Inspection on 09/12/08 for The Chestnuts

This inspection was carried out on 9th December 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Chestnuts 15/12/06

The Chestnuts 03/10/05

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chestnuts 169 Norwich Road Wisbech Cambridgeshire PE13 3TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Don Traylen     Date: 0 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Chestnuts 169 Norwich Road Wisbech Cambridgeshire PE13 3TA 01945584580 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Arnas Mauremootoo Type of registration: Number of places registered: Arnas Mauremootoo care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home The Chestnuts is registered as a care home for up to eighteen people over 65 years of age. The home is situated in a residential area in the town of Wisbech and is 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 bungalow. A ground floor extension has been added. There are sixteen single rooms and one double room. All bedrooms have wash hand basins and thirteen 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. There is a garden to the rear and one side of the home. The driveway has parking facilities for approximately seven cars. At the time of inspection fees charged by the home were £347- £450 per week dependent on needs. Copies of the CSCI inspection reports are available at the home or from the CSCI website. Care Homes for Older People Page 4 of 26 0 Over 65 18 Brief description of the care home Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service tok place on 08/12/2006 and an Annual Service Review was carried out on 28/11/2007. This inspection started at 12:30 pm and ended at 19:30 pm on 09/12/2008. The manager and the assistant manager were in the home during the inspection. People were spoken to throughout the inspection and eight people gave their views about the care they receive. Two visiting relatives were asked for their views. Two care staff were spoken to about their understanding of aspects of their work. The home completed and Annual Quality Assurance Assessment (AQAA) prior to the inspection and several survey forms were sent to people at the home, although these were returned with minimum information provided and no comments. Feedback was provide to the manager during and at the end of the inspection Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured the home can meet their needs and are given every opportunity to visit before deciding to move there. Evidence: The admission process was shown to be safely managed. Good pre-admission assessment information is obtained by the home who assess each person before they agree to the person moving into the home. The home had ensured the continuing assessment of one persons health related needs which was undertaken by Health Service professionals. The home expect to have a Primary Care Trust care management assessment if the Local Authority are commissioning the care. People told us they were given the opportunity to visit the home before moving there and had a lot of information given to them about the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are treated with respect and their personal and health care is planned and recorded. People are not fully assured the home has a suitable policy regarding all aspects of managing medication. Evidence: Care plans are presented in an indexed form and contain up to date and detailed information about needs. Information about one persons medical condition was saved in their plan. Risk assessments are recorded. One care assistant explained how she used these plans and how they gave clear information about the care to be provided. She said that she was was responsible for entering some of the details written in these plans and demonstrated a good understanding of how to use these care plans. Daily records are kept for each person in their plans. The home accesses Health Services community support when necessary and this was seen in the arrangements made for dietitian and physiotherapist intervention to one person with swallowing and nutrition concerns. Her food consumption was being measured and recorded. A record of professionals visits was maintained in her care plans. A nursing assessment conducted Care Homes for Older People Page 12 of 26 Evidence: on 08/07/2008 stated her needs were met by Chestnuts. Eight people said they were receiving good care and attention from the care staff and each person confirmed they were more than pleased with the home. One person stated she would rather live at the home than live on her own. The management of medication was assessed. The Medication Administration Records (MAR) sheets showed accurate records were kept and accurate amounts of individual medicines reflected these records. One person in the home was receiving PRN medication prescribed as required and this was for mild pain relief. The homes written policy for managing medication did not contain information about the management of medication prescribed, as required, or pro re nata (PRN). The policy had not included a persons capacity to make informed judgement about their medication, or about self-administration. There was no reference to mistakes, or omissions of medication should they be discovered. The policy had not been reviewed since the last key inspection on 08/12/2006 when a requirement was made to include procedures relating to PRN prescribed medication. All of these issues were discussed with the manager who stated he would ensure the policy is comprehensively reviewed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their daily lives are peaceful and of their preferred style and level of activity. Evidence: Six