Inspection on 31/05/07 for The Chestnuts

This inspection was carried out on 31st May 2007.

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 09/11/05

The Chestnuts 15/06/05

The Chestnuts 17/11/04

The Chestnuts 22/07/04

The Chestnuts 20/10/03

The Chestnuts 28/01/03

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Chestnuts Lavric Road Aylesbury Bucks HP21 8JN Lead Inspector Mike Murphy Unannounced Inspection 31st May 2007 09:30 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 DS0000039058.V331016.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. DS0000039058.V331016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address Lavric Road Aylesbury Bucks HP21 8JN 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) 01296 414980 www.heritagecare.co.uk Heritage Care Mr Satyanarain Lutchmiah Care Home 64 Category(ies) of Dementia - over 65 years of age (32), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0), Old age, not falling within any other category (64), Physical disability over 65 years of age (0), Sensory impairment (0) DS0000039058.V331016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That staffing levels on the dementia care groups are reviewed 3monthly to ensure staffing is sufficient to meet service users needs. The outcome of each review is to be documented and maintained in the home. 9th November 2005 Date of last inspection Brief Description of the Service: The Chestnuts is a purpose built home owned by Heritage Care who have homes nationwide. The home is situated on the Southcourt Estate in the market town of Aylesbury, which has a variety of shops and other amenities. The Chestnuts is registered to accommodate sixty-four service users, thirtytwo of whom have dementia care needs. All bedrooms are single, spacious and have en-suite facilities. The home is divided into four groups, each with its own lounge, dining room and small kitchen. The home has two passenger lifts and a range of moving and handling equipment. The home has its own mini bus which enables residents to travel to Aylesbury town centre and surrounding areas. Weekly fees at the time of this inspection were £535.60 for direct (‘spot’) purchase. There are additional charges for podiatry, hairdressing and newspapers. DS0000039058.V331016.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was conducted in May 2007. The inspection visit to the service took place on 31 May 2007 and was carried out between 10:00 am and 7:00 pm by one inspector. The inspection included consideration of information supplied by the registered manager, discussion with the registered manager, service users and staff, examination of records (including care plans and tracking the care of four residents), a walk around the building and grounds, observation of practice, and consideration of information provided by residents, relatives and health and social care professionals who had completed survey forms. The inspection finds that this home is generally providing good care to the people it supports. It has good systems for assessing the needs of prospective residents. Care plans are in place to meet those needs and the home liaises appropriately with health and other social care agencies as required. Some of the documentation routinely included in care plans might benefit from review but the overall structure supports the aim of identifying, recording and meeting the needs of residents. The home provides a range of opportunities for residents to participate in social events. It arranges meetings with residents and families throughout the year to consider whether the service is meeting the needs and wishes of residents. The home’s complaints and POVA (Protection of Vulnerable Adults) procedures are good. Residents and relatives express a good level of satisfaction with the service. Some concerns about staffing levels were expressed. As a condition of its registration the home was required to review staffing levels in the dementia care groups on a quarterly basis. It has not done so. There may well be areas within the home where there are pressures on staffing and these need to be explored by managers. Arrangements for staff training and support are good. The environment is pleasant, well maintained, clean and in good order. New carpets have recently been laid in some care units and these have noticeably brightened up those areas. It is hoped that the home will be able to continue to redecorate and refurbish other areas as required over the coming year, thus maintaining a good quality environment for residents. The home seems well managed. There is a good level of continuity at management level and managers have a clear idea of the strengths and weaknesses of the service. Overall this is a good home but there are a few matters to address as a result of this inspection. DS0000039058.V331016.R01.S.doc Version 5.2 Page 6 What the service does well: 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 summary of this inspection report can be made available in other formats on request. DS0000039058.V331016.