Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: The Chestnuts 72 Church Road Altofts Normanton West Yorks WF6 2QG The quality rating for this care home is:
three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Railton
Date: 2 7 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home
Name of care home: Address: The Chestnuts 72 Church Road Altofts Normanton West Yorks WF6 2QG 01924220019 01924223460 maggie-thechestnuts@homecall.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bond Care Ltd care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Can accommodate one named service user under 65 years of age in PD category One specific service user under the age of 65, named on variation dated 9th February 2007, may reside at the home. To accommodate a maximum of 5 persons in category TI(E) (Terminally Ill - Older People) at any one time. Date of last inspection Brief description of the care home The Chestnuts provides personal and nursing care for 41 older people. Set back in its own grounds the home is situated in a residential part of Altofts between Wakefield and Castleford. There is car parking provided to the front and a large garden and patio area to the rear. Through the main entrance to the front there is a large hallway, Care Homes for Older People
Page 4 of 24 Over 65 41 0 Brief description of the care home which leads to all areas including lounges to the front and left, dining room to the right and a passenger lift to bedrooms on the first and ground floors. All bedrooms provided by the home are single accommodation and there are assisted baths with hoists for those who require it. There are qualified nurses on duty at all times. The home is close to local shops, churches and public houses and the M62/A1 link roads are close by. The current fees for December 2006 range from #378 per week per person. The service provider ensures that information about the service is available to prospective service users and the current service users by way of the home?s Statement of Purpose, the Service User Guide and through CSCI inspection reports, which are available in the home and upon request. Care Homes for Older People Page 5 of 24 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Following this inspection visit the service has been given a Three Star Rating which means people living in the home experience excellent outcomes. This visit started at 09:00 and ended at 15:00. During this visit there was the opportunity to speak to people living in the home, the Registered Manager, Nurses, care staff, kitchen and domestic staff, the administrator and the handyman. There was the opportunity to look around the home and observe people and their morning routines. Some peoples records were seen and included assessments, risk assessments, care plans, reviews, daily and medical records. Some peoples medicines and finances were also seen and checked. Some staff records were seen and included application forms, references, police and POVA (Protection of Vulnerable Adults List) checks. Staff training records were seen and some staff supervision records. Other documents seen included the record of of complaints, the homes maintenance records. The previous inspection visit report was considered along with information provided by the home before this visit
Care Homes for Older People Page 6 of 24 and in particular the AQAA (Annual Quality Assurance Assessment). Some returned CSCI surveys were also taken into account as was the homes Quality Assurance Surveys from people living in the home and their relatives. The complement records were also seen. What the care home does well: What has improved since the last inspection? Since the previous inspection visit the Registered Manager and the staff team have been awarded a Gold Standard for caring for poorly people reaching the end of their lives. Letters from relatives of those that lived in the home show they were very pleased with the quality of care and services provided. For the benefit of people living in the home ten new specialist Profiling beds have been provided along with some new pressure relieving mattresses. Two new shower or wet rooms have been provided for those who prefer to have a shower and there is a Parker bath so people have a choice of bathing. There is a small kitchenette provided to encourage people to maintain their independence and make drinks and simple snacks if they wish. Raised flower beds have been provided along with garden furniture in the rear garden for people to enjoy during the summer months. For the comfort and benefit of people living in the home forty replacement windows have been provided. The Registered Manager says this has been a massive investment but has improved the home and the lives of people living at the Chestnuts. These Care Homes for Older People
Page 8 of 24 investments are to be commended. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 24 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To make sure the service can meet peoples personal and health care needs these are assessed before coming to live in the home. The home does not provide a specialist rehabilitation service. Evidence: To make sure the service can meet peoples care and support needs these are assessed before coming to live in the home. The Registered Manager confirmed that they or a Registered Nurse goes to meet people and ask them what their care and support needs are before being offered a place. A sample of some peoples records show there is an assessment of their personal care and health care needs. Records show the assessments and care plans are been updated and improved to make them easier to staff to follow. The registered manager says the home has a good reputation and there is a waiting list of people wanting to live at the Chestnuts. Care Homes for Older People Page 11 of 24 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs are met and in particular those that are poorly and receiving end of life care. People are also