people informed us they were very pleased and liked everything about the home. The home has a relaxed and friendly atmosphere. Eight people said they are happy with daily life at the home and were encouraged to maintain their independence and control of their lives as much as possible. Two relatives who were spoken to said they were regular visitors to the home and that they could visit whenever they wanted. There was a record of meals provided. Choices for meals are made on the day. People told us their meals were excellent and always good. They said they had plenty of drinks throughout the day. It was noticed that the lunchtime meal was enjoyed and that all the food served was eaten. A community dietitian has worked alongside the home to help promote nutrition and mealtime experiences. The dining room was set out in a clean and tidy arrangement and with table cloths laid. In all, the atmosphere was of enjoyable communal experience. Care Homes for Older People Page 14 of 26 Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are safeguarded by the home and that their complaints would be listened to. Evidence: People are given opportunities to raise any concerns. Eight people said they would confidently raise any issue with the manager if they felt they wanted to. Two care workers showed they would not hesitate to report abuse to the manager. When they were asked they were unsure what might happen after this. They said they expect to report to the manager, but not directly to Cambridgshire County County or the Police. The manager has completed the train the trainer course offered by Cambridgeshire County Council. It was discussed with the manager that the home should promote safeguarding more overtly, so that staff were empowered to report a suspicion of abuse independently and that any visitor to the home knew the policy about safeguarding and could also independently report an allegation, or suspicion of abuse. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they live in a warm and comfortable well maintained environment. Evidence: The home was warm and comfortable and homely. No rooms had any persons name, although some were signposted with pictures that the person recognised. The home has continued to make environmental improvements. The external area at the front of the home is now larger and lighter after the removal of trees. New wooden fences have been erected around the home for additional security. There is a new raised fish pond outside the conservatory. The kitchen has been completely refurbished and refitted with new appliances and flooring. The manager has arranged for the home to have new replacement double glazed windows fitted throughout the home and this work is scheduled to commence at the start of 2009. Redecoration of the dining room and new flooring to this and toilets has taken place. The home is in need of further modernisation and redecoration and the manager is aware of all the aspects that could be improved and has systematically made sound financial plans to bring about these improvements. Combination locks have been fitted to each persons room. Whilst these were not noticed to cause any restrictions on the day of inspection, this was discussed with the manager who agreed to write a risk assessment around the use of these, so that they Care Homes for Older People Page 17 of 26 Evidence: are not used as a restriction, or deprivation of liberty. Bedrooms had been personalised with private possessions. The managers office was small and slightly cluttered with a few items stored there. Staff have a dedicated cloakroom and toilet. There is no separate staff facility for team meetings. The manager said his office can be used by staff should they wish to use the computer. An electric lead from a plug that was switched on was lying next to one person. A care assistant removed this immediately when she was asked. The home has various items of furniture and equipment stored throughout the home, such as the wheelchairs stored near a fire escape door to the front of the building; electrical extension leads; small dustbins and other pieces of furniture that are potential obstacles. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were assured they would be safe and cared for by trained staff, although recent actions have shown this protection has not been assured when recruiting and inducting new care staff. Evidence: Staff training in suitable topics have been undertaken by staff. All staff have received dementia care training through Cambridge County Council. All staff have received training in safeguarding and this was provided by the manager who has attended the train the trainers course in adult protection, provided by Cambridgeshire County Council. Staff who administer medication have received training. It was discussed with the manager that he would arrange further training from Cambridgeshire Primary Care Trust to ensure staff were familiar with all aspects of medication. Staff have received training in using nebulisers. 