Inspection on 25/05/06 for The Chestnuts

This inspection was carried out on 25th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Chestnuts 24/05/07

The Chestnuts 13/11/06

The Chestnuts 16/01/06

The Chestnuts 07/06/05

The Chestnuts 30/09/04

The Chestnuts 21/07/04

The Chestnuts 08/03/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Aldwick House

49 Glendale

The Springs Community

Crossways Community

Belle Vue Country House

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

CARE HOME ADULTS 18-65 The Chestnuts (Welcome House) Watts Avenue (10) Rochester Kent ME1 1RX Lead Inspector Alex Turner Unannounced Inspection 25th May 2006 10:00 The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 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 (Welcome House) DS0000028336.V298704.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 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 (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts (Welcome House) Address Watts Avenue (10) Rochester Kent ME1 1RX 01634 842084 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) Dr Toqeer Aslam Vacant Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: The Chestnuts is a registered care home for adults with mental health problems. It has registration for 15. The home is a large detached property with accommodation over two floors. Communal areas include a large lounge, a dining room and kitchen. The home is close to Rochester town centre and has a selection of local shops and services nearby. The current fees for the service at the time of the visit were £540.00 per week. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been informed by a site visit to the home by two inspectors during one day in May 2006. During the day one of the inspectors spent the majority of time around service users and staff while the other looked through records and spent time speaking with the manager of the home. Preinspection questionnaires returned by services users, visiting professionals, relatives and the manager of the home also contributed to the body of information drawn on to inform the findings of the report. What the service does well: What has improved since the last inspection? What they could do better: The monitoring and planning of care should improve. The system and tools in place to do so should be fully implemented. The number of people working in the home is minimal and should be reviewed with a mind to increasing numbers on duty. The arrangements for residents to contact staff during the night should be improved. The arrangements to support service users pursue activities and interests in and away from the home should be reviewed. The approach to risk management needs to be better coordinated and more closely monitored. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 6 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 (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 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 (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 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, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose provides useful information regarding what can be expected in terms of service provision. Prospective service users’ needs are assessed. Working through the home’s assessment and admission procedures prospective service users may be able to form an initial opinion whether the home will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test-drive” the home. Individual contracts are entered into between the home, the service user and for funded placements the funding authority. EVIDENCE: The Statement of Purpose has been revised since the last inspection. The registered provider explained that the Service Users guide would also be updated to reflect changes in the Statement of Purpose. Service users spoken to who had moved in to the home during the last 12 months indicated that The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 9 they had the opportunity to visit and have a look around before doing so. These service users said that they were introduced to staff and other people living in the home. It was ascertained that placements had been planned in stages. Service users said they were able to discuss their situation with their care managers. Service users said that they felt they were able to make the choice whether they moved in or not. A number of service users’ files were reviewed. In each was evidence that work has gone into revamping the assessment and care planning procedures. It was noted however that for many service users, assessments and care plans had yet to be completed using the improved procedures. It is recognised that the tools in place provide a sound framework on which to assess and plan future care. It should be noted that in the one instance where the previous manager had used the tools they led to a good account of care needs and work to meet them. The opportunity was taken to speak with a care manager who was visiting the home at the time of the site visit. The care manager confirmed that the home had worked with them to complete a preadmission assessment of their clients’ needs. On the files sampled there was a contract of residence that was signed by a person on behalf of Welcome Homes, the service user in question and, where applicable, the funding authority. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 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): 6,7,8 & 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have not had the benefit of knowing that their assessed and changing needs have been reflected in their individual plans. Service users make decisions about their own lives though have not benefited from knowing how to access advocacy services. Service users are consulted with and can take part in many aspects of life in the home though it is not clear what if any action has arisen from consultation that has taken place with them. The home’s approach to supporting service users take risks has been patchy, uncoordinated and poorly documented. EVIDENCE: The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 11 There was evidence that the home’s risk assessments and care plans had been reviewed at various times though not in a manner that indicated a regular and coordinated approach to the task. The acting manager explained that in view of the action to improve the assessment and care planning process all plans including risk management plans would be revised and a more structured approach to the task would in future be apparent. A plan that related to a service user who had been aggressive covered monitoring mental health, medication and crisis interventions. The plan did not include consideration of staffing levels, additional support, positive behaviour, willingness and abilities. It was noted that in two of the files inspected there was an up to date risk assessment prepared within the context of the local mental health services care program approach. These risk assessments clearly articulated risks identified, relapse indicators, prevention and contingency plans. Service users reported that they are able to make decisions on how they live their lives. They said that they receive allowances weekly or monthly depending on which they prefer. Monies can be paid directly into their bank accounts or they can have cash. The service users said that staff helps them with this if needed. Those who are able are encouraged to go shopping for their own toiletries/ clothes etc. There was no evidence of advocacy services to compliment the role taken by staff, relatives, friends and care managers. Records inspected indicated that service users meetings are held and are chaired by the service users. Minutes are kept however there was no evidence provided to indicate if the minutes had been actioned and out-comes achieved. The acting manager produced questionnaires completed by service users rating the service provided. There was no indication of what if anything was done with the information that these provided. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 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, 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users have limited support to pursue opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities though have limited support to do so. Service users are part of the local community. Service users have limited support to engage in leisure activities. Service users have opportunities to develop personal relationships though have limited support to do so. Service users’ basic rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 13 EVIDENCE: There was no evidence provided to show that the home provides any activities or leisure pursuits. As with the assessments and care plans, a format to develop activities programmes is in place though had not been completed on an individual basis. Six of the seven service users spoken to reported that they would like more to do. They reported that nothing happens in the home and when they are in the house they just sit around watching television. Service users said that they would like more in-house activities. Two service users said that they have free bus passes and are able to travel independently throughout the county and regularly go on day trips. Two other service users said that they attend a local day centre but that they did not do this as frequently as they wished as they relied on taxis for transport and found the cost prohibitive. Service users spoken to say that they did not get the support that they needed when they went out. Some said that they would like support with shopping for personal items but felt that there was not enough staff on duty to assist them. Service users did report that they often have to rely on their social workers to help them do this therefore it did not happen very often. One service user said he needed to go shopping for some clothes but had no one to support him in doing so. Two service users said that they would like to have an annual holiday and would be able to fund the holiday themselves but said that they would need the support of staff to go away and would need someone to go with them. They did not think that the home would be able to provide this service. A day trip was organised last year to a zoo with other homes within the company. This was reported to have been very successful but the service users didn’t know if anything would be organised this year. One of the service users had a guitar which he enjoyed playing. A piano had been obtained for another. Service users reported that they are encouraged to develop friendships both in side and out side the home. One visitor was spoken to and they said they were made welcome at the home at any time within reason. Service users are able to see visitors in there rooms or in any of the communal areas of the home. Service users reported that staff and other service users are respectful of their privacy and knock before coming into their rooms. Each resident had a key to their room but were still awaiting keys to the front door. The acting manager offered the assurance that this matter is in hand and that keys will be distributed to those who wish to have them. Those who are physically able come and go from the home as they wish and are able to decide how they spend their time. Service users receive their own mail and open it themselves. Care staff involved service users in all conversations and staff and service users communicated well and effectively. Service users are able to spend time The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 14 in their rooms or in the communal areas of the home; the choice is theirs. Service users who illnesses lead to isolation and withdrawal are monitored and encouraged to spend time with others. Menus follow a three weekly cycle. Service users reported that they have no involvement in planning the menus and that the menus were completed by the acting manager who goes out to buy the food. The menus seen indicated that the home provides a varied and nutritious diet for the service users. There was no evidence however to show that the home provided a choice if a service user did not like what was on the menu although staff did report that they would provide alternatives if requested. There is no record kept of the dietary intake of the service users. On the day of the inspection there was no fresh fruit or vegetables in the home. The acting manager did report that she was due to go shopping the following day. There was a good supply of dry store and frozen food. Service users reported that are not involved in the preparation of meals. Service users confirmed that they could prepare drinks for themselves. The kitchen is locked at 10pm and some of the service users do not have access to hot drinks after this time. This was discussed with the registered provider who agreed to look at ways of addressing this. Five of the seven service users spoken to said that they enjoyed the meals provided by the home and they had enough to eat. Two said, “that the food was good but need more of it”. This had been identified in a residents meeting and the acting manager asserted that extra food was made available for those who wanted more. On the day of the visit the inspector ate with the service users. The meal was well prepared and presented. The portions were adequate and there three different types of vegetables. The majority of the service users ate in the dining area. Those who did not wish to eat at this time were able to have their meal later. Service users can choose not to eat in the dining room and can eat separately if they wish. All the service users in the dining at this time said that they enjoyed their meal and had enough to eat. The kitchen was clean and tidy. Food was stored at the correct temperatures. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 15 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 & 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The personal support service users receive is adequate though male service users do not have the option to be supported by a person of their own gender. Service users physical needs were not being adequately addressed. The home’s policies and procedures for dealing with medication were inadequate in terms of protecting service users. EVIDENCE: All the staff employed by the home are female therefore male residents do not have a choice about receiving personal support from a member of their own gender. Some male service users require a degree of assistance with bathing. The service users spoken said that they did get the support from the staff if they needed it. All service users are encouraged to do their own laundry. One service user reported that it is sometimes difficult to use the washing machine as it is usually in use. There is a rota in place but it is apparently not always adhered to. All the Service users spoken to said that they choose their own clothes and can wear what they want. Service users did report that they would The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 16 like more accessibility to hairdressers or barbers .The acting manager reported that a member of staff was a qualified hairdresser and would be able to undertake this task. Service users reported that they received appointments with dentists, opticians, and chiropodists however the home’s records did not support this. There was no clear system to ensure that all the service users received the specialist support that they need. Service users are encouraged to be as independent as possible but there remains the need to ensure that appointments are happening at regular intervals and that service users are reminded, prompted and supported if they needed. The care file was checked of a service user who had diabetes and who had been living at the home for almost a year; there was no evidence to show that he has had any input or medical follow up checks to monitor his diabetes. There are no records to support that the diabetic nurse or G.P have been consulted with regards his condition and that any routine checks had been undertaken. The service user’s care plan did not identify or reflect his needs. Risks were not identified. On reviewing other files no evidence was found to show that service users had been offered or had received an annual healthcare check. The home uses an established system to manage the ordering, receipt, administration and disposal of medication. All administration records were adequately completed and all records tallied. All staff had undertaken training to help ensure medicines are administered safely. Storage of medication was inadequate. No risk assessments had been completed or specialist advice sought with regards to service users self administering medication. There was a lack of clear written protocols in relation to medication to be administered as and when required. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 17 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 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users feel that their views are listened to and taken into account. Service users are protected from self-harm, abuse and neglect. EVIDENCE: Service users spoken to said that knew how to complain within the home. Service users explained that they would report any concerns to the manager and then to the registered provider though were not sure where to go after this. A copy of the complaints procedure was displayed on the service users’ notice board together with forms that could be used to write down any complaints they had. No complaints had been made since at least the time of the last inspection. The home has established procedures to protect service users from abuse. The procedures state that all staff should read and sign that they have understood them. Records indicated that this has not been the case in practice. Staff training in adult protection has taken place. There have been no incidents requiring referral in the context of adult protection since at least the time of the last inspection. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 18 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, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 24. The home’s premises are suitable for its stated purpose and meet service users’ individual and collective needs in a comfortable and homely way. 25. Service users’ bedrooms suit their needs and lifestyles. 28. Shared spaces complement and supplement service users’ individual rooms. 29. Equipment in the home to maximise independence is in line with the statement of purpose and needs of service users. 30. Adequate standards of hygiene and cleanliness were being maintained. EVIDENCE: The premises are in line with the statement of purpose. The location of the home near to the centre of Rochester puts it in close proximity to local The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 19 amenities, shops and transport links. Furnishings and fittings were in keeping with providing a homely environment. It was reported that a handy man visits when necessary. The frequency of these visits may however not be as often as is required. For example curtains had been pulled down in one service users room. It was reported that the curtains were still to be replaced some days after they had become detached from the fixings. Rooms are personalised and service users can bring in their own furniture and buy extras for their rooms. They can also decorate their rooms to their own tastes. The majority of rooms were decorated and maintained to a reasonable standard. An exception to this though was in a room to be occupied by a service user who moved in on the day of the inspection. The room had not been fully prepared for the new service user. The home has a back garden which service users have access to. There is also a covered lean to where service users who smoke can partake in their habit. Shared space within the home includes a large lounge, a separate dining area, kitchen, and bathroom and laundry facilities. In line with the function of the home, equipment and adaptations to cater for people with physical disabilities are minimal. There is a stair lift installed though it has been decommissioned. There is an electric bath hoist. The service records for the hoist showed that it had been last serviced in 2004 which is somewhat less in terms of frequency than what could be reasonably be expected. Overall the home was clean and free from unpleasant odours. Two bedrooms had a slight smell of urine. Service users are encouraged to keep their own rooms clean and tidy and have access to housecleaning equipment to do so. One service user said that they are given assistance and support from staff if they need it. Laundry facilities were adequate. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 20 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): 32, 33, 34 & 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Experienced and trained staff provide support to service users. The number of people working in the home is minimal and may be having a detrimental impact on outcomes for residents. Service users are protected from the risk of unsuitable people working in the home by the recruitment procedures. EVIDENCE: The acting manager and three staff take on the multiple tasks required to carry on the home and deliver the service to residents. The experience, skills and knowledge base of staff are diverse and add to the service provided. Staff engaged with residents frequently and worked in line with promoting their welfare. Of the three care staff one had attained a National vocational qualification in care. The acting manager had also attained the qualification. All service users spoken to said that they thought there was not enough staff on duty day or night. Three service users expanded upon this view saying that staff were very busy all the time and were not able to spend any time with them. Staff on duty cook, clean, assist some service users with personal The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 21 hygiene needs, administer medication, complete administration tasks, write reports, and do shopping. One service user reported that she had felt anxious and unwell during the night but had no way of alerting the sleep in night staff as she was frightened to leave her room and there was no call system. The registered provider offered the assurance that a call system would be arranged and that additional staff during the daytime would be made available. The registered provider emphasised the commitment to keep staffing levels under review and would take steps to ensure the service is operated in a manner that would ensure service users needs are met. At the time of the last inspection recruitment procedures were rated as satisfactory. There have been no staff additions to the home since this time. Training records showed that there is an induction programme (completed by all staff) followed by ongoing provision of training in areas identified as core to staff roles and functions. The business plan for 2006 expresses a commitment to staff training and development. The training programme was under review and development at the time of the site visit. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 22 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, 39, 42, 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Taking into account staff numbers the home is being carried on competently by acting manager on a practical day-to-day basis. Quality assurance and development has been lacking and is yet to become embedded in practice. In terms of consequence the health and safety of those living and working in the home has been maintained though a more coordinated approach to risk assessment is needed. The home operates within the company structure and may now begin to benefit from a greater degree of quality assurance. EVIDENCE: The home was without a registered manager at the time of this inspection. The acting manager has a number of years experience in similar roles. The home has been lacking in any coordinated quality assurance measures. This is now changing by virtue of company strategy and action. The first fruits The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 23 of some of this work have been seen for example in revised systems to complete the assessment, planning and review of care. Further implementation and development of the monitoring and quality assurance systems is necessary before any judgement can be made as to its positive impact on outcomes for residents. Staff training in safe working practices includes first aid, food hygiene, health and safety, fire safety, medication and manual handling. Safety certificates and records showed that the homes gas installation and electrical appliances were periodically maintained and checked for faults. An up to date safety certificate for the fixed electrical installation could not be located. Adherence to good food hygiene practice was evident in the home and this was supported by a recent inspection carried out by the local environmental health department. Procedures and resources were in place for the management of hazardous substances. There was a lack of evidence to show that health and safety risks around the home have been systematically identified, assessed and where necessary action taken to eliminate or reduce necessary risks as far as it is practicable possible. Examples could include hot water temperatures, moving around at night, maintenance of bath hoist and residents using the kitchen after hours or using kettles and storing food in their rooms. An outline of the business plan for 2006 has been made available to the Commission. The plan sets out the direction and aspirations of the home in the context of the wider companies development strategy. No records or dealings with matters relating to budgets or the financial operation of the home were in the day-to-day concerns of the acting manager. The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 2 LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X X X 2 X X 2 X The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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. 9. Standard YA2 Regulation 14(2)a,b,d Requirement The registered person shall ensure that the assessment of the service user’s needs is kept under review; and revised at any time when it is necessary to do so having regard to any change of circumstances. Timescale for action 01/11/06 10. YA6 15(1) Unless it is impracticable to 01/11/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make the service user’s plan available to the service user; keep the service user’s plan under review; where appropriate DS0000028336.V298704.R01.S.doc 11. YA6 15(2)a,b, c,d 01/11/06 The Chestnuts (Welcome House) Version 5.2 Page 26 and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and notify the service user of any such revision. 12. YA6 12(1)(a)12(1)(b) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The registered person shall ensure that the care home is conducted so as to make proper provision for the care of service users. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service DS0000028336.V298704.R01.S.doc 28/08/06 13. YA9 13(4)(b)13(4)(c) 28/07/06 14. YA11 12(1)(b) 28/07/06 17. YA33 18(1)(a) 28/07/06 The Chestnuts (Welcome House) Version 5.2 Page 27 users. 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 YA16 Good Practice Recommendations A key to the front door should be provided without delay to those service users who have expressed the wish to have one. Staff should help service users that wish to, to find and participate in local independent advocacy/self-advocacy groups. Service users should be supported to help choose and plan menus The registered provider should make efforts to ensure that a male member of care staff is employed to work in the home. The registered person should work to ensure that service users are all aware how they can contact the Commission, advocacy services and funding authorities to raise any concerns they may have about the services provided by the home. The registered person should ensure that the homes own policy regarding adult protection is complied with in respect to ensuring staff are aware of and understand the homes adult protection policies and procedures. The registered person should review the frequency of visits by a handyman to the home and seek to ensure repairs are carried out in a timely manner. The registered person should ensure that bedrooms together with the furniture, fixtures and fittings within meet minimum standards prior to their occupation by service users. 2. YA3 YA7 YA22 YA17 YA18 YA33 3. 4. 5. YA22 6. YA23 7. YA24 8. YA26 The Chestnuts (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 (Welcome House) DS0000028336.V298704.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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