Inspection on 09/11/05 for The Chestnuts

This inspection was carried out on 9th November 2005.

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

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

Other inspections for this house

The Chestnuts 31/05/07

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 Mrs Rosemarie James Unannounced Inspection 9th November 2005 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 The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 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 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) The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 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. 15/06/2005 Date of last inspection Brief Description of the Service: The Chestnuts is a purpose built home owned by Heritage Care who has 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, thirty-two 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 shaft lifts and a variety of moving and handling equipment. The home has its own mini bus which makes access to Aylesbury town centre much more accessible. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit carried out on the morning of the 11th November 2005; the lead inspector was Mrs Rosemarie James. In the absence of the registered manager who was on annual leave the two deputies assisted with the inspection process. The inspection consisted with meeting the residents in Cedar and Beech Units, talking with members of staff, looking at a variety of documentation and following up on the requirements made at the last inspection held in June 05. The inspector would like to thank the deputy managers for their time and warm hospitality shown during the inspection visit. What the service does well: What has improved since the last inspection? Every resident has had a new bed and Ash Unit was coming to the end of a total redecoration exercise. All the furniture in this unit had also been replaced along with some furniture in Cedar. More comprehensive pre admission assessments are being carried out and the care plans are in the process of being computerised. All staff that has the responsibility of administrating medication have now been trained and deemed competent to carry out this task. Improved communication with all GP’s used by the home has meant safer transcribing of information by staff at the home onto the MAR sheets. A visit from the fire safety officer has meant that minor alterations to some bedroom doors have eliminated the need to use door wedges. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 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 The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 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 Pre admission assessments are always carried out and the information gained allows the home to make an informed decision on whether or not they can meet an individuals needs. EVIDENCE: At the last inspection a requirement was set for improvements to be made in the pre admission assessments carried out by the home. At this visit the pre admission documentation of the latest three residents to be admitted to the home was looked at. Pre admission assessments are carried out by the deputy managers or team leaders and on occasion by a key worker if they have been trained or are skilled with regard to the assessment process. The assessments made available for inspection purposes had been completed to a satisfactory standard. Information had been obtained with regard to the proposed residents background, their current situation including medical history, their abilities in the areas of eating, washing, bathing, dressing, use of WC, continence management, mobility, risk of falling, transfer, sociability, communication, orientation and memory etc. The information gained would have certainly given the home enough information to help decide whether they The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 9 could meet an individuals needs and for interim care plans to be in place at or soon after admission. Heritage are always looking at how they can improve the services given to the people they care for. At the time of this inspection visit, new pre admission documentation had very recently been introduced and tried out for the first time on the day prior to the inspection. The new documentation had been drawn up with input from another large provider. The deputy manager who carried out the assessment felt it was too soon for her to make a judgement on how much it will improve the pre admission process. The home also use a checklist to ensure all pre admission documentation is in place and just what needs to happen on that all important first day from making a note of a birthday on the kitchens cake list, to showing an individual around the home, introducing their key worker, going through health & safety issues and finding out whether they like a duvet on their bed or blankets. This is a useful tool, which ensures the big step of entering a care home runs as smoothly as possible. For information only, The Chestnuts does not provide an intermediate care facility. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10 All residents have a care plan that details how identified care needs are to be met. New practices with regard to the recording and administration of medication has meant greater safeguarding of residents wellbeing. The policies, procedures, staff training and empathy staff have for the people they care for ensure the residents rights to privacy and dignity are upheld. EVIDENCE: The care documentation of 4 residents was chosen at random to be looked at. All contained a life history that had been completed with the help of family members. These were really informative and give the staff a good insight into what makes the individual into the person they are. As a consequence, the ability for staff to have meaningful conversations with the residents about their lives, hobbies and interests etc. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 11 At the last inspection it was found that some care plans were inconsistent in the level of information recorded and not always up to date. Since then staff had been working hard to improve their recording in the care documents. Those made available for inspection purposes were quite informative and there were no obvious inconsistencies. There was evidence of the information contained within them being reviewed. It is also pleasing to be able to report there was no signs of Tippex being used and visits from healthcare professionals were documented. The home has begun to change the way care records are maintained by moving over to IT recording. The deputy managers reported that staff have “taken to this running”. It is hoped that this will improve care-recording practices still further and the inspector looks forward to monitoring progress at the next inspection. It was also a criticism in the last report that staff knowledge with regard to specific health care needs such as diabetes was lacking. Since then staff have received training in caring for people with this condition. Information about diabetes is now held for staff reference and weekly urine testing has been introduced. Shortfalls in the recording and administration of medication were noted at the last inspection. The deputy managers informed the inspector that ALL staff that has the responsibility for the administration of medication has now been trained by Boots and successfully completed a written test of their knowledge. In addition to this each member of staff must carry out 3 supervised drug rounds and deemed competent to carry out the task before they are given the responsibility of administrating medication. The home have also worked hard with the seven GP practices that serve the home to ensure safe practices are carried out when making hand written entries on the MAR sheets. Evidence was produced at this inspection of photocopied prescriptions and faxed instructions from doctors as to what medication a new resident for example was on. The inspector has recommended that two staff members sign off the written entries. Advice was sought on the appropriate storage of eye drops and problems regarding the opening dates have been resolved by routine changes to the drops at the start of a new monthly cycle of medication. During this inspection staff were observed treating the residents with dignity and respect in the way they communicated with them and how they provided hands on care. This is reinforced by the homes policies and procedures for example, finding out what their preferred term of address is and whether they would rather male or female staff provided intimate care. It was observed routine practice that staff knock on all doors before entering. It was pleasing to see that a situation on one of the dementia units where a resident’s dignity could have been compromised (not the fault of the staff), was quickly dealt with. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 The home provides a comprehensive programme of activities and social events that ensure the social, religious and recreational interests and needs of the residents are met. Contact with family, friends and the local community is facilitated in a number of ways to ensure contact with them is not lost. Wherever possible service users are consulted about how they live their lives giving them choices and maintaining control. EVIDENCE: The walls of lounge areas are adorned with photos of the social events that had taken place in the past few months. These included a visit from the Mayor at the homes summer fete, a visit from the Brownies that included a fish a chip supper and a 10-week reading project organised by the local library. Residents commented on how much they enjoyed these last two events. This was quite something as the residents making these comments had poor shortterm memory problems so the events must clearly have been a very enjoyable experience. Coffee mornings are held every 2 – 3 months with family, friends and neighbours invited. More recently the residents enjoyed a firework display arranged by the staff. The activities organiser puts together a weekly activities The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 13 programme that residents can choose to take part in this includes: bingo, keep fit, singing, art & craft, quizzes, games, shopping trolley, mobile library, befrienders, and church services. Outings are also organised as well as entertainment from professional entertainers. The activities leading up to Christmas had already been planned and these included: carol singing, visits from local schools, Christmas coffee morning and a staff pantomime. It is pleasing to be able to report that the activities organiser also finds time to offer one to one contact as evidenced by the care records of a service user who suffered from depression and liked to spend time alone in his room; and the arrangements being made for a resident to visit a fellow resident in hospital who she had become great friends with. Orientation as to the seasons for those on the dementia units was helped by the activities organiser organising activity sessions around the bluebells (spring) and leaves (autumn) she had brought into the home. A simple but very effective exercise. Visitors to the home are encouraged and the visitors’ book was evidence that The Chestnuts is a frequently visited establishment. There are posters around the home inviting visitors to help themselves to tea or coffee. Families are invited to contribute to care plan content. Family Committee meetings are regularly held and a copy of the minutes for the October meeting was given to the inspector. The deputy managers confirmed that residents have a choice on when they rise and retire and to facilitate flexible getting up a continental type breakfast has been introduced in Ash Unit. It has been so successful that plans are underway to introduce it in Oak. Colour choices in the recently decorated Ash Unit were the residents. The residents’ forum organised by Age Concern is well attended. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 14 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): 16, 17 & 18 The home has a complaints procedure the contents of which are well publicised giving residents, their relatives and friends confidence that any concerns will be listened to and acted upon. Staff enable residents to take part in the election process and to have access to an advocacy service helping to ensure their legal rights are protected. The home has an adult protection policy and all staff are trained in abuse awareness and whistle blowing thus ensuring residents are protected. EVIDENCE: Copies of the homes complaints procedure are given to all residents and their next of kin. A copy is also posted up in the foyer of the home and leaflets covering this topic are readily available. How to complain is also mentioned at the relatives forum meeting. It is pleasing to be able to report that in the period between the last inspection and this visit, there had been only one minor complaint about the temperature of the bath water, which was quickly resolved. The Commission for Social Care Inspection had not been notified of any concerns. All residents are on the electoral register and arrangements are made to have postal votes at election time. PoVA training is now mandatory for all staff. At the time of this inspection 48 had been trained and as part of the homes business plan the remaining The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 15 52 will be trained by April 2006. This training is in addition to that that forms part of the induction package that all staff have to complete prior to taking up their position in the home. It is interesting to note that questions on abuse and adult protection are also asked as part of the interview process. This is good practice. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 16 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): EVIDENCE: These standards were not assessed at this inspection. However it is pleasing to be able to report that of the 6 standards assessed at the last inspection 5 were considered as met and the 6th exceeded. The Chestnuts is certainly a lovely environment in which to live. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 17 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): 30 Staff training is actively promoted by Heritage Care ensuring that staff are trained and competent to do their job. EVIDENCE: Staff training commences right at the start of their employment with a comprehensive two-day induction programme that all staff has to satisfactorily complete before they can take up their position. A new development since the last inspection has been the personal development portfolio for all staff that includes their induction training, supervision notes, PDP, certificates, probationary assessment records and appraisal documentation. Not all staff has received their file records yet but progress to this end is well under way. At the time of this inspection visit approximately 50 of the staff team were trained to NVQ Level 2 with another group about to start. Key skills training has been another recent introduction involving IT, English, Communication and Maths. Two staff members are currently doing this. The deputy managers stated that the training that had taken place over the past few months included: PoVA Dementia Care Induction First Aid Manual Handling Food Hygiene Care Team Leader Training The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 18 Dementia Care Mapping Business Planning Appraisal Training Training for the Trainer Food and Nutrition Diabetes Care Since the last inspection managers have reviewed rota deployment to ensure the right skill mix is available for each shift. There has been an increase of one staff member at night taking numbers to 5 to accommodate the rise in the numbers of residents being cared for in the home that have dementia. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 19 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): 33 & 35 The whole ethos of this home is based on meeting individual service users needs in a group living environment thus ensuring what goes on in the home is in the residents best interests. Appropriate money management systems are in place to ensure the financial interests of the residents are safeguarded. EVIDENCE: The environment, and all the available facilities have been provided with the needs of the service users in mind. Staff training and their ways of working mean individual needs can be met as evidenced from the records seen at this inspection and observed practices. Routine is kept to a minimum but is more The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 20 prevalent on the dementia units where a certain amount of routine is important to aid orientation. Residents’ money for day-to-day use is maintained in one bank account. However, individual ‘statements’ are available and interest for individual sums held is paid. The administrator at the home keeps the records of all transactions; these were made available for inspection purposes and appeared in good order. Staff confirmed that residents could access their money at any time. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 21 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X x X X X x X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations It is recommended that when staff has to make an entry on the MAR sheets that two staff signatures be used to record the entry. The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 The Chestnuts DS0000039058.V264998.R01.S.doc Version 5.0 Page 24 - 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. 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