protected by the way medicines are dealt with by the home. Evidence: One person living in the home says there is no place better Another says The Chestnuts is the best. A sample of peoples records show their care needs are set out in a plan of care. The Registered Manager says the care plans have been improved and are now easier to follow. The registered Nurse says the care plans are much better and show staff what they should do to meet peoples personal care needs. To make sure peoples care needs are met records show they are are assessed. The assessments include Nutritional assessments, Tissue Viability, and Mental Wellbeing assessments. The reviews show these are looked at regularly and changed to reflect peoples changing care needs. People were observed throughout the visit being treated with dignity and having their wishes respected. However, the daily records did not contain many descriptive words to reflect and show peoples choices and preferences. The daily and medical records show peoples needs are met and reflect peoples any
Care Homes for Older People Page 12 of 24 Evidence: changes to their health care needs. People are protected by the way medicines are dealt with as records show they are monitored and checked regularly. On the day of the visit some peoples medicines were checked and found to be correct and safely administered. To further protect people in the home those giving medicines have been trained to do so safely this includes specialist Syringe Drive Training. The registered manager says since the last inspection visit the home has been achieved a Gold Standard Award for End of Life Care. This good practice is to be commended. Health records show the home is well supported by the Palliative Care Nurses and General Practitioners. The registered Manager says end of life care is very important and the award is recognition of best practice provided by the whole staff team. It was also noted the home has invested in ten new specialist Profiling Beds for the comfort and safety of poorly people living in the home. Care Homes for Older People Page 13 of 24 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lifestyle matches their experience and they have a say in what they do and how they live their lives. People are offered a varied and balanced diet of their choosing. Evidence: People were observed relaxing in the lounges and dining room and in their own bedrooms. People were socializing, some knitting, some watching television, others relaxing listening to music in their own rooms. Some people were receiving visitors and others talking to a local Priest. People were observed throughout the visit being treated with dignity and having their wishes respected. Positive relationships were observed being fostered between people living in the home and those caring for them. Discussion with the activities organizer found activities are arranged regularly for those who wish to participate. However, the activities records did not show if people were asked or if they had chosen to participate in the activities or not. People said the meals provided are excellent another says the meals are very good and they have a choice of meals. Records show some people are on special diets and others have peg feeds. Training records show staff are trained in how to do this properly and safely. Discussion with the cook found that there is a varied and balanced diet provided. The menu confirmed this. The cook says people living in the home can
Care Homes for Older People Page 14 of 24 Evidence: request meals of their choice and the home can accommodate this. The returned quality assurance surveys show people and their relatives are happy with the meals provided. A tour of the premises found there is now a small kitchenette provided for people to make drinks and simple snacks. The registered manager says this is for people who want to maintain a little bit of Independence. Is was noted there is a orange juice dispenser available for people living in the home. This practice ids to be commended. Care Homes for Older People Page 15 of 24 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. What people say is listened to , taken seriously and acted upon, and they are protected from any kind of abuse. Evidence: People were observed throughout the visit being treated with dignity ad having their wishes respected. People know that what they say is taken seriously and acted upon as the record of complaints show their concerns have been acted upon. People have access to the complaints policy and procedure as it is displayed in the home and forms part of the Service User Guide. To protect people from abuse the home has a Safeguarding Policy and Procedure for staff to follow. To further protect people staff training records show they have Safeguarding training. The homes returned quality assurance surveys show that people living in the home and their relatives know how to make a complaint but have never had to. Records show no complaints have been recieved by the CSCI about the home. Records also show the home has not had to make any Safeguarding Referrals. Care Homes for Older People Page 16 of 24 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy living in a well decorated, well maintained home that is comfortable, safe clean and well equipped. Evidence: People were observed relaxing in well decorated and well maintained surroundings that are relaxed , homely and comfortable. The homes returned quality assurance surveys show people living in the home and their relatives are happy with the home and the services provided. For the comfort and benefit of people in the home the registered manager confirmed that forty replacement windows have been provided since the previous inspection visit. This investment by the home is to be commended. A tour of the home found there are two new shower rooms provided to offer people a choice of when bathing. There is also a new kitchenette available for people and their relatives to make