Inspection on 07/02/06 for The Chestnuts

This inspection was carried out on 7th February 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Chestnuts 13/01/09

The Chestnuts 02/01/07

The Chestnuts 16/09/05

The Chestnuts 28/01/05

The Chestnuts 23/09/04

The Chestnuts 29/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Chestnuts, The The Avenue Ross-On-Wye Herefordshire HR9 5AW Lead Inspector Wendy Barrett Announced Inspection 7th February 2006 10:00 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 Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Chestnuts, The Address The Avenue Ross-On-Wye Herefordshire HR9 5AW 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) 01989 562031 01989 567608 caring@chestnutsha_freeserve.co.uk Chestnuts The (Ross-On-Wye) Housing Association Ltd Mrs Julie Caroline Powell Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability over 65 years of age (30) Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: The Chestnuts (Ross-on Wye) Housing Association Limited (also a charitable organisation) has operated this home since 1991. The provider leases the building from Herefordshire Council and must carry out the maintenance and any improvements to the property. The home is registered to accommodate up to thirty people aged at least sixtyfive. One of these places is currently registered to accommodate a named individual who is under 65 years of age. Service users may require care due to a range of care needs arising due to the ageing process, including physical disability, dementia or a mental health disorder. The Chestnuts comprises of a large Victorian house, set in private grounds, and is situated in a residential area within a reasonable walking distance of Rosson-Wye town centre. The property was converted to a care home many years ago and an extension was added to the original house in the 1960s, which has been totally upgraded within the last few years. All of the bedrooms are single, sixteen of them having en-suite facilities, and are located on three floors with two shaft lifts provided. The bedrooms on the upper floor in the original part of the building are not easily accessible for service users with restricted mobility although those in the extension are suitable to accommodate wheelchair users in respect of the space available and their accessibility. The home offers two sitting rooms, a separate dining room and a sun terrace as communal space for the service users. The garden is reasonably sized and provides a very pleasant and easily accessible area for service users and their visitors. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was pre-arranged so that the Care Manager could be present to provide information about the recent admission and early residence of a resident who is under 65 years of age. The Chairman of the Chestnuts Housing Association was present at the start of the inspection. The catering manager helped with an inspection of the meals service, and a Senior staff member helped with an inspection of arrangements for managing medication. Five residents spent some time describing their experience of the service and others were met around the home. The focus of the inspection was on assessing key National Minimum Standards that were not inspected last time. Action taken to comply with previous requirements was also reviewed. A number of records maintained at the home were inspected and reference has been made to correspondence with the Commission between inspections. In order to gain a comprehensive view of the service the last inspection report should also be referenced. What the service does well: What has improved since the last inspection? There has been more work to maintain and improve the standard of the accommodation e.g. a new storage room, purchase of tools for the maintenance man, decoration. There are now regular health and safety audits of the premises and a professional consultant has undertaken a fire safety Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 6 assessment. New I.T. software has been purchased to make the administrator’s job easier. The recruitment process recently used in employing a staff member was thorough. It followed legal requirements that are designed to make sure new staff are suitable to work with vulnerable adults. 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. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 the following standard(s): 3 Potential residents are carefully assessed through their initial period of residence and an initial care plan is designed to ensure needs and preferences can be met. EVIDENCE: The Provider was recently registered to accommodate a named resident who is under 65 years of age. The Care Manager demonstrated through discussion and production of care records a thorough period of assessment, initial care planning and review work. This included consultation with other care professionals who had prior knowledge of the resident. Particular attention had been given to enabling the resident to receive support in continuing her links with the local community, and to the provision of an en-suite bedroom (something she had especially requested). Although the resident did not wish to be interviewed, she was observed arriving home after a shopping trip with her support worker who was specifically funded to provide this type of help. She appeared happy and relaxed with staff at the home. She was happy for her bedroom to be viewed. This was very nicely presented and contained many personal items brought into the home on the resident’s admission. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 the following standard(s): 7, 9 and 10 Residents can handle their medication if they are safe to do so. All residents are protected by the home’s procedures and the training of all staff who handle medicines. Staff listen to the wishes of residents, and their right to privacy is respected. EVIDENCE: A sample of care records reflected a satisfactory method of assessing, planning and reviewing care. Risk assessments are being appropriately completed when residents’ personal activities may result in risk to themselves or others. The senior staff member demonstrated a good awareness of recognised good practice in managing medication. Records of receipt, administration and disposal were being properly maintained to identify a clear audit trail. A sample check of controlled drugs stock showed there was accurate recording of the remaining balance in a controlled drugs register. Additional records were seen e.g. storage temperature checks, instructions for staff with medication prescribed ‘as required’ and monitoring forms to record effects of new medications e.g. sleep patterns, risk assessments for residents who prefer to self-administer. The Commission’s pharmacy Inspector has previously approved the home’s policy and procedures for medication management. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 10 All staff who handle medication have received training in monitored dosage systems from Boots pharmacist. Six staff were due to undertake advanced training from Boots in March 2006. Residents are able to choose whether they spend their time in the privacy of their bedroom, in communal rooms, or out in the local community. Relatives are encouraged to continue actively supporting residents if that is their wish e.g. a family were trying to sort out transport arrangements for a resident who wanted to continue attending a day centre where she could meet her friends. All the residents spoken to on the day expressed satisfaction with the attitude of the staff. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 the following standard(s): 13 and 15 Residents are supported in maintaining links with their families and the local community. The meals are planned to ensure they are varied and healthy. Residents are able to eat their meals as they prefer e.g. privately or with other residents. EVIDENCE: A resident spoke about various social opportunities, including trips out. Care records refer to continuing involvement of families and special arrangements had been made to support the new resident in maintaining her community links. The catering manager felt that the kitchen staff team work well together and this view was reflected in the findings of the inspection. Four residents spent time discussing the meals and all residents who were met were happy with the catering service. Invoices from local suppliers of fresh produce showed a good variety of products. Menus, records of food, storage temperatures and cleaning rotas are being maintained. The catering manager displayed awareness of resident preferences and needs e.g. low lipid diet. She had written guidance to help her plan this resident’s meals. Diabetic residents are offered homemade sugar free dishes so they can enjoy the same variety of food as others. The kitchen was clean and tidy. Fresh and dry produce was being stored tidily. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 the following standard(s): 18 Staff are familiar with adult protection issues and they have written guidance to help them in protecting residents from abuse. EVIDENCE: The home has an adult protection and whistle blowing policy. The Care Manager described an experience in 2004 of dealing with a staff disciplinary involving issues of protection. This work had strengthened her, and other staff’s knowledge in dealing with abuse issues. The local authority Vulnerable Adults co-ordinator had been to the home and provided a training session for staff. Two staff were due to attend an adult protection training day during the week of this inspection. They would then cascade their learning to other staff at the home. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 the following standard(s): 19 and 26 The residents have well-maintained, clean and comfortable accommodation. EVIDENCE: The home was warm, clean and tidy when this inspection took place. There were examples of work being done to maintain and improve the quality of the accommodation e.g. new storeroom, purchase of tools for the maintenance worker, new IT system software, refurbishment of the kitchen and decoration of some areas. Peeling wallpaper on the office ceiling had been repaired. The reports of visits to the home by the Provider’s representatives show that there is regular assessment of the condition of the premises with recommendations made for attention. The catering manager had requested a fluorescent light on a wall and this request had been addressed promptly. Regular health and safety audits have been introduced so that any risk areas can be quickly identified and dealt with e.g. fire safety equipment, water controls. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 14 There are two sluice facilities – one on each floor of the building. Disposable protective wear is distributed around the home and a system of colour coding cleaning equipment assists with infection control. There are other references in this report that confirm attention to hygiene factors. The home has implemented policies and procedures relevant to infection control. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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): 28, 29 and 30 Staff are carefully recruited to ensure they will be suitable to work with vulnerable adults. They are receiving training they need to work safely with the residents and understand their care needs although there will need to be a higher percentage of staff who hold an NVQ level 2 qualification. EVIDENCE: There is evidence of ongoing attention to staff training e.g. annual manual handling instruction, fire safety instruction from a professional fire safety consultant, health and safety training. The catering manager had completed food hygiene training and has also attended training days on good nutrition and diabetes. The staff member who described medication management had completed training provided by Boots pharmacist and was due to undertake a more advanced training course. Some staff have completed, or are pursuing NVQ awards although the Care Manager felt that there are not yet 50 of care staff with this award. This is the target identified in the National Minimum Standards. Staff are being offered some training in care practices that are particularly relevant to the resident group e.g. continence management. A thorough recruitment process had been applied in the recent employment of a staff member. This indicates compliance with the procedure required under regulation, and with a previous inspection requirement. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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, 33 and 38 An experienced and qualified care manager is managing the care service. There are systems in place to monitor the quality of the service. The views of residents and their relatives are an important part of this work. The premises and working practices are well managed to promote and protect the health and safety of the residents and staff. EVIDENCE: The Care Manager is registered with the Commission and has obtained the qualifications required e.g. Registered Manager’s Award, NVQ level 4 in Care. She also holds a Licentiateship Award in Caring Services and continues to update her knowledge. There are a number of practices already in place that contribute to a quality monitoring system for the service. A representative of the registered Provider visits the home regularly to assess the situation. Detailed reports of these visits are being supplied to the Commission and contain considerable Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 17 information. The Care Manager conducts other types of audits e.g. health and safety. Residents and relatives are consulted as part of care plan reviews. A visual picture of the outcomes of a formal consultation with relatives was displayed on the notice board at the home. It is recommended that there be an annual summary report produced to inform residents and the Commission of the general outcome of the quality monitoring process. The ability of care services to self assess their performance will have increasing importance in regulatory work in the future. A Health and Safety policy and associated procedures have been implemented and copies were seen at the home. There has been considerable work completed since the last inspection to address four previous requirements relating to the safety of the premises. A professional fire safety consultant undertook a fire risk assessment of the accommodation in October 2005. The record of this exercise includes reference to potential risks of wedging open doors. A regular and recorded audit of health and safety aspects of the premises has been introduced. This includes checks of water temperatures. A bath thermometer with a notice of instructions for use was seen in a bathroom. The Care Manager has supplied the Commission with a copy of a risk assessment for legionella control. The catering manager gave examples of attention to safety and hygiene controls in the kitchen area e.g. new wall tiling, written assessments of all potentially hazardous substances, cleaning rotas, checks of fridge and freezer temperatures. All requirements resulting from a recent inspection by the Environmental Health Officer had been addressed e.g. purchase of new fridge. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 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 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? yes Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 20 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 OP28 Regulation 19 (5) b Requirement Timescale for action 31/03/06 2 OP36 18 There must be more staff involvement in NVQ level 2 qualifications so that the National Minimum Standard target of 50 is achieved. Care staff must receive 31/03/06 appropriate induction training. The induction programme introduced by the home must be in accordance with relevant specifications and be fully implemented. (Not reviewed. Carried over with revised timescale) 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 Refer to Standard OP33 Good Practice Recommendations There should be a summary report produced periodically to inform residents and the Commission of the overall outcomes of the internal quality monitoring processes at the home. Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chestnuts, The DS0000024734.V282760.R01.S.doc Version 5.1 Page 22 - 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!