Inspection on 23/09/05 for The Chestnuts

This inspection was carried out on 23rd September 2005.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Chestnuts 23/08/07

The Chestnuts 20/09/06

The Chestnuts 14/01/06

The Chestnuts 10/08/04

The Chestnuts 18/05/04

The Chestnuts 06/01/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Chestnuts 9 Lodge Road Yate South Glos BS37 7LE Lead Inspector Chris Lewis Unannounced Inspection 23rd September 2005 09:30 The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 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 DS0000003402.V251037.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 Adults 18-65. 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 DS0000003402.V251037.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address 9 Lodge Road Yate South Glos BS37 7LE 01454 227252 0117 9709301 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) Aspects and Milestones Trust Miss Michaela Jane Spray Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8) of places The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2004 Brief Description of the Service: The Chestnuts is registered to accommodate up to eight service users with learning disabilities. The Home is run by Aspects and Milestones Trust and is divided into two segregated units called Woodland and Meadow View, which are managed as one. The Home is situated in a quiet lane with few other residential buildings nearby. The centre of Yate is about a mile away. The Trust is in the process of building bed-sit accommodation on a plot next door. The property consists of a large, extended Victorian house set in its own grounds and with a well kept garden and patio area. The Home has two cars for the use of service users and public transport can also be accessed a short distance from the Home. Parking is available at the front of the premises. The Chestnuts DS0000003402.V251037.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 carried out by Christopher Lewis. He was able to meet with most of the service users who live at “The Chestnuts”. The Inspector also spoke at length with the Manager and her Deputy and also with other members of staff individually. Staff were also observed going about their duties during the course of the inspection. Virtually all of both of the Home’s units were seen apart from a few of the service users’ bedrooms. Gardens and patio areas were also seen. A selection of care records were examined along with the Home’s policies and procedures, which are produced for the guidance of service users, relatives and staff. What the service does well: What has improved since the last inspection? What they could do better: Individual preferences for funeral plans remain unrecorded and must be addressed. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 6 Some individual service user care plans need to be updated. 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 DS0000003402.V251037.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Available information about the Home is good with a well written and attractively presented service user’s guide. Assessment processes are established and statements of terms and conditions are in place, with a need for some to be updated. Potential service users are given the opportunity to visit and try out the Home. EVIDENCE: The Home’s Statement of Purpose has recently been comprehensively updated and it gives a good overview of the Home and what it provides. The guide contains photographs of both the interior and exterior of the Home. The update covers such matters as a change from the use of an eight-seater minibus to the purchase of two cars, which affords more opportunity for one-to-one trips out with service users. Full assessments of the needs of service users have been completed including their health, personal and social needs. The details of the most recent admission of a service user to the Home was examined in some detail by the Inspector and they showed the involvement of a social worker and CLDT (Community Learning Disability Team in the process, coupled with introductory visits to see if the setting was right for all concerned. Evidence was also seen of input from outside professionals generally to ensure that service users are receiving good quality care overall. Confirmation of care plans being put into The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 9 action was seen by the Inspector as he toured the Home, with such items as various aids to communicate etc being in use with individual service users. Examples of contracts and statements of conditions were examined; most held had been completed satisfactorily but several were in need of updating with such matters as the latest fees, transport charges and so on, a task which the Inspector was assured was in hand. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Care plans are in place, though some need updating in writing. Independence is encouraged as far as is practical. Risk assessments have been completed and confidentiality is maintained. EVIDENCE: All service uses have essential life style plans and profiles. Examples of three of these were reviewed by the Inspector. All were clearly written, but two needed some updating. The Manager was confident that this task was in hand and would soon be completed. Each service user has a co-ordinator who should oversee the majority of care plan updates, reviews etc. Service users are encouraged to make their own choices as far as is reasonably practical and they are also encouraged where they are able to manage their own money. Risk assessments are comprehensive and evidence was seen that staff are working hard to encourage service users to be as independent as possible within the parameters of their risk assessments. This, in some cases, has been a slow process given that many service users in previous placements were positively discouraged to be too independent. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 11 Service users records are kept locked away either in a cupboard or in secure filing cabinets with a safe being used to store cash. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 17. Staff at The Chestnuts work strenuously at enabling service users to participate in the life of the Home and the local community and to promote social and leisure activities. Contact with family and friends is encouraged. Food is adequate and healthy and service users have an input into the choice of menus. EVIDENCE: The Inspector saw evidence that service users are given opportunities and encouragement to develop personally, with wall charts displayed in the office listing college attendance for such courses as cookery, arts and crafts and communication skills. Dates for participation in such activities as horse-riding and swimming were also shown. Besides these regular time-tabled activities, service users go out a great deal to local shops and for walks in the surrounding area. Two residents attend local churches. During the inspection, several service users were taken out by staff, trips which they obviously enjoyed a great deal. Other staff were observed to be engaged in artwork with service users. On some Saturday The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 13 nights, a social event is organised with staff providing the entertainment which the Manager said was greatly looked forward to by service users. The Manager stated that there had been some disquiet locally when the Home first opened, particularly from the day nursery next door, but that they now appeared to be well accepted by the local community. Contact with friends and family is encouraged and the Manager declared that, following a recommendation at the last inspection, if someone wished to develop a closer relationship, staff would not stand in the way of that relationship, but that they would work with any issues such a relationship may bring. One resident has a boyfriend at present. The Home has recently changed its mini-bus for two cars which gives greater opportunities for individual trips out. Menus are prepared at the moment on a four-weekly programme; service users are encouraged to help with menu planning. The Home is considering moving towards a weekly approach to menus. The Managers appeared well aware of the issues around healthy eating. Service users who were spoken with by the Inspector appear to be happy living at “The Chestnuts”. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 21. Staff support service users in a caring way. Healthcare professionals are involved in the care planning process. Staff continue to work on up-dating details on what arrangements should be made should any individual service user die in the Home. EVIDENCE: The Inspector observed the staff on duty on the day of the inspection to be interacting with the service users in a helpful, calm and sensitive way. Service users were also seen to approach the staff with confidence and it was evident that good relationships have grown up between staff and service users. Staff spoken with by the Inspector demonstrated a commitment to providing good standards of care to service users and a desire to promote their independence. Each service user has a separate health care file, a selection of which were seen by the Inspector. All service users are on medication and no service user self-medicates. The flies showed that there was regular support for service users and staff from outside health and social care professionals. Past problems over staff disquiet over medication changes mentioned at the last inspection are, according to the Manager, not now an issue with a greater The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 15 understanding now in place between staff, managers and senior health professionals over the reasons for any drug changes etc. Many adaptations are fitted within the Home to help service users to overcome any problems over washing, toileting etc. The Home still needs to finish its work on recording what the funeral wishes of each service user and/or their relatives are in the event of the death of that service user. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. A system for dealing effectively and efficiently with complaints is in place and procedures for the protection of vulnerable adults are well established. EVIDENCE: The Inspector had sight of the Home’s complaints policy and procedure which appeared to be robust. One complaint by some of the service users against another was recorded and evidence was seen that this has been dealt with quickly and in a fair way with the Area Manager having become involved. The Commission for Social Care Inspection’s number if required is contained in the complaints procedure. Policies and procedures for the protection of vulnerable adults were in place with staff all trained on such issues or about to go on courses. An example of the Home’s guidance over issues of the vulnerability of their service users was outlined by the Manager. Staff had picked up that there was a problem with one service user, sensitive probing lead to a disclosure and a consequent investigation. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. All bedrooms are single occupancy, homely and clean. Overall the Home is safe, bright and well maintained. Service users like their accommodation and privacy is maintained. EVIDENCE: Both units of the Home are bright, cheerfully decorated and well maintained. At the time of the inspection, painters and decorators were at work and had produced a finish of a very high standard. Furniture and fittings are good. All rooms were clean and tidy including the bathrooms and toilets which were free of any odours. There are sufficient toilets for the number of service users accommodated and they are readily accessible. A selection of bedrooms were seen, all either with the permission of the occupiers or actually with the service user showing the Inspector around. All rooms meet the spatial requirements and are single occupancy and their contents reflected the individual interests of service users. Those spoken with about their rooms said they were happy and comfortable with their accommodation. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 18 In stark contrast to the rest of the Home, one room was almost completely bare and reflects the fact that the service user wishes to sleep in an environment without furnishings, on a stripped bed in a sleeping bag. Staff have worked in ways to ensure privacy despite the lack of curtains, by adapting the windows with opaque film. Communal spaces are well kept. Access to the kitchen is more controlled in Meadow View but service users are supported to make tea etc. There is a well used activities room with evidence of painting and drawing having been undertaken. Woodlands also has a ‘snoozelen’ room, with soft lights etc, which the Deputy Manager explained beneficial calming effect on a couple of service users in particular. This room also presents a good opportunity for one-to-one care. The Home’s gardens are well kept with chairs, patio sets and so on. The problems over poor workmanship on the covered way, mentioned at the last inspection, has now been resolved. The patio has been extended to ensure safety following an injury to a service user. A sensory garden has also been constructed. One resident likes to sit regularly outside on the patio to eat her dinner if weather permits. A well equipped laundry is in use to keep the clothes of service-users in good shape, staffed by housekeepers and support workers. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 33, 35 and 36. Staff roles and responsibilities appear to be clear. Staff are trained and competent and are supervised regularly. EVIDENCE: Overall staffing and employment procedures are in place at “The Chestnuts” as determined by Aspects and Milestones Trust. The Inspector noted from observation, discussion with staff and managers and by sitting-in on a handover session, that clean lines of accountability now appear to exist within the Home. Some confusion over responsibilities had been apparent at the previous inspection. Records showed that some staff are undertaking the Trust’s induction training with an expectation that they will then begin NVQ (National Vocational Qualification). Six members of staff have completed NVQ qualifications and four are working towards them – 50 of staff will be thus qualified shortly. Evidence was seen that the housekeepers have now also completed the relevant NVQ training. Overall evidence was seen to show that the Home’s staff team was effective and of sufficient numbers to meet the needs of the eight service users accommodated. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 20 A copy of the Home’s supervision of staff audit was viewed; the management team aims for monthly staff supervision to take place. The audit showed that this had dropped back over recent months with holidays and sickness; the Manager explained that things were now back on track. Copies of supervision notes are given to the worker’s concerned and examples of such notes were seen and were satisfactory. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. The Manager and her management team displayed a clear and straightforward style of leadership and is well qualified. Quality assurance systems are in place. Records are securely kept and the home is safe with service users happy and protected. EVIDENCE: The Manager has achieved NVQ level four in Management and is planning to apply for a course in the treatment of autism. Her Assistants are also well qualified. Both impressed the Inspector by their clear and open management approach, demonstrated in particular at a hand-over of staff witnessed by the Inspector. The management’s overall caring approach to the service users was also evident. Service users are consulted wherever possible about how the Home is run and how they feel about any possible changes to routine. Quality monitoring systems are now in place to measure how successful the Home is at achieving its aims and objectives. Staff away-days have been held to underpin this The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 22 monitoring and evidence was seen of staff and user meetings that fed into this process. The management team is considering the creation of questionnaires also to seek service users’ and relatives’ views of the service on offer. It is accepted that most of the service users at “The Chestnuts” will need support in filling in such questionnaires. Service users’ records are kept securely locked away and required staff details are now accessible in the Home, though only to managers. Fire records were inspected and the required drills and tests of equipment have been done. Records showed that a fire drill had been done the day before. Emergency lighting has been tested regularly and maintained properly. The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Chestnuts Score 3 3 X 2 Standard No 37 38 39 40 41 42 43 Score 3 4 3 X 3 3 X DS0000003402.V251037.R01.S.doc Version 5.0 Page 24 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. 1 1 2 Standard YA5 YA6 YA12 Regulation 5 15 21 Requirement Timescale for action 31/01/06 The home must ensure that all residents contracts are updated. The Home must ensure that all 31/01/06 service user’s plans are reviewed and updated Work must be completed on 31/01/06 recording service user’s funeral preferences. 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 DS0000003402.V251037.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Chestnuts DS0000003402.V251037.R01.S.doc Version 5.0 Page 26 - 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. 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