CARE HOMES FOR OLDER PEOPLE
The Chestnuts 169 Norwich Road Wisbech Cambridgeshire PE13 3TA
Lead Inspector Don Traylen Announced 26 April 2005 @ 10:00 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 169 Norwich Road Wisbech Cambridgeshire P13 3TA 01945 584580 01945 584580 chestnutscare@btconnect.com and chestnuts.qualitycare@virgin.net Mr Arnas Mauremootoo Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Arnas Mauremootoo Care Home 17 Category(ies) of Older Persons not falling into anu other category registration, with number (OP)=17 places of places The Chestnuts Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 04/11/2004 Brief Description of the Service: The Chestnuts is a care home for up to seventeen older people, over 65 not falling into any other category. The home is situated in the town of Wisbech, close to local amenities and has good road links to the cities of Cambridge, Ely, Peterborough and the town of March. The home is an older property of two floors in a mainly residential area of Wisbech. The building has been adapted and extended to provide accommodation for older people. There are fifteen single rooms and one double room. All bedrooms have wash hand basins and twelve rooms each have a toilet. A stairlift allows easy access to the first floor. The home has two separate lounges a dining room, an impressive wide entrance hall, a designated activities room and a hairdresser’s room. The garden and grounds around the home are pleasant. The driveway has parking facilities for five cars. The Chestnuts Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. On the day of inspection there were 17 service users resident in the home. The inspector spoke to four service users, two care staff, four visiting relatives, the contracted maintenance worker, the cook and made observations of a group of service users in the lounge for a period of 20 minutes. During the inspection, a well-known company who regularly visit the home were demonstrating their range of natural cosmetics to a group of interested service users and relatives. The registered provider was given additional copies of service user and relatives questionnaires to distribute. What the service does well:
The registered provider and the deputy manager and care staff were eager to assist in the inspection process and have shown a commitment to work in parnership with the CSCI in their various communications with the CSCI. The registered provider, Mr Mauremootoo, has made numerous and extensive improvements to the home since he became the new proprietor in May 2004. Mr Mauremootoo stated that he intends to continue with other improvements to the building as soon as possible. The home manages in a way that promotes staff and service user views and ensures their views and choices are actually implemented. Inclusion is not tokenistic; it is a reality. The home respects service users through a philosophy and culture of openness that is clear to see in the comments made by staff and relatives and the service users. The home has managed to form networks with partner agencies such as the PCT/Social Services, three GP surgeries and District Nurses and has been pro-active in sourcing new equipment for the home. Consultation with the CSCI has been a feature of the provider’s eagerness to commit to quality. Service users are protected from abuse. All staff have received training in preventing adult abuse and the provider is very aware of the nature of abuse. Staff training is provided in the appropriate skills for the home’s service users and is also the subject of constant review by the provider and the deputy manager. The provider stated that his approach is to operate as an interdependent team and that it is in everyone’s interests to have well-trained staff. Staff supervision is recorded and is arranged on a regular basis. The
The Chestnuts Version 1.10 Page 6 deputy manager is competent and suitably qualified for her role and has an important function in managing staff training. Potential new staff are invited to work alongside existing staff so they can be observed, but only after they have been carefully vetted and all references have been returned. The new employee is placed on a trial period before a contract is agreed. Furniture is replaced as and when it can be. The home has a dedicated activity room and an activity co-ordinator. What has improved since the last inspection? What they could do better:
Improvements to Care Plans could be achieved by focusing completely on a person centred approach and descriptive elements of giving care to each service user. This approach would provide written proof of the homes inclusive culture that is already practiced, as well as adding value to the Care Plans. It was discussed with the deputy manager that reviews of Care Plans could include care staff to promote their development and for them to become familiar with the system of assessing and commissioning care. The re-assessment of some service users’ needs should be considered. The home should enquire if some service users have dementia related care needs.
