improved since the last inspection? There has been continuing investment to make sure the residents’ accommodation is well presented and comfortable. An independent consultant has been employed to help the Care Manager develop the management of the kitchen and catering. More staff have been encouraged to gain a qualification and induction programmes have been updated. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 6 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. Chestnuts, The DS0000024734.V317768.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 Chestnuts, The DS0000024734.V317768.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): 1,2,3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to choose a home that will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: An up to date copy of a Residents’ Handbook was available at the home. It included details of the home’s charging policy. Each resident receives a copy of the handbook when they are admitted to the home and a copy is also offered to any potential residents. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 9 Sample copies of signed contracts of residence were seen during the inspection visit and there was also a copy of a letter informing a resident of a change in the fee arrangements. A lady had been admitted the day before the inspection visit. She said a social worker had helped her with her choice of home and she had been to visit the home to help her decide if it would suit her. She was very happy with her initial experience of life at The Chestnuts and was particularly pleased that she would be easily able to get to the local shops. An example of an initial assessment report was inspected. This is a written account of a potential resident’s needs and wishes and the Care Manager gathers the information so that she can decide if the home will be suitable. On the day of the inspection visit she was due to visit an existing resident who was receiving in patient hospital care because she wanted to be sure the resident would be sufficiently mobile for the staff at the home to help him move around safely. Chestnuts, The DS0000024734.V317768.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care received by residents is based on their individual needs. The principles of respect and dignity are put into practice. EVIDENCE: Every resident has a written plan that advises staff what care is needed and how this should be provided. A sample of records was inspected during the inspection visit. There was evidence to show that the staff regularly check the plan to make sure it is still relevant. When there are any particular risk areas e.g. fragile skin, dietary difficulties, mobility problems, the staff assess these and decide what needs to be done to protect the resident. For instance, a resident was receiving a food supplement and others were having their food and fluid input monitored by the staff. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 11 A resident was met in her bedroom. She was being cared for in bed although she had been up and had her hair set by the hairdresser earlier in the day. The resident was laying on a special mattress to protect her skin and she looked well cared for e.g. clean linen and nightwear. She agreed that she was very comfortable. Two visiting nurses and two social workers were very happy with the way staff were caring for residents – ‘always found the staff to be very good with all the care’, ‘no concerns about The Chestnuts’. The Care Manager explained a charge for transport to the local doctor’s surgery was applied after relatives became increasingly dependent on staff to take residents. No top up charges are made so the Provider felt it was reasonable to apply the charge. No resident would be disadvantaged and would always have access to medical support when needed. An Assistant Care Manager described the way staff manage the residents’ medication at the home. She had received training from Boots pharmacy and had also read the home’s written guidance regarding medication procedures. It was clear that the staff follow good practices e.g. the records showed clearly how medication moves through the home, residents who choose to look after their own medication are monitored in case they need more guidance from staff. Sometimes the staff have to work closely with other care professionals in consulting with particular residents who are causing concerns regarding their safety or the safety of other residents. The Commission receives details of the work done when this sort of situation arises and the information received from the Care Manager reflects an approach that carefully balances the rights of residents against the potential risks involved. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle and when the staff have concerns about the choices they make they consult with other care professionals so that the best decisions can be made for the particular resident. Residents enjoy the food and meals are prepared with good attention to dietary need and general hygiene. EVIDENCE: Feedback comments from relatives indicated satisfaction with this aspect of the service – ‘food superb, staff well mannered and helpful and caring’, ‘homely atmosphere which puts residents and relatives at their ease’. When residents have particular interests the staff try to see that these can continue to be pursued e.g. a resident needed additional time to help her keep in touch with the local community. Arrangements on admission were made for social service staff to provide extra support with this. Many of the residents had been out to a Christmas lunch. During the inspection visit a resident was met in her bedroom. She was reading a daily newspaper Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 13 and looked very comfortable in the privacy of her own room. She said ‘everyone is friendly. Probably the best home you could find’. A more frail resident was listening to her radio as she rested on her bed. Other residents were having their hair done by a visiting hairdresser. Sometimes the staff have to work closely with relatives and other care professionals in balancing the rights of residents to live as they wish with the potential risk to the resident or other residents at the home. Written records of this work have been submitted to the Commission and they demonstrate a professional, sensitive approach. A new care assistant understood about the need to respect residents’ privacy. He explained that he had been instructed about this as part of his initial training programme. The Provider had recently employed an independent consultant to help the Care Manager review food safety procedures at the home. This was proving to be very helpful. The cook had been given written guidance to help her organise her work. The kitchen was very clean and tidy at the time of the inspection visit and a menu for the day was displayed out in the home. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to raise concerns and when they do the staff take them seriously. Residents are protected from abuse by staff who know how to identify and deal with concerns. The written guidance relating to complaints and protection should be more regularly reviewed to be sure it is up to date. EVIDENCE: A copy of the home’s complaints procedure was displayed in the main hallway at the home so that anyone could check how to raise any concerns. A new staff member had already received instruction on the home’s whistle blowing procedures that support staff in raising concerns about resident protection and safety. A record of complaints received at the home was inspected. It contained several accounts of minor concerns with details of action taken to respond to them. An assistant manager understood how to deal with any concerns she might receive and she also knew she must record these in the relevant record. The home has implemented policies and procedures related to complaints and protection but these had been written some time ago and should be reviewed and updated more regularly. There is an open and co-operative approach when dealing with complaints e.g. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 15 the Care Manager keeps the Commission fully informed of situations that affect the safety and welfare of residents. This open approach includes appropriate consultation with residents’ social workers and in one case, the Care Manager had offered to bring in an independent advocate to help the resident represent themselves. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well maintained environment. EVIDENCE: Fire safety is well addressed at the home e.g. when door wedges have to be used this practice is carefully monitored to be sure it doesn’t compromise the overall fire safety arrangements. The Provider had responded to requirements made at a Fire inspection in September 2006. There is routine attention to maintaining and improving the quality of the residents’ accommodation e.g. decoration and replacement furnishings and fittings since the last inspection. There were two specific compliments in relatives’ feedback forms – ‘cleanliness first class’, ‘rooms are kept very clean’. A tour of the home during the inspection visit supported this view. Everywhere was clean, warm and tidy. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 17 The kitchen was particularly well presented and the cook was pleased with the guidance she had received from an environmental health consultant who the Provider had employed at the request of the Care Manager. Attention to hygiene practices was also being well addressed in other areas of the home e.g. the laundry room contained written guidance for staff so they work in a safe manner. Protective clothing and red laundry bags were supplied to reduce the risk of cross infection. Potentially hazardous cleaning materials were safely locked away. During the tour there were other indicators that the home is being kept safe and well maintained e.g. evidence of regular testing of electrical appliances, servicing of fire extinguishers. A resident was spending time in her bedroom. It was noted that staff had ensured her call bell was well in reach so she could summon help if needed. A toilet door had a large sign on it to help residents find the toilet. The Care Manager explained that this had been designed following guidance received at a dementia care training day. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained and in sufficient numbers to meet the needs of the residents. EVIDENCE: Relatives express considerable confidence in the way staff go about their work – ‘management and staff are excellent’, ‘friendly and helpful’, ‘staff well mannered, helpful and caring’. There were enough staff on duty when the inspection visit took place and duty rotas confirmed this situation. Two staff agreed that this was the case – ‘they get relief staff if someone doesn’t come into work’. The Care Manager confirmed that she can employ agency staff and she finds this works well because they tend to be workers who regularly cover duties at the home. When there is a particular need the Provider has approved extra staffing e.g. a resident temporarily needed extra attention during the night. There are records to show that staff receive the health and safety training they need to work safely with residents e.g. a new care assistant had already received manual handling instruction as part of an induction programme. An Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 19 assistant manager had completed all required health and safety training and had received instruction in medication management and dementia care. The Care Manager was looking for opportunities to offer staff more training that would help them understand any particular medical conditions any residents may have. There has been good attention to increasing the number of staff who hold a national vocational qualification. The home is on target to have more than half the care staff with this qualification by early 2007. A new care assistant described the way he was selected for work at the home. His personnel file contained written evidence to show that his suitability had been carefully assessed e.g. written references, a criminal records bureau check. The staff member had felt well supported through working shadow shifts when he first started work and the records confirmed that he was constantly supervised until all checks had been completed. He was doing an induction course and was already aware of essential aspects such as manual handling techniques, ways to protect residents’ rights to privacy, how to raise any concerns he had about resident protection issues. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 20 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is centred on the welfare and safety of the residents and the Care manager is particularly competent in her role. There will need to be more work on developing and reviewing relevant policies and procedures at the home as part of the overall quality monitoring system. EVIDENCE: The Care Manager is qualified and very experienced. There were complimentary comments about her effectiveness in feedback responses – ‘efficient and well organised’. The Provider supports the Care Manager. Committee representatives make Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 21 regular visits to the service and resources are made available to help her develop the service and comply with regulatory requirements. e.g. the Provider employed an independent consultant to help develop kitchen procedures, she is authorised to increase staffing at times of special need. There are some policies and procedures that are relevant to the service but have not yet been implemented e.g. record keeping, recruitment and employment, pressure relief, management of residents’ money and valuables. The Care Manager was already addressing the shortfalls although she recognised that this is an extensive piece of work. It is recommended that the Provider considers ways of providing her with additional support to get these policies in place. The Care Manager was also devising survey questionnaires for residents and relatives. These would be used as part of the home’s overall quality assurance system. The Provider and Care Manager are advised to familiarise themselves with the new regulatory requirement to undertake annual quality assurance assessments in the future. Families and appointees handle residents’ money except in one case where minimal assistance is offered by the home. An expense account is kept for personal allowance management. The Commission receives comprehensive reports from the Care Manager when accidents or incidents occur at the home. The records at the home are well written and produced. There is evidence contained in this report to indicate satisfactory attention to health and safety and other legislation. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 22 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 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x 3 3 Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP33 Good Practice Recommendations Some relevant policies and procedures need to be implemented. Existing policies and procedures should be subject to regular review to ensure they comply with current legislation and good practice advice. Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Chestnuts, The DS0000024734.V317768.R01.S.doc Version 5.2 Page 25 - 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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