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000039058.V331016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed prior to admission and the first few weeks of a person’s stay are considered a trial period. This process aims to ensure that the prospective resident is comfortable in accepting the offer of a place and that the home is able to meet the person’s needs. EVIDENCE: The majority of referrals are received through social services care management arrangements. Buckinghamshire County Council have a contract for 48 of the home’s 64 places. The remaining 16 places are for ‘spot purchase’ – private or through other authorities. Examination of the records of a recently admitted resident provided evidence of the home’s systems for carrying out assessments of prospective residents. DS0000039058.V331016.R01.S.doc Version 5.2 Page 9 Prior to carrying out its own assessment the home obtains a copy of the referring care manager’s assessment of needs and of the care management plan. An experienced member of staff – deputy manager, care practitioner or team leader – is then assigned to carry out an assessment of the person’s needs at their current place of residence. In the case of the person most recently admitted this was carried out in hospital. The assessment form is completed and provides an assessment of the person’s needs and an indicator of dependency (an estimate of the level of care required). The outcome of this assessment is discussed with the manager and deputy manager and a decision made on whether the home is likely to be able to meet the needs of the person. An offer of a place is then made. If accepted, arrangements for admission are made. A further assessment is carried out on admission. This, combined with information provided by the care manager, that acquired during the course of the pre-admission assessment, and information obtained from the resident and his or her family, forms the basis of the plan of care. The assessment process includes a manual handling assessment, recording the condition of skin (although a pressure sore risk assessment tool is not routinely used), a ‘depression score’, and assessment of particular care needs. A falls risk assessment is not routinely carried out unless the history indicates that a person may be susceptible to falls. The home establishes contact with health and social care professional staff involved with the person to ensure that relevant information is acquired and that the person receives appropriate support during the transition from home or hospital to the home. In all cases the first four to six weeks of the person’s stay in the home is considered a trial admission. This allows the person to decide if they wish to continue their stay and allows the home time to consider whether it can meet the person’s needs. This may be extended if both parties agree. The home does not offer intermediate care, therefore standard 6 does not apply. DS0000039058.V331016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans are based on assessment of needs and support the provision of appropriate care. Liaison with healthcare agencies is good. Together, these ensure that residents’ healthcare needs are met. Arrangements for the control, storage and administration of medicines are satisfactory and aim to ensure that residents receive medicines as prescribed and to minimise the risk of errors in administration. EVIDENCE: Care plans are in place for all residents. Those examined included a photograph of the person, pre-admission assessment, ‘life history’, personal care and support required, daily living, physical care needs, social care plan, night care plan (a good practice), manual handling assessments, depression assessment (not completed in many care plans examined), skin chart, specific risk assessments and, where indicated, information sheets on diabetes or first aid in the event of choking. DS0000039058.V331016.R01.S.doc Version 5.2 Page 11 It was noted that one form on file was headed ‘Consent to treatment/Resuscitation and Final Instructions’. Apart from the broad range of potential subjects which might fall under such a heading, questions might also be raised about the legal status of such a form – in particular where the form is signed by a relative. This may touch on issues raised by the implementation of the Mental Capacity Act 2005 which comes into effect in 2007 and the home would be advised to seek authoritative or expert advice on this. Care plans also included guidance on genograms (a diagrammatic representation of a family tree which facilitates analysis of factors such as patterns of illness in families) but which did not appear to be used. The quality of care plans varied but the overall standard was good, with some considered excellent. Care plans are reviewed monthly. The quality of daily notes varied. While generally informative, it would be helpful to see more entries reflecting the psychosocial aspects of residents’ lives in the home, as well as those recording physical aspects of care. The home maintains regular contact with a range of health professionals including GPs, district nurses and a chiropodist who visits every six weeks. Opticians either visit residents in the home or residents visit their optician in Aylesbury. Dental services are provided from a local NHS clinic. Nutritional advice or screening is accessed through Stoke Mandeville Hospital. Residents are weighed monthly. Arrangements for medication are