Inspection on 03/10/05 for The Chestnuts

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Chestnuts 09/12/08

The Chestnuts 15/12/06

The Chestnuts 26/04/05

The Chestnuts 04/11/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Chestnuts 169 Norwich Road Wisbech Cambridgeshire PE13 3TA Lead Inspector Don Traylen Unannounced Inspection 12:30 30th September & 3 October 2005 rd X10015.doc Version 1.40 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 DS0000059065.V255175.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000059065.V255175.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address 169 Norwich Road Wisbech Cambridgeshire PE13 3TA 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) 01945 584580 Arnas Mauremootoo Arnas Mauremootoo Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: The Chestnuts is registered as a care home for up to eighteen people over 65 years of age. An increase from 17 to 18 places was approved by the CSCI on the 26th September 2005, but is not shown in the details of the Service Information on page 4 of this report. There are no conditions of registration recorded for this service. 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 integration of an older two- story house and an adjacent ground floor extension that has been added to a pre-existing bungalow. The home is in a residential area of Wisbech. The building has been adapted and extended to provide accommodation for older people. There are sixteen single rooms and one double room. All bedrooms have wash hand basins and twelve rooms each have a toilet. One room has full on suite facilities. A stair lift allows easy access to the first floor. The home has two separate lounges, a dining room, a spacious entrance hall, a conservatory and a hairdressers room. The garden and grounds to the front and rear of the home are pleasant. The driveway has parking facilities for five cars. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was conducted over two days. Six service users were spoken to and seven other service users were observed in a communal setting. The care planning for one service user confined to bed was inspected. Care assistants were spoken to and were observed for their interaction with service users. Training records, two Care Plans and the Medication Administrations Record sheets were read. The inspectors had discussions with service users about their perceptions of the home and their level of satisfaction with their care. Discussions with the registered provider and the assistant manager about the provider’s aspirations for the future of the service also informed this inspection. Feedback and discussion of this inspection was given to the Registered Provider, Mr Mauremootoo and to the Assistant Manager, Julie Bryant-Roggero at 5pm on 3 October 2005. What the service does well: What has improved since the last inspection? The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 6 • • • • • A new stair lift has been installed. By converting a previous activities room to a large bedroom with ensuite facilities, the registered provider has created an additional bedroom. As a result and immediately prior to this inspection, the CSCI agreed to approve the home’s application to vary their registration by an increase of one additional place for a service user in the category of Older Person (OP). The provider has installed a purpose designed and built conservatory that is used by service users and visitors. More staff have achieved NVQ level 2 awards. All but one care assistant have achieved this award and the remaining one care assistant is expected to achieve this award by November 2005. Training in relevant care courses continue to be arranged by the Assistant Manager, who is an NVQ Assessor and who has overseen the progress of the NVQ level 2 awards achieved by all the care staff employed by the home. What they could do better: The two Requirements and the three Recommendation made in this report build upon the progress the home has already made that was acknowledged in the last inspection of the 26 April 2005. The Recommendations are suggestions for the home to adopt as good practice. One of the two Requirements made are to ensure that care is person-centred and recorded in sufficient detail for any service user who has become dependent on others to assist with feeding. Such detailed recording should give an accurate account of food consumed and hence be the record of the home’s response to a service user’s changing needs. The home may wish to reconsider their registration status and plan for the service they are likely to provide in the future to service users who may develop dementia related care needs. A risk assessment of the ground floor windows must be made. Please contact the provider for advice of actions taken in response to this The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3,4,5, Prospective service users, or their representatives, are given adequate opportunity to make a judgement about the home. EVIDENCE: Pre-admission assessments are requested from the local authority or the PCT. The home also carries out their pre-admission assessment. The inspector and the Assistant manager discussed one service user’s assessment provided by a Care Manager that indicated confirmation should be sought by the home about the information provided in the assessment. A trial visit is always offered to prospective service users and family, or representatives, are encouraged to be part of the admission process. Two service users admitted during the two days of the inspection had previously visited the home and both confirmed to the inspector they had made the choice to move into the home and had been provided with enough information about the home. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 7,8,10,11, Care planning and care giving is individually tailored to meet the needs of each service user. EVIDENCE: Two service Users’ Care Plans were read. The Inspector discussed with the assistant manager and the registered provider that it would be good practice and an accurate reflection and record of care and needs, to record the amount, type and frequency of food and drink consumed by one very dependent service user. A nurse is involved with the nursing care for one service user who is confined to bed. Records of community nursing intervention and care given by the home are maintained in daily records. The home have agreed to keep additional and detailed records in relation to this person’s care. Care Plans were neat, well presented and comprehensively addressed needs based on assessment details and were constructed by using 12 or 13 points of care, written in an outcome based approach. It is recommended that the home The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 11 maintain Care Plans in a more person-centred manner that reflects the home’s person-centred approach to giving care. Medication Administration Record sheets were read for one service user and provided an accurate crosscheck with her Care Plan. The care need of service users was discussed with the assistant manager and how the home should manage and refer a service user for specialist assessment of their mental health. The manager and assistant manager are mindful of ensuring that all service users care needs are appropriately assessed and kept under review. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12,13,14,15, Service users experience a satisfactory and preferred daily lifestyle. EVIDENCE: Service user confirmed with the inspector they enjoy a lifestyle that meets their wishes and they are comfortable with the daily routines of their lifestyle. Service users spoken to stated they receive frequent visitors. One service user stated that her visitors could arrive at any time they choose. Service users stated that meals were plentiful and met with their approval. During the inspection service users were offered drinks and were asked about their choices of food for teatime and for their choice of main meal the following day. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 18, Service users are adequately protected from abuse that is underwritten by the home’s philosophy that starts from a perspective based on respect. EVIDENCE: The home has an adult abuse policy that adheres to the guidelines for preventing adult abuse issued by Cambridgeshire County Council. All staff in the home were trained in March 2005 in preventing and dealing with abuse. One member of staff confirmed her understanding of her responsibility to immediately report any allegation or suspicion of abuse. The inspector discussed with the assistant manager about arranging for refresher training in preventing abuse for all staff and that this could be requested from the Cambridgeshire County Council Adult Abuse Co-ordinator. Four service users informed the inspector they would raise their concerns should they feel they wanted to. The home has a Whistle Blowing policy. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 19,20,21,22,23,24,25,26, The home provides a safe, comfortable and friendly environment for all service users. EVIDENCE: Observations were made of the friendliness and of the eagerness of service users to smile and to talk about their experiences of living in the home. Six service users stated they were happy with living in the home. One service user who is confined to bed has been supplied with a specialist pressure mattress. New hoists and slides and belts to facilitate service users to manoeuvre have been purchased by the home. Three service users rooms were seen and each room had been equipped and fitted with appropriate furniture for their individual uses. The home was very clean and hallways and entrances were clear and accessible. The outside patio and gardens were neat and accessed through a recently installed conservatory. A new stair lift has been installed. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 15 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Service users are protected by strict recruitment procedures and by satisfactory supervision of staff. EVIDENCE: Eight of the nine care staff have achieved NVQ level 2 awards and the ninth person is expected to complete her course in the very near future. Sufficient staff are employed to meet the needs of service users. Usually two care assistants, an assistant manager and the manager are on duty during the daytime and one care assistant works during the night. Six staff are trained in safe handling of medication. The assistant manager explained that she arranges training for all staff on the understanding that it is an essential part of their job description and they are expected to attend this training to be suitably skilled and able to meet service users’ needs. The training matrix analyses indicated for 2005 showed that all staff have recently received and are in the process of receiving further training in ‘Healthy Eating’, that was described by the manager and one other staff as very extensive and relevant to everybody. ‘Infection Control’, ‘Safe Handling of Medication’ have been provided to all staff through the Isle College Wisbech, whilst ‘Falls Prevention’, ‘Diabetic Care’ and ‘Catheter Care’ have been provided by specialist nurses to all staff. Cambridgeshire County Council has provided prevention of Abuse to Vulnerable Adults to all staff in March 2005. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 16 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,37 Service users benefit from a well managed home with a suitably skilled and competent manager and assistant manager. EVIDENCE: The skills of the manager and assistant manager were acknowledged in the last inspection report of the 26 April 2005 as highly competent and very well suited to the philosophy of inclusiveness promoted in the home: “The registered manager/ provider holds an NVQ level 4 management award and has had previous experience of management tasks in a 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 DS0000059065.V255175.R01.S.doc Version 5.0 Page 17 The management of the home is especially open and inclusive of staff views and service users opinions and welfare. It is a management style and model recommended by the inspector. The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 18 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 3 3 3 3 2 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 3 3 3 X X 3 3 X The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? N/A 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 OP7 Regulation 15(2)(b) Requirement Service users’ Care Plans must record full and detailed description of food and drink they have consumed or refused if they are dependent on care assistants to help them feed and are unable to feed themselves. A risk assessment must be carried out regarding the safety and security and heat retention of the ground floor windows. Timescale for action 10/10/05 2 OP25 13(4)(a) & (c) 01/11/05 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. 3. Refer to Standard OP3 OP7 OP30 Good Practice Recommendations Care Management assessment details should be clarified with the Care Manager prior to admission when ambiguous information has been given to the home. The home should continue with their intention to record Care Plans in a person- centred manner. Refresher training for all staff in the prevention of abuse to vulnerable adults should be arranged. DS0000059065.V255175.R01.S.doc Version 5.0 Page 20 The Chestnuts The Chestnuts DS0000059065.V255175.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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. 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