CARE HOMES FOR OLDER PEOPLE
The Chestnuts 72 Church Road Altofts Normanton WF6 2QG Lead Inspector
Tony Brindle 2nd Inspector Gillian Walsh Unannounced 27 July 2005 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 J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Chestnuts Address 72 Church Lane Altofts Normanton WF6 2QG 01924 220019 01924 223460 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) Bond Care Ltd Mrs Anne Bradley Care Home 41 Category(ies) of Older People 41 registration, with number of places The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 17 February 2005 Brief Description of the Service: The Chestnuts provides personal and nursing care for 41 older people. Set back in its owngrounds the home is situated in a residential part of Altofts between Wakefield andCastleford. There is car parking provided to the front and a large garden and patio area tothe rear. Through the main entrance to the front there is a large hallway which leads to allareas including lounges to the front and left, dining room to the right and a passenger lift tobedrooms on the first and ground floors.All bedrooms provided by the home are single accommodation and there are assisted bathswith hoists for those who require it. There are qualified nurses on duty at all times. The homeis close to local shops, churches and public houses and the M62/A1 link roads are close by. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit was a positive and enjoyable inspection. The inspectors would like to take the opportunity to thank the service users, the manager and support workers for their hospitality and patient cooperation throughout the inspection. During the inspection, the following documents were inspected: 4 care plans, the daily records, health and safety records, the complaints log, the menus and the medication records. A service user’s invitation to see their bedroom was welcomed and accepted, and the building and gardens were seen. There have been no additional visit to this home since the last inspection in February. However, the Commission has had dialogue with the manager over unsatisfactory staff recruitment and selection procedures. . There have been no changes to the Registered Persons registered with CSCI. What the service does well:
The systems and procedures operated by the staff at the home make sure that the assessed needs of the service users are set out in plan, ensuring that their health, physical and social needs are recorded, along with the actions needed to be taken by the staff. The systems and procedures operated by the staff make sure that the social and recreational interests of the service users are met. Relatives are welcome at the home. Service user choice is promoted and service users receive a wholesome, balanced diet. The systems and procedures operated by the staff at the home make sure that service users and their carers are made aware of how to raise issues and complain. There are satisfactory systems on place that protection service users from abuse and harm. Service users live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. Service users needs are met by the numbers and skill mix of staff. Staff are trained and competent to do their jobs. The systems and procedures operated by the staff makes sure that the service user’s financial interests are safeguarded. The health and safety of service users and staff are promoted and protected by satisfactory systems and procedures. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 7 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 J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 8 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) 3 The use of a pre-admission tool, such as that put together by the deputy manager, would improve the admission procedures operated by the staff at the home. EVIDENCE: The manager explained that she and her deputy routinely visit prospective service users either in their own homes or in hospital, prior to admission to the home. She confirmed that new service users are admitted following a full assessment of their needs. The deputy manager recently devised a preadmission assessment tool, however, this was found not to be in use. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The systems and procedures operated by the staff at the home make sure that the assessed needs of the service users are set out in plan, ensuring that their health, physical and social needs are recorded, along with the actions needed to be taken by the staff. Double signing hand written medicine records and making sure that there is a running balance of medicines, would ensure that service users and staff are protected by a good practice medicine procedure. EVIDENCE: The service user plans of care were found to be set out the actions which need to be taken by care staff to make sure that the health, personal and social care needs of the service users are met. The care plans were found to contain information and records relating to the ways in which the staff promote and maintain service users’ health and ensuring access to health care services. There is a medication policy and procedure, giving details of the way medications should be received, recorded, stored, handled, administered and disposed of. The medication records were found not to contain a running balance of individual medicines received into the home. Hand written medicine records were not double signed. The manager explained that service users are able to take responsibility for their own medication if they wish, within a risk assessment framework. The arrangements for health and personal care ensure
The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 10 that service user’s privacy and dignity are respected with the staff being heard to speak to people in respectful ways, and with service users themselves saying that the staff are kind, caring and very patience. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 11 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 The systems and procedures operated by the staff make sure that the social and recreational interests of the service users are met. Relatives are welcome at the home. Service user choice is promoted and service users receive a wholesome, balanced diet. EVIDENCE: The routines of daily living and activities made available to service users were found to be flexible and service users said that they are varied to there needs, preferences and capabilities. Service users confirmed that they are able to have visitors at any reasonable time and one staff member said that links with the local community are developed with service users sometimes going to local churches and going for short walks. The manager said that service users can handle their own financial affairs for as long as they wish to and as long as they are able to depending on their capacity to do so. One staff member said that service users are entitled to bring personal possessions into the home when they move in. Two service users said that they have a varied, appealing, wholesome and nutritious diet, which is suited to their individual requirements. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 12 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) 16,18 The systems and procedures operated by the staff at the home make sure that service users and their carers are made aware of how to raise issues and complain. There are satisfactory systems on place that protection service users from abuse and harm. EVIDENCE: There is a simple, clear and accessible complaints procedure, which gives details of the stages and timescales for the process. There has been one complaint received by the manager since the last inspection in February. There are systems in place such as staff training and reporting systems, which safeguarded service users from abuse and neglect. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 13 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) 19,26 Service users live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The location and layout of the home was found to be suitable for its stated purpose. The building was found to be accessible and well-maintained. A number of service users said that the home was comfortable and homely. .The premises were found to be clean, hygienic and free from offensive odours with systems are in place to control the spread of infection. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 14 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) 27,29,30 Service users needs are met by the numbers and skill mix of staff. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: The rota showed that there is a satisfactory mix of qualified and unqualified staff working at the home, appropriate to the assessed needs of the service users, the size, layout and purpose of the home. The training records show that the staff training and development programme makes sure that the staff meet the changing needs of service users. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 15 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) 35,38 The systems and procedures operated by the staff makes sure that the service user’s financial interests are safeguarded. The health and safety of service users and staff are promoted and protected by satisfactory systems and procedures. EVIDENCE: The manager said that service users can control their own money except where a lack capacity leads to safeguards needing to be in place to protect the interests of the service user. Written records of all transactions were found to be maintained. The manager makes sure that so far as is reasonably practicable the health, safety and welfare of service users and staff, by way of staff training, fire safety system testing, risk assessment and safety system monitoring. The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 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 x 3 x x x x 3 x x 3 The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 17 none 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 Requirement None were identified during this inspection 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 OP3 OP9 Good Practice Recommendations The use of an appropriate pre-admission assessment tool should be adopted when working with prospective new service users. Upon recepit of individual medicines into the home, a running balance should be maintained. Hand written MAR sheet entries should be cheked and doubled signed as a matter of good practice. (Royal Pharmaceutical Society guidelines) The Chestnuts J51J01_s6173_the chestnuts_v219658_270705.doc Version 1.40 Page 18 Commission for Social Care Inspection Park View House Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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