simple snacks if they so wish. For the comfort of poorly people ten new Profiling Beds have been provided that can move up and down and be put into peoples preferred positions. These improvements are also to be commended. Some new pressure relieving mattresses have also been provided for those who require them. One person living in the home said the home is excellent and they have everything they need. Another said the home is wonderful. People live in a home that is safe and well maintained as records show the passenger lift, hoists and fire equipment are checked and serviced regularly. Care Homes for Older People Page 17 of 24 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs are met by trainied and qualified staff and the care provided for poorly people who are reaching the end of their lives is excellent. People are also prtected by the way staff are recruited and selected. Evidence: Throughout the visit people were observed being treated with dignity and having their wishes respected. Positive relationships were also observed being fostered between those living in the home and those caring for them. There appeared to be enough staff available to meet peoples care and support needs in a relaxed and unhurried manner. The staff rotas confirmed and show there are enough staff planned to be on duty to meet peoples needs. The returned quality assurance surveys show people and their relatives are very happy with the quality of care provided. One person says the staff are very caring and nothing is to much trouble. Another says staff are wonderful, another said the staff are angels. People are protected by the way staff are selected and recruited as records show references, police and POVA (Protection of Vulnerable Adults List) checks are taken up before they are employed. People are also protected by the training provided for staff as records show they have Safeguarding, First Aid, Moving and Handling, Infection Control, and Health and Safety training. Records show specialist training is also provided for staff in supporting those who are very poorly and needing end of life care. The Registered manager confirmed the home has been awarded a Gold Standard Award for palliative care. The Registered Manager and the
Care Homes for Older People Page 18 of 24 Evidence: staff team are to be commended for their efforts in maintaining such good standards of care in the home. The compliments book shows people have been very happy with the the care provided for their relatives. The returned quality assurance surveys show people and their relatives are very happy with the quality of care provided. So people living in the home and their relatives can see what training staff have received the Skills Matrix is displayed in the entrance. Peoples care needs are met by trained and qualified staff as records show over 50 of staff have a National Vocational Qualification. Records also show the nursing staff are very experienced and qualified and have time given to update their training and competencies. One very experienced and qualified nurse new to the home says the quality of care provided is excellent. One visiting Social Worker says the care provided is second to none. The registered manager says staff turn over is very low and people enjoy working in the home. Care Homes for Older People Page 19 of 24 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home where they have a say in how they are supported and cared for. People also benefit from the ethos and leadership and management approach of the home. Peoples health , safety and welfare is also promoted and protected. Evidence: The quality assurance surveys show people , their relatives and other visitors have the opportunity to comment on the running of the home and the quality of the services provided. However the home has yet to collated the information gathered through quality assurance surveys and provide a report showing what people say about the home. Records show there have been many improvements to the care management systems and in particular for those that are poorly and needing special end of life care. Records show there have also been improvements to the training provided for staff to make sure people receive the care and support they need and require. For the benefit and comfort of people living in the home there have also been improvements to the environment and major investments in providing specialist equipment require to
Care Homes for Older People Page 20 of 24 Evidence: improve the standard of care provided. All of these improvements are to be commended. People live in a safe home as records show regular health and safety and fire checks are undertaken. To further protect people staff training records show they have health and safety training. People are protected and their best interests promoted as a a sample of peoples finances were checked and found to be correct and properly administered. People were observed throughout the visit being treated with dignity and having their wishes respected. The reviews and the daily records show people have choices and make decisions about how they live their day to day lives. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 As a matter of good practice the home should consider increasing the use of descriptive words in the daily records to show and reflect peoples choices and preferences and any decisions they might make about their daily lives. It is acknowledged that activities are arranged for people to participate in if they so wish, however. as a matter of good practice a better record should be kept of those participating using descriptive words to reflect peoples choices and preferences. 2 12 3 33 The information gathered through quality assurance surveys should be collated and a report provided to reflect what they say and any changes made to the way the home runs as a result of their comments. Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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!
