CARE HOMES FOR OLDER PEOPLE
The Chestnuts 29 Station Road Ruskington Lincs NG34 9DR Lead Inspector
Mr Toby Payne Unannounced Inspection 22nd September 2005 08.45 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 DS0000002439.V251792.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 DS0000002439.V251792.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 29 Station Road Ruskington Lincs NG34 9DR 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) 01526 832174 Mr George Eric Stafford Mrs Sheila Stafford, Mr Graham David Stafford Mr George Eric Stafford Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (12) The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd March 2005 Brief Description of the Service: The Chestnuts Care Home is family owned and has been adapted and extended from a former domestic house to provide the present accommodation. The home is provides personal care for up to 14 people over he age of 65. The home is a detached two storey building with a stair lift serving the first floor. All the rooms provide single accommodation but none of them are en-suite. Communal rooms consist of 3 separate sitting areas as well as a dining room adjacent to the kitchen. There is a small car parking area to the front of the home with more car parking space at the rear. There is a garden area at the rear of the home. The home is situated close to the village of Ruskington, which contains a range of community facilities including shops, Post Office and churches. There are also rail and bus services close by. The Chestnuts DS0000002439.V251792.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 and started at 8.45 a.m. It took place over 4 hours. The inspector spoke to 8 residents, one visitor, 3 staff, a visiting community nurse and GP as well as the acting manager. The main method of the inspection was called “case tracking”. This involved selecting one newly admitted resident and tracking the care they received through the checking of records, discussion with them and the care staff. The inspector also observed how care was delivered and how staff responded to other residents living in the home. What the service does well: 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 DS0000002439.V251792.R01.S.doc Version 5.0 Page 6 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 DS0000002439.V251792.R01.S.doc Version 5.0 Page 7 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, 2, 3, 4 and 5 All residents are involved in their admission to the home. They decide about where they wish to live. Each person receives a detailed assessment, which results in his or her needs being met. EVIDENCE: All residents are assessed before entering the home and written confirmation is sent to them that the home is able to meet their needs. People can come to the home on a 4 week trial visit to see whether it suits their needs. There is a detailed statement of purpose and service user’s guide and a copy of the service user’s guide is given to each person when being admitted to the home. There is a detailed admission procedure, which identifies the needs of residents coming into the home. One newly admitted person confirmed that they had been involved in their assessment and felt satisfied with the care provided by the home. A member of the care staff was spoken to and knew about the needs of the residents.
The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 8 Each resident is given a detailed contract/terms and conditions when moving into the home. The Chestnuts DS0000002439.V251792.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, 9 and 10 Resident’s care, health and welfare needs are met by staff who know the resident’s needs. Where required residents can receive attention from their GP and Community Nurse. EVIDENCE: All residents had detailed and up to date care plans. The care plans included an information sheet about the person’s personal care, mental health and physical intervention, a care plan identifying medical, individuality, independence and mental health and a daily report. Where required, risk assessments are also included. There was evidence to show that wherever possible residents had been involved in their care. Their signatures showed this. There was evidence to show that the care plans had also been reviewed. Staff were observed attending to residents in a kind and courteous manner giving time to talk and laugh with them. Residents commented, “staff are superb” and “the staff are very kind”. Staff were also seen to be encouraging independence by allowing residents to do as much for themselves with the guidance and supervision of staff. This was done in an unhurried manner.
The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 10 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, 13, 14 and 15 Social activities provide stimulation for residents living in the home. Meals are nutritious and offer a healthy and varied diet. Visitors are welcome in the home. EVIDENCE: Staff members are responsible for activities. The home does not have a written programme of activities. However activities are provided including outside entertainers. People also attend local churches or go into the village, which is close to the home. Residents were offered a choice of well-balanced and wholesome meals. The inspector was present lunch and saw lunch being served to the residents who were sat at dining tables with clean tablecloths and flower decorations. The people were very complimentary about the food being provided in the home. Comments were, “if I don’t not like the food provided in the set menu an alternative can be provided without question” and “the food is very enjoyable”. Clear and detailed up to date records were also being kept. A visitor said she could visit whenever she wished and always received a warm and friendly welcome. Comments were, “I am very satisfied and “nothing is too much for the staff”. The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 11 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 and 18 Residents know that any concerns they have are taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: Each resident is given a complaints procedure when they are admitted to the home. No complaints have been received by the home and the CSCI since the last inspection. None of the residents had any complaints about the home and felt they could discuss any concerns they had with the staff and manager. Staff also knew what to do if a resident wanted to make a complaint. Staff have also received training concerning what to do if a complaint is received. Staff knew what abuse was and what to do if abuse was suspected. The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 12 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 Residents live in clean and comfortable surroundings with accessible gardens. EVIDENCE: Residents told the inspector they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. There is a comfortable lounge and dining room, which is off from the kitchen. The grounds are also accessible. Residents were satisfied with the way their clothes were washed and returned to them. The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 13 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 28 There is a trained, knowledgeable and competent staff team. The numbers of staff are sufficient to meet the needs of the residents. Staff are correctly recruited. EVIDENCE: The last new member of staff was recruited in 2001 and there is a stable and established team of staff. All residents who spoke to the inspector were satisfied with the level of staff in the home. Comments were, “nothing is too much for the staff” and “we are well looked after”. Staff also felt they had sufficient time to care and offer support to the residents. One commented, “I have time to talk to the residents”. Another commented, “I feel safe working here” and “it is a privilege to work here”. Staff receive supervision and training to carry out their caring role. The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 14 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): 31, 32 and 33 People living in this home have confidence in the staff and management and are consulted about any changes taking place. Users of the service are asked their opinion about the home. EVIDENCE: The home is family run with the registered providers having an active role in the management of the home. They have 17 years experience in managing and providing care in the home. A number of roles are delegated to the care manager and representative of the providers who achieved a management qualification and intend to apply to the CSCI to be the registered manager. Staff, many of whom have been employed in the home for many years spoke of the support they received. Residents made positive remarks about the staff team. Comments were “I like it here”, “staff are very nice” and “I am very happy”. A visiting GP and
The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 15 Community nurse both had total confidence in the staff and felt there was very good communication between the home and their services. A detailed quality assurance survey was carried out in March 2005 and 47 questionnaires were sent out to residents, visitors, GPs, Community Nurses and other professional staff. Many positive responses were received. Comments were “it is a small caring home where you feel like a happy family and know you will be looked after” and “my mum has settled in really well. I am at ease knowing she is well looked after at all times”. The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 16 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 x 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 4 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x x x x x The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 17 no Are there any outstanding requirements from the last inspection? 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. Refer to Standard Good Practice Recommendations The Chestnuts DS0000002439.V251792.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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