satisfactory. Medicines are prescribed by the residents GP and dispensed by Boots Chemists. A copy of the prescription is retained by the deputy manager who has (delegated) overall responsibility for standards of practice. Medicines records have a photo of the resident, copies of relevant correspondence and medicines administration records (‘MAR’ charts). Staff attend the Boots one day training course and do not administer medicines until they have been assessed in the home by the deputy manager, care practitioner or team leader. Arrangements for the storage of medicines are satisfactory. Medicines requiring cool storage are kept in a locked metal box which is kept in the fridge. The home’s arrangements are periodically audited by a Boots pharmacist. It is noted that the most recent audit included the comment ‘Overall, exceptionally high standards in this home – excellent’. It is noted that the subject of ‘Medication policy’ (and practice) was discussed at a senior recent staff meeting and it is clearly evident that senior staff are monitoring standards of practice. Residents’ need for privacy and dignity is respected. Staff were observed to treat residents with sensitivity. One health care professional observed that ‘[staff are] very good at ensuring privacy maintained during our intervention’ DS0000039058.V331016.R01.S.doc Version 5.2 Page 12 (treatment). To the question ‘Does the care service provided respect individuals privacy and dignity?’ another ticked ‘Always’. DS0000039058.V331016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ well being and quality of life is maintained through the home’s diverse programme of activities, contact with the local community, and the choice and quality of food. EVIDENCE: The home appears to have a positive and flexible approach to resident choice. Residents may have visitors at any time, they are not obliged to join in activities and their wishes are taken into account with regard to meals. This was observed in practice in one of the first floor units during the course of this inspection visit. Residents have access to a range of activities and photographs of residents’ participation in many events are on display around the home. Events have included a dog show, pet therapy (dogs and cats), singers and entertainers and events around special occasions such as Christmas, when children from local schools entertain the residents, or a forthcoming 100th birthday celebration. Some residents have contact with befrienders from a local church and the Salvation Army. The mobile library visits regularly. DS0000039058.V331016.R01.S.doc Version 5.2 Page 14 The activity organiser arranges trips out in the home’s minibus to such places as local nurseries, villages or places of interest. Activities such as art and crafts, sing-a-longs, quizzes and bingo regularly take place. The Family Committee which meets quarterly may suggest or organise social events for residents, staff and relatives. A relative respondent told this inspection that ‘Activity and Social events are second to none, everyone is encouraged to join in, creating a lovely atmosphere’ another wrote ‘There are plenty of activities to suit all tastes, including excursions’. However, in answer to the question ‘Are there activities by the home that you can take part in?’ a resident responded ‘Usually…but don’t do so many now’. Another resident said “It’s a very good home – it’s good regarding everything – staff are always polite and helpful – can’t complain – the food is OK – can’t expect perfect food – I go out regularly with friends and staff”. A resident who had moved from a smaller home said “People are not so close here – carers move on – people watch TV – My [relationship] visits and we go out together – I’m happy with the way staff deal with matters – it’s a big place though”. The chef manager is experienced in providing meals in care settings, having worked in the NHS and other care services prior to working in the home and is used to meeting special needs. He said that there is always a cook or kitchen assistant on duty between 6.30 am and 5.30 pm. The environmental health department inspected the home about four or five months ago and found everything to be satisfactory. Meals are planned on a four-week seasonal cycle. Snacks are available in between the main meals. This would be important for residents who may be unable to eat when the main meal is served or who are restless and need additional nutrition. The chef said that care staff liaise with him and that he goes around the home to check how the residents are finding the food. The Family Committee give feedback to him as well. It is noted that the home has set the objective ‘All service users will receive a wholesome nutritious balanced diet according to their individual needs’ as one to be monitored closely in its 2007/08 business plan. Menus, the main and an ‘alternative menu’, were supplied for this inspection. Breakfast is cereals, toast and beverages. Lunch is the main meal of the day and consists of a two course meal of main choice and vegetables followed by dessert. Selections from week 4 included ‘Shepherds pie, mixed vegetables, cabbage and mashed potato’ followed by ‘Steamed chocolate pudding & chocolate sauce’, ‘Breaded scampi or