77 of staff have NVQ level 2 awards in care and approximately half the staff have NVQ level 3 awards in care and six staff have NVQ awards in Customer Care. Three staff are working toward an NVQ level 4 award in care. The manager and the assistant manager have NVQ level 4 awards in care. This indicates the home has invested in promoting staff training and in creating a professional workforce. The homes AQAA stated they have a, rigorous recruitment procedure (p16). The Care Homes for Older People Page 19 of 26 Evidence: recruitment records of one recently employed care assistant were read. An application form had been completed with a history of employment and named referees. The home had not obtained a CRB prior to him commencing employment on the 14/10/2008. The manager explained that he thought that the CRB disclosure the applicants previous employer had received on the 18/08/08, was an appropriate check. There were no written references available, or a record of these having been received. The manager said these references had been received and were given to the employee. The homes recruitment policy indicated that, a full Police check will be made, when recruiting new staff but did not state at what stage this is expected. The staff roster showed the above care assistant had commenced work on the 14/10/08 and worked the first two days training alongside another care worker. The staff roster showed he then worked alone at night time on the 21,25,26,28,29,31 of October 2008 and afterwards for three nights each week. The same persons induction records were read. His induction was based on the Skills for Care Councils Common Induction Standards and most of this had been recorded as being received over two days on the 13 & 15/10/2008. There were two items not completed on his induction record. The manager had signed to show competency had been achieved, but there was no supporting text to explain how this had been measured. This care worker had received training by his previous employer for Adult Protection; Moving & Handling; Basic Food Hygeine and in Administering Medication. The duty roster showed there are always two care staff working between 7:30am and 10 pm. The assistant manager and manager work five days a week between approximately 8am and 6 pm, although both are very flexible in their arrangements and often work longer hours. A cook and a domestic cleaner are also employed each day. The manager had not been included in the staff roster. One care assistant works at night between 10 pm and 8am. It was noted that the working arrangement for handover period between staffing shifts at 1:30 pm and 10pm is not accounted for on the staffing roster. The manager stated that handovers are managed when staff either stay longer, or the oncoming shift worker arrives earlier. The manager stated he considered the one person working at night was adequate. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured the home is generally run in their best interests but would be better assured if the management was consistent in the recruitment procedures and supervision of staff. Evidence: The manager and the assistant manager form the management structure of this home. They both promote an ethos of good care and have set clear examples and have worked well with the Commission at all times. Both have NVQ level 4 awards in care. Staff reported they are supported by the manager and felt able to approach him at all times. Similarly, people felt they could speak to the manager whenever they wanted to and considered they were kept informed of developments within the home, such as the refurbishment of the kitchen. The immediate requirement made during this inspection concerning the unsafe recruitment of one care worker was responded to by the manager during the Care Homes for Older People Page 21 of 26 Evidence: inspection in a satisfactory manner and was followed up by a written confirmation of the action taken. The manager acknowledged that supervision of this new care worker without a POVA First, had not been given. Supervision of other care staff had been regularly provided. People have satisfactory and daily opportunities to comment on the quality of their service. Relatives have sent complimentary letters thanking the home for their kindness and attention. Contacts with relatives is a regular feature of the Chestnuts. A recent Xmas party gave relatives another opportunity to be involved and meet staff. The regular assistance and advice from Community Health Service professionals has resulted in them making positive comments about the home. Quality was seen to be appreciated in the letters sent to the home by grateful relatives. The Fire Safety Officer had recently visited the home. Fire alarms are checked weekly as are emergency lights. The home has an evacuation plan in the event of a fire that was not needed further clarification about the planned evacuation of people living at the home. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 No person shall be employed 10/12/2008 without a POVA First check having been received, pending a Criminal Records Bureau disclosure so that people are assured staff are recruited in a safe manner. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The policy relating to the safe management of medicines must be reviewed so that people are assured that there is a policy that includes suitable information relating to medication prescribed as PRN or as required and the action to be taken following any mistakes in administering medication. 10/01/2009 2 30 18 Staff must be suitably 25/12/2008 competent and have received appropriate training so that people are assured that the night time care staff Care Homes for Older People Page 24 of 26 are adequately trained to meet their needs. 3 36 18 Staff must be appropriately supervised so that people are assured they are cared for by staff who are appropriately monitored. 09/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 The use of combination locks on bedroom doors should be risk assessed and agreed with each person for their use and be recorded. The home should ensure that furniture and electrical equipment used around the home is not a risk to people. Staff should receive refresher training in the administration of medication. 2 3 25 30 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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!