The Chestnuts Version 1.10 Page 7 Additional training in the Prevention of Abuse to Vulnerable Adults should be considered, so that staff are more confident about the process for reporting abuse. This was discussed with the provider and deputy manager during the inspection. Further environmental improvements to the home were discussed with the registered provider who intends to totally refurbish and update the kitchen as well as to sensitively change furniture so that it does not confuse, or cause anxiety to service users who may be content with familiar surroundings. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts Version 1.10 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Chestnuts Version 1.10 Page 9 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 standard(s) 1,2,3,4,5, Service users benefit from a generous, open and inclusive policy for determining prospective service users’ needs. EVIDENCE: The Statement of Purpose and the Service User Guide are separate informative documents that are provided to any person requesting them. Comprehensive Social Services pre-admission assessments were completed for two service users and included their signatures and the care managers’ signatures. Copies of signed contracts were read. The home has a system of completing an in-depth assessment and conducts a home visit prior to any new admission. The service users’ views and their families’ views are sought. The deputy manager explained to the inspector that the home assures they are able to meet needs and offers each new service user an individually appropriate trial period. Service users who are funded by the local authority automatically enjoy a six-week trial period. Contracts are not issued until the service user is in agreement and happy about the home. The proprietor stated that prospective service users and their families are The Chestnuts Version 1.10 Page 10 informed they have an open invitation, without a pre-arranged appointment, to visit the home and make their own judgements. The Chestnuts Version 1.10 Page 11 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 standard(s) 7,8,9,10,11, The registered provider is committed to ensuring the home provides care in a person-centred manner that is based on respect. EVIDENCE: Two Care Plans were read and contained sufficient and appropriate information. Plans were clearly written, logically presented and contained identified outcomes. Key workers were named in Care Plans. Discussions with three service users and four relatives indicated that they are treated with respect. One relative said he was pleased with the quality of care shown in the home and that his family were happy their mother was placed in the home. One service user was being cared for in her bed with the assistance of a visiting District Nurse. Another service user has regular visits from the District Nurse for her pressure sore. A district nurse attends to assess one service user for pain relieving medication. Observations showed that the registered provider and care staff speak to service user in a particularly respectful and attentive manner. The home has a medications policy. MAR sheets were accurately maintained. All staff have received training in administering medication and one named person per shift has responsibility for administering medication.
The Chestnuts Version 1.10 Page 12 The Chestnuts Version 1.10 Page 13 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 standard(s) 12,13,14,15, Service users experience an inclusive and engaging lifestyle and their family links are maintained. Service users are provided with a nutritious and plentiful diet. EVIDENCE: The home has employed an activities co-ordinator to work for three days per week. A hairdresser visits twice each week and uses a dedicated hairdressing salon. The deputy manager stated that some service users have formed friendships. ‘Residents’ meetings are planned to become regular events. One service user stated that he is “well satisfied” and that he eats well and likes the food provided. Menus are organised by the two cooks who agree the menus in advance with the manager. The menu for 17 service users was read on the day of inspection. Service users are always offered two alternatives and a further alternative choice should it be necessary. Another service users stated that staff, “are good to all” and that she sees a district nurse occasionally to test her blood because of the medication she takes. Another service user stated that his son visits every week and they always go out. The inspector spoke to four relatives who were visiting service users during the inspection. The home has a policy for relatives to visit at any time they choose.
The Chestnuts Version 1.10 Page 14 During the inspection the daily life of service users was enhanced by the interaction of one care worker who brought smiles to the faces of a group of service users and decidedly animated them by her interactions with them. She took time to speak to each person who had all previously been sitting still and quiet and slightly withdrawn. She took time to notice them and treat then with respect. Service users are included in deciding colour schemes for redecorating the home and choosing furnishings and carpeting for their rooms. The Chestnuts Version 1.10 Page 15 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 standard(s) 16,17,18, The Chestnuts comprehensively ensures the safety and protection of service users. EVIDENCE: Three service users stated they would complain if they wished, but all were keen to point out they had nothing to complain about. The home had no recorded complaints. It was discussed the home might wish to keep a, “compliments and complaints” book. The inspector saw that each service user had received a postal voting form and had been registered for a postal vote for the forthcoming General Election and thereby for subsequent postal voting. Protection of vulnerable adults training has been provided for all staff by Cambridgeshire Social Services. The home’s policies on abuse and Whistle Blowing policy was read. Staff discussed with the inspector their views about the training and how they need more confidence or involvement in the process of reporting abuse. This comment was reported to the provider and the deputy manager during the inspection. The Chestnuts Version 1.10 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26, Service users enjoy a clean, comfortable and safely maintained environment that has a relaxed and happy atmosphere. The social environment is anxiety relieving and attentive to service users. EVIDENCE: The inspector toured the building and saw most service users rooms. There has been evidence provided in the summary of the extensive refurbishment and redecoration of this home by the registered provider since he purchased the home in May 2004. The environmental improvements have been recorded in the previous two inspection reports dated 04/11/2004 and the 19/05/2004. Improvements have continued at a pace that is to be commended and have achieved positive outcomes for service users. Staff and relatives and service users have seen these improvement made on behalf of all service users. Simple attention to low wattage electric lighting, as well as lighter colours to reflect light, are some of very basic changes that have been implemented. At the other extreme, some immediate major repairs to the roof have been attended to during the winter of 2004-2005.