cod in sauce, chips/creamed potatoes and peas’ followed by ‘Mandarins in jelly and ice cream’, and, ‘ Roast lamb, mint sauce, roast/mashed potatoes, green beans, glazed carrots’ followed by DS0000039058.V331016.R01.S.doc Version 5.2 Page 15 ‘Fruit cocktail trifle’. The ‘alternative menu’ main course choices included ‘Omelette’, ‘Jacket potato and Tuna filling’, and, ‘Salad’ (among others). Lunchtime was indirectly observed in two units. Three staff served around 16 residents in each unit. Lunch that day was ‘Pork, Rice, Potatoes and Vegetables’. The meal was served at a pace which suited the residents. Residents who did not wish to eat were encouraged but not put under pressure. Staff checked with them again before lunch finished. Fruit cordial was available on tables. Medication was administered at the end of the meal. In discussion later, the chef said that he provides both rice and potatoes on such occasions because many residents are not keen on rice. DS0000039058.V331016.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has very good systems for investigating complaints and robust procedures with regard to the protection of vulnerable adults. Together, these aim to ensure that complaints are thoroughly investigated and to protect residents from abuse. EVIDENCE: The home has a good complaints procedure. The procedure informs residents or relatives who may be dissatisfied on how to direct their complaint within the home, within Heritage Care, and to CSCI if they wish. The home has received four complaints since the last inspection. The complaints and compliments record was examined. This included records of three complaints (one of which was for the ‘Extracare’ service which is not part of this inspection but which is managed from this service) and two compliments. All residents are registered to vote. The manager said that residents have tended to use postal votes. The process is facilitated by the administrators where necessary. The organisation has a good policy governing the protection of vulnerable adults (POVA) (reviewed in August 2006) and abuse. This includes notifying DS0000039058.V331016.R01.S.doc Version 5.2 Page 17 relevant statutory bodies within 24 hours. Copies of a Buckinghamshire leaflet on reporting abuse were on display in the foyer – an excellent practice. The home had a copy of the Buckinghamshire joint agency guidelines on POVA. One event had been appropriately dealt with under POVA procedures since the last inspection. Training on POVA was scheduled for May (two events) and June (three events). DS0000039058.V331016.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an accessible, clean and well maintained environment which provides residents with a comfortable and safe place to live. EVIDENCE: The home is located in a residential area about two kilometres from the centre of Aylesbury. Parking is available in the grounds. Local buses serve the area. The nearest rail station is Aylesbury. The home was purpose built and opened about five years ago. It provides a spacious and good quality environment for residents. All bedrooms are single and have en-suite facilities (Shower, WC and hand basin). The home is divided into four living Units, each of 16 places. Two units are designated for people with dementia – 32 places. Entry to those units is DS0000039058.V331016.R01.S.doc Version 5.2 Page 19 controlled by a coded lock. The layout of each unit is identical. Each comprises single bedrooms, a bathroom, WC, small kitchen, dining room and living room. Each has a staff workstation and storage areas. There is one visitor’s room. The kitchen, laundry room and offices are on the ground floor. The home has a pleasant good sized enclosed garden to the rear. All areas of the home are accessible by wheelchair. Staircases and two passenger lifts connect the ground and the first floor. Aids to assist residents – grab rails, bath chair and hoists – are provided where needed. All areas of the home visited over the course of this inspection were clean, tidy and well maintained. Since the last inspection a new carpet had been laid in Cedar and Oak Units. This noticeably brightens up the environment in those areas. One bedroom had been redecorated. The quality of the furniture and soft furnishings appeared good and the overall ambience of the home was pleasant. DS0000039058.V331016.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Signs of pressure on staffing levels were communicated to this inspection and the home has failed to review staffing levels in the dementia care units as required under a condition of its registration. This may mean that some residents are not receiving the level of care they require. In conjunction with the organisation’s human resources and training departments the home provides staff training across a range of subjects. This helps to ensure that staff have the skills required to meet residents needs. EVIDENCE: The present staffing of the home provides for two staff in each of the residential units and three staff in each of the units for people with dementia throughout the day. There is one member of staff in each unit at night plus one ‘floating’ staff member. The home’s registration currently includes the condition that ‘…staffing levels on the dementia care groups are reviewed 3monthly to ensure staffing is sufficient to meet service users needs. The outcome of each review is to be documented and maintained in the home.’ The home has not carried out such reviews. It is now required to do so. Concerns about staffing were made at a number of points during this inspection. Prior to the inspection a concern was communicated to CSCI about DS0000039058.V331016.R01.S.doc Version 5.2 Page 21 staffing levels in the dementia care units at night. It was suggested that one member of staff for 16 people with dementia was inadequate. A relative respondent who completed a survey form wrote ‘Although they are always quite busy as there is only ever two staff on duty in the unit they do look after my [relationship] very well but it would be good if there were more staff on duty which would make the carers work easier and they would be able to give more time for things’. A resident respondent wrote ‘Need more staff, could do with one extra person to each department’. Another wrote ‘I get the care I need. The staff don’t have the time they used to have for me’. Pressure on team leaders seemed evident, balancing the pressure of the work on their units with the additional demands of the team leaders role. In addition to care staff the home has two part-time administrators, a laundry assistant, activity co-ordinator, housekeeping staff, a chef manager, cook, assistant cook, and catering assistant. The staffing position was discussed with the registered manager. The home did have staff vacancies at the time of the inspection and in fact on the day of the inspection visit was interviewing candidates. The discussion included consideration of the total hours vacant, the hours which the manager hoped to appoint to, and those which he would wish to hold in reserve to cope with variation in demand (to fund bank, agency or overtime where needed). The qualities of the staff, at all levels, was never in question. Staff spoken to during the course of the inspection visit seemed committed to their work and were observed to treat residents with care and sensitivity. A relative respondent wrote ‘[the staff] look after [relationship] very well so that she can live her life as well as she can as she is unable to do things for herself. They give her life a quality that she wouldn’t have otherwise’. Another wrote ‘This is a well run residential home where the staff, from the manager to all the other staff do their best to give each individual resident the care and attention they require. They are constantly looking for ways to improve the service to both residents and families’. The recruitment of new staff is managed from the organisation’s HR department in Hazlemere (Bucks). The department places advertisement, deals with enquiries and collates applications. Short listed applicants are invited to interview in the home. Candidates are interviewed by managers and residents. Four residents have expressed a willingness to act in such a role. Applicants are required to complete an application form, have an ‘enhanced’ CRB (‘standard’ for ancillary staff on the basis that such staff do not provide personal care) and complete a health declaration which is assessed by an occupational health service in Cardiff. DS0000039058.V331016.R01.S.doc Version 5.2 Page 22 The files of four personnel were examined. All were generally satisfactory although a recent photograph was not on file. Details of CRB certificates – number, date received and level – were recorded on the file. The certificates are retained at the HR department and were not inspected during this visit. Arrangements for staff training are good. Training is organised by the organisation’s training co-ordinator based at the head office in Loughton. The organisation has ‘Investors in People’ accreditation. The manager reports that the home has now achieved the 50 minimum standard for staff qualified to NVQ2 or above. Team leaders have acquired NVQ3 and the deputy manager NVQ4. A copy of the training programme for May to September 2007 and details of training carried out over the previous 12 months were supplied. Training includes; NVQs, Medication, POVA, Manual Handling, Dementia Care, Fire Safety, Health & Safety, First Aid, Food Hygiene, Understanding and Managing Challenging Behaviour, Personal Care and Infection Control, and Listening and Counselling Skills. The home has its own training room which is separate from the main building. DS0000039058.V331016.