CARE HOMES FOR OLDER PEOPLE
The Chestnuts 57 Bargate Grimsby North East Lincs DN34 5AD Lead Inspector
Ms Matun Wawryk Unannounced Inspection 21st March 2006 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 DS0000034324.V287076.R01.S.doc Version 5.1 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 DS0000034324.V287076.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 57 Bargate Grimsby North East Lincs DN34 5AD 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) 01472 345513 Cleethorpes Care and Nursing Ltd Marie Rose Land Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the occupant of the room must have no significant mobility problems 24th October 2005 Date of last inspection Brief Description of the Service: 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. 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 Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced took place on the 21st of March 2006 and lasted for 4 hours forty-five minutes. To find out how the home was run and if the residents who lived there were pleased with the care they received the inspector spoke to three service users individually, the wife of one service user and spent time in the dinning room over the lunch period observing staff carrying out their work. The inspector also spoke to the manager, a senior care worker and a care worker who were working in the home at the time of the inspection. In addition the inspector looked at a range of paperwork in relation to staff recruitment, rotas, menus, activity records, complaints and carried out a partial tour of the home. What the service does well:
The home was very clean and tidy and had a friendly and homely atmosphere with lots of space in the rooms where people sit, relax and eat. There was a core group of staff that had worked at the home for several years. The inspector found the staff to be very friendly and they knew about the care the residents who lived in the home needed. The residents who the inspector spoke to said the staff were helpful, and did anything they could for them and made their family and visitors feel very welcome. Residents said the staff always knocked on their doors before going into their rooms or the toilets and if they needed help staff made sure their privacy and dignity was respected. The inspector spoke to one visitor, the visitor stated she was always made welcome when visiting the home and was very positive about the care her relative received. She said the standards in the home were good. Residents said they liked the meals and said that there were plenty of different things to eat, and if they didn’t like something they would be offered something else. Staff and residents said the manager was very good, friendly and approachable. All reported they would feel confident in making a complaint where this was needed.
The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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 DS0000034324.V287076.R01.S.doc Version 5.1 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 DS0000034324.V287076.R01.S.doc Version 5.1 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): Key standards 3 and 6 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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, 8 & 9 The home generally provides comprehensive care documentation to enable all service users needs to be monitored to assist staff to deliver the appropriate care to each person. The home has a robust system for administering drugs. EVIDENCE: The inspector examined three care programmes for service users with a range of needs. Generally the documentation system was found to be detailed and well maintained although some minor deficiencies were noted relating to care records for service users at risk of developing pressures sores. For example: The care plan for one resident did not accurately identify all care needs. Daily records indicated the service user had a pressure sore and was receiving district-nursing support. An individual care plan for pressure area care was not in place. The inspector advises that for those service users at risk of
The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 10 developing pressure areas, individual care plans are developed. These must contain sufficient information to guide staff practice for example, they should set out in detail tasks staff are expected to carryout for that individual e.g. where ‘regular’ positional changes are advised care plans must be more specific in terms frequency, manoeuvres and monitoring arrangements etc. All the residents spoken to stated the staff were very good and described how care was provided in a way that respected their privacy and dignity. All the residents were registered with a GP. A record of routine eye tests, dental and chiropody checks had been maintained, residents weights were monitored and the home had sit on scales to weigh resident who were unable to weight bear. There were risk assessment tools for mobility, falls and nutrition. Daily records described the care provided and communication with other parties for example district nurses and G.P.s. A pressure area risk assessment for one service user had not been updated for over a year. The registered person must ensure risk assessments are updated regularly. This is needed to ensure risks are properly assessed and planned for. A policy and procedure for the safe handling of medication was available in the home. The systems for the safe handling of medication were examined. Records had been maintained for the receipt, administration and disposal of medication and there was a procedure for handling and recording receipt and return of medications. The inspector examined a sample of medication administration records. These were found to be in good order no errors or omission in recording administration of medication was noted. Stock medication is stored in a small cupboard; this appeared very warm on the day of the inspection. The inspector advises that the temperature is routinely monitored to ensure safe storage of the medication and where necessary remedial action must be taken to address this. The home’s manager and senior care workers administer medication. Evidence from a sample of staff training records evidenced staff had had medication training. The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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): Key standards 12, 13, 14 and 16 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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): Key standards 16 and 18 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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): Key standards 19 and 26 were assessed and met at the last inspection and were therefore not reassessed on this occasion. EVIDENCE: The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 14 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): 28 & 29 The arrangements for recruiting staff are satisfactory. An NVQ training programme is in place in the home. EVIDENCE: The home had a recruitment policy and the manager assured the inspector that the home works within equal opportunity policies and procedures. Since the last inspection the manager had improved the way in which staff are recruited to comply with regulations. The inspector examined the personnel records for three staff and all records required by Regulation 19 of the Care Homes Regulation were in place. Criminal Record Bureau (CRB) checks had been completed or in the absence of a CRB, POVA first checks had been sought. This means the home takes all practicable steps to ensure the welfare and safety of service users through good recruitment and selection practice. Since the last inspection, there was evidence of an increased commitment to NVQ training. Currently three care worker holds an NVQ qualification and a number of other care workers had enrolled to complete an NVQ. The registered person must continue the programme of NVQ training to ensure 50 of care workers obtain an NVQ or equivalent. The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 15 The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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): The home has a quality assurance programme in place, however this requires further development. EVIDENCE: The home had a quality assurance programme in place. The quality assurance system consisted of weekly and monthly audits and surveys of service users. This was evidenced through taking to residents and examination of records. The home was in the process of sending out questionnaires to other key stakeholders. Once all the information has been obtained and analysed the home should have a more robust system for reviewing the quality of services
The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 17 provided and this should help the home plan its continuous improvement programme. The registered person should ensure copies of the home’s quality assurance plan or a summary of this is made available in the service user guide and for inspection purposes. The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 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 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x x x The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 19 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. 1 Standard OP7 Regulation 15 Requirement The registered person must ensure care plans reflect all areas of need. Where service users are at risk of developing pressure areas care plans must provide clear and specific guidance for care delivery. Care plans must be supported by current risk assessments The registered person must produce and make available a quality assurance plan for the home that address of those issues identified in NMS 33. Timescale for action 07/04/06 2 OP33 35 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP9 Good Practice Recommendations The registered person should ensure 50 of care staff achieve an NVQ The registered person should monitor the temparature in
DS0000034324.V287076.R01.S.doc Version 5.1 Page 20 The Chestnuts the medication storage area. Plans should be in place for reducing the temperature in if it exceeds 28°C. The Chestnuts DS0000034324.V287076.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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