The Chestnuts Version 1.10 Page 17 One environmental and care improvement has been the installation of a new computerised nurse call system. For instance a call from a service users may be activated in any part of the home that can be identified by a care worker, who is then expected to respond immediately. The computer software records the time of the carer’s responding to the service user’s request and stores and collates this information. The usefulness of this system was discussed with the registered provider who demonstrated the system to the inspector. Sensors in bedrooms that can identify if a service users is active during the night. Additional sensors can be added to the system. An accountability chart that records environmental and care standards expected to be observed for each service users, is kept in their room. The Chestnuts Version 1.10 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30, High quality care for service users is ensured by strict recruitment and supervisory policies and by the provision of appropriate staff training. EVIDENCE: The registered manager and provider holds an NVQ level 4 management award. The deputy manager also holds an NVQ level 4 award in management and is an NVQ Assessor and holds NVQ level 3 in teaching. She is a competent deputy with eight years experience of NVQ assessing and is capable of managing the home. She has a job description that includes a responsibility to manage staff training. 70 of staff hold an NVQ level 2 award. The three staff who make up the remaining 30 are expected to complete their NVQ level 2 awards within five months and this includes one recently employed care worker. Training records were read. Training has been provided for catheter care, falls prevention, infection control, healthy eating, diabetic care and have been provided by the Isle College, Wisbech. The home has a three- month long induction arrangement, prior to offering an employment contract. Job descriptions are given to new staff and the provider is eager to offer new contracts to all staff who are employed under the previous owner’s contractual agreement. Recruitment of new staff is thorough. Potential staff are expected to work alongside existing staff so they can gain an insight into care work and be observed for job suitability. This pre-induction taster is only arranged after new
The Chestnuts Version 1.10 Page 19 staff have been carefully vetted and after all references have been returned. The new employee is placed on a trial period before a contract is agreed. The provider stated he is aware that not all applicants are suited to care work. Two care staff and the deputy manager and registered provider work at the home most days. The deputy manager undertakes care tasks as and when necessary, as does the registered provider. It was observed that staff were able to attend to service users needs and their calls for assistance were swiftly answered. The Chestnuts Version 1.10 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36,37,38, There is no doubt that service users health, welfare and protection is promoted. Leadership by example has produced a culture of respect for service users that is constantly being reinforced. EVIDENCE: The registered manager/ provider holds an NVQ level 4 management award and has had previous experience of management tasks ina care home. The deputy manager also holds an NVQ level 4 award in management and is an NVQ Assessor and holds NVQ level 3 in teaching. She is a competent deputy with eight years experience of NVQ assessing and is capable of managing the home. She has had 11 years in a management position prior to working at the Chestnuts in January 2004.
The Chestnuts Version 1.10 Page 21 Discussions the inspector had with the provider and the deputy manger and with relatives, with service users and with care staff, provided collective evidence that the management of the home is service user orientated and is the overriding reason why service users enjoy a safe and caring home to live. During the inspection it was noticed that the three care staff on duty and the managers, showed commitment and consideration to all service users. Leadership by example was evidence of a culture of respect for service users being reinforced in the home. Fire safety checks are maintained for equipment on a 4 times per year arrangement. Weekly fire drills are recorded. Portable electrical appliances are checked annually and laundry equipment and clinical waste disposed of by contractual agreements. The stair lift has a record of maintenance. The Chestnuts Version 1.10 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 3 3 3 3 3 The Chestnuts Version 1.10 Page 23 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. 1. Standard Regulation None Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7 18 Good Practice Recommendations The homes should record Care Plans in a person- centred manner. Addditional training for all staff in the prevention of abuse to vulnerable adults should be arranged. The Chestnuts Version 1.10 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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 Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