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This is a well managed home, which has arrangements in place for consulting residents and relatives. Residents should benefit by having their views taken into account and having influence on the delivery of the service. Arrangements for health and safety are satisfactory and aim to ensure the safety of residents, staff and visitors. EVIDENCE: The registered manager has had experience in the NHS and in Buckinghamshire County Council. He has worked with Heritage Care since 2001 and has managed the home since it was established. He has completed the Registered Manager’s Award (RMA) and has an adult teaching certificate. DS0000039058.V331016.R01.S.doc Version 5.2 Page 24 The manager is therefore, appropriately experienced and qualified for his position. He is currently responsible for the home ‘Chestnuts’ and an adjacent supported living scheme, which is also run by Heritage Care, ‘Willowmeads’. In 2006 the manager attended a training course on POVA for managers and later in 2007 intends to attend a Heritage Care course on the care of people with dementia. Lines of managerial accountability are clear. The manager reports to an area manager. The deputy manager and care practitioner and other staff report to the manager. The home participates in an annual quality assurance initiative, which is coordinated by the organisation’s head office in Essex. This takes the form of a peer audit in which managers ‘carry out an audit of a home other than their own. The manager said that the audit is based on ‘care pathway’ standards. The process includes completion of a questionnaire and interviews with residents and relatives. A report summarising the findings of the audit is written up. This, in part, informs the home’s business plan for the subsequent year. Details of the audit carried out towards the end of 2006 were seen. The manager said that the results were fed back to residents and relatives at a meeting during the first quarter of the year (although this does not appear to have been documented in the notes of meetings). A ‘Family Committee’ meet quarterly. The home would like to hold meetings with residents on a monthly basis but has been unable to maintain this since Age Concern Advocacy had to withdraw its support for residents when it lost funding in 2006. The notes of the meetings for ‘Ash’ Unit were seen. To varying degrees, the home manages money for all residents. Systems are primarily managed by the home’s administrators. Policies and procedures are in place and residents monies are handled separately from the home’s own petty cash systems. All transactions are recorded. The administrators report that internal auditors have checked the home’s procedures within the last six months or so and area managers do spot checks when conducting Regulation 26 and other visits to the home. Arrangements are in place for the secure storage of cash and valuables. Staff (‘one-to-one’) supervision is established. Supervision meetings with senior staff are held two monthly and with other staff quarterly. A system of annual appraisals for all staff had not yet been fully implemented. Staff meetings are held every month or two in each unit, meetings with senior staff are held monthly. The organisation has a health and safety policy. The director of human resources has lead responsibility for health and safety at board level. The manager and deputy manager have been trained in health and safety risk DS0000039058.V331016.R01.S.doc Version 5.2 Page 25 assessment. The subject is included in the induction programme for new staff and periodic update training is provided as required. The home was inspected by an environmental health officer in November 2006 and received a satisfactory report (seen). The manager reports that the home was visited by the fire service in May 2006 and that no requirements or recommendations were made. Fire training for staff was carried out in August and November 2006 and a fire drill took place in January 2007. Arrangements are in place for in-house testing of fire alarms and emergency lighting and for contractors to maintain fire safety equipment and emergency lighting. It was noted that the laundry door was held open with a rubber wedge. The manager said that the fire authority had approved the practice when staff are working there. The organisation has a policy governing the use of COSHH materials. The home has a contract for the disposal of waste. Testing of the home’s fixed electrical wiring is likely to be due in 2007 when it is five years old. The central heating system was checked in February 2007. Other gas appliances do not appear to have been checked since July 2005. This is a matter for the partner housing association which owns the building, English Churches Housing Association. Call systems are checked by contractors only if a fault occurs. The lifts were checked by contractors in February and May 2007. DS0000039058.V331016.R01.S.doc Version 5.2 Page 26 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 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 DS0000039058.V331016.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP27 Regulation 18 Requirement The registered manager must conduct a thorough review of staffing levels in the dementia care unit. The outcome of the review must be documented and retained in the home. Timescale for action 31/08/07 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 OP3 2 OP7 Refer to Standard Good Practice Recommendations The registered manager should consider adopting a standard approach to falls risk assessment, both with regard to assessment at the point of referral and on an ongoing basis within the home. The registered manager should review the inclusion in care plans of the form headed ‘Consent to treatment/Resuscitation and Final Instructions’. DS0000039058.V331016.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000039058.V331016.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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