Care Home: Chesterfield House

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What the care home does well The home is in a quiet setting and is situated on the edge of a shopping area, close to amenities. People are cared for in a clean and comfortable environment and the home is decorated to a very high standard. All people spoken with made positive comments about the care they received; one said `I`m really happy here` and another said `This is a fantastic place`. The staff group is well trained and knowledgeable about the people living at the home and how they prefer to be cared for. The manager and senior staff work well as a team and there is a very stable staff group, enabling good knowledge of the needs of people. People are encouraged to make choices about their daily lifestyles and individual likes and dislikes are catered for. Surveys returned to us were very positive and comments included praise for the staff and the manager. What has improved since the last inspection? This is a new service and has not been inspected before. What the care home could do better: There were no issues of non-compliance evident on the day of the visit. Key inspection report Care homes for adults (18-65 years) Name: Address: Chesterfield House 411 Newark Road Chesterfield House North Hykenham Lincoln Lincolnshire LN6 9SP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julie Western     Date: 1 3 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: Chesterfield House 411 Newark Road Chesterfield House North Hykenham Lincoln Lincolnshire LN6 9SP 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Healthclinic Individual Care Ltd Name of registered manager (if applicable) Mr Gary Bentley Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability Code LD Date of last inspection Brief description of the care home 6 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 23 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards, which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to The Care Quality Commission (CQC). The visit lasted approximately four hours and we took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we had been notified of since the last inspection. Before we made our visit the provider had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent Care Homes for Adults (18-65 years) Page 5 of 23 out surveys to people before we visited the service. The main method of collecting information during this visit is called case tracking, which includes following the care of a sample of three people through their records and assessing their care. We spoke to two people who use the service and saw rooms of those people who said we could and to two staff members. The manager was present throughout the visit and the general outcomes of the visit were discussed with him. Care Homes for Adults (18-65 years) Page 6 of 23 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 benefit from a thorough assessment and can be assured that their needs will be met. Evidence: We saw the statement of purpose, which, with the exception of the new address of the commission, was up to date and gave details about the facilities provided. There is a service user guide in place, which contains up to date information about the type of care the home can provide. Photographs of the home and the activities it offers support the written information in the document. All the people who moved into Chesterfield House were previously living in a hospital environment and brought their detailed assessments and care plans with them. Assessments we saw covered needs such as communication, self care, independence skills, health care, diet, behaviour and leisure. The assessments were very detailed and told people what the wishes and preferences of each person were. Records we saw showed that they were reviewed and updated at least every six months. The records also showed that people, where they were able, relatives and other relevant people were involved in carrying out the assessments. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Detailed care plans help people to develop their independence, whilst risks are minimised. They are consulted about their daily lives, and supported in an individualised and respectful way. Evidence: All the current people moved from a hospital environment, three of them were under the Mental Health Act with restrictions. We saw care plans for three people. All had been reviewed and were up to date. They were very detailed and linked clearly with their assessments. They included needs such as communication, self-care and health care. The plans showed likes and dislikes and how people made their own choices or decisions. Risk management plans were in place, and covered needs such as mental state, kitchen access, vulnerability and travel. They also cover any restrictions to choice or freedom, which are in place where there is a high risk to health or safety. The manager said that in the coming year he hoped to have more person centred care plans in place. Records showed that care plans and risk assessments were reviewed regularly. Review Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: records show that relevant people are consulted about, and agree to care plans. Surveys said that people have a good quality of life at the home. They also said that people are helped to maintain and develop their independence. Through discussions and observation of practice the staff showed that they have a very clear understanding of the needs of each person. They were seen offering choices in whatever way the individual could understand, for example using objects of reference, pictures, gestures or verbally. They also responded to people in a respectful way, and offered gentle reassurances where necessary. Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a wide range of social and educational opportunities, which help them to develop their skills and live a fulfilling life. Evidence: We saw that each person had a weekly activity programme, which clearly showed leisure, educational and home management activity. Activities such as meal preparation, walks, art, music sessions, sports sessions, shopping and and meals out are offered. On the day of the visit people were going ten pin bowling in the morning and in the afternoon had a sports class on the lawn. People we spoke with said they liked to do things such as changing their beds, shopping and listening to music. Two described how they were going to Blackpool with two staff members for their summer holiday and one said she went home to her parents at weekends. Staff members we spoke with said that the transition from a large institutional building to a small home with more freedom had proved hard for some people and as a result Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: plans for entering the community were slower than had been expected. They respected the decisions of people not to join in with activities. Personal effects, photographs, individual records and surveys show that people were supported to maintain their relationships with families and friends. Menus were arranged on a weekly basis so that it is easier for people relate the shopping they do more closely to the menu. People helped make their own lunchtime meals and three assisted with the main meal in the evening. People said that they enjoyed their meals, and they said what their favourite foods were. These preferences were reflected in the menus, and the foods available in the home. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. There are good arrangements to make sure that the health needs of people are met, and they are protected by the medication policies and procedures. Evidence: We saw individual care plans containing information about their health needs, and this information links with care plans. They showed staff how to support needs such as behaviours and emotional needs such as anxiety. Records show when people have seen health professionals such as a GP, dentist or optician and they show that things like weight are monitored. People have an allocated nurse and a key worker so that they have a consistent support network. Staff demonstrated through discussions and practice that they know health needs of people very well. They also made sure that any personal support was provided in a private and dignified way, and they respected decisions about things like what time people got up in the morning. Records show that staff receive training in how to administer medications in a safe way. There is a company policy regarding general administration of medicines and staff followed the procedures satisfactorily. One person administers her own medication with monitoring by staff. Care Homes for Adults (18-65 years) Page 14 of 23 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 protected by clear procedures for handling complaints and allegations of abuse, and by the knowledge of staff who are well trained. Evidence: Since the service was registered, there have been no complaints or concerns regarding the home. Policies about adult protection were available. Staff demonstrated a good knowledge of what abuse is and how to protect people and records we saw showed that they receive training in this subject. People we spoke with did not want to make a complaint but knew where to go if they did want to. Care Homes for Adults (18-65 years) Page 15 of 23 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a clean, comfortable and homely environment, which is well maintained. Evidence: Externally, the building was very well maintained, with electronically operated gates leading up the drive and well tended gardens to the front. There is a patio area and lawned garden to the rear, with a summerhouse, a greenhouse and a vegetable plot. Internally, the home is decorated and furnished to a high standard. People we spoke with said they had been able to choose their bedding, pictures and room colours. They said they were responsible for keeping their own rooms clean. Communal areas were comfortably furnished and had pictures painted by residents on the walls. The building was clean and fresh throughout. Care Homes for Adults (18-65 years) Page 16 of 23 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A well-trained and supported staff team ensures that people are cared for safely. Evidence: The staff rota we saw showed that usually there was a trained nurse plus two carers on duty during the day and at night there was a senior plus a wakeful carer. In addition the manager worked Mondays to Fridays. We looked at records for two staff members. The recruitment records included criminal record bureau checks, application forms and two written references. Surveys from staff show that they receive a good induction and training package, and this was confirmed by individual training records, and by talking to staff. We saw extensive training records that included subjects such as fire safety, moving and handling, medication administration, infection control, food hygiene, observation skills, diversity and autism. All staff must complete an induction course on joining. The manager said that 5 staff members now hold the national vocational qualification [a nationally recognised award] at level 2, with one working towards it and 2 have level 3 with one working towards it. The home has a dedicated training budget managed by the area training manager. Records we saw show that supervision sessions are carried out regularly with staff, and they confirmed this during discussion. They said that supervision helps them to look at their personal development, and they are able to voice their views and Care Homes for Adults (18-65 years) Page 17 of 23 Evidence: opinions. They said that there are good communication systems within the home such as handover periods. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The home is well managed, which means that people receive a good standard of care and support. The systems within the home protect their health, safety and welfare needs. Evidence: The manager is a Registered Learning Disability Nurse with 30 years experience; 15 of these have been managing Nursing/Care and Residential homes. He was appointed manager for this service and helped to open it. He operates an open door policy and staff members said he provided excellent support to them. Staff also said that there are regular staff meetings, and minutes we saw showed discussions about subjects such as supporting people, training, and health and safety. He is supported by an area manager, but has control of the overall annual budget for the service. The most recent legally required monthly visit by a representative of the providers was in February 2010. The manager was aware of this and said that a recent takeover of the company had led to a reshuffle of posts and a delay in visits by management. Chesterfield House operates a number of self monitoring systems covering health and Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: safety, finances, medications, individuals records, support delivery and the environment. Quality assurance and health and safety are monitored by an external consultancy and records are regularly audited both internally and externally. There are comprehensive policies and procedures covering all aspects of the running of the service. Monies for people were well managed and the three people who had capacity had their own building society accounts. Care Homes for Adults (18-65 years) Page 20 of 23 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 Adults (18-65 years) Page 21 of 23 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 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 41 17 Staff folders must contain an 02/07/2010 up to date photograph of the staff member In accordance with Schedule 3 regarding documents in respect of persons working at a care home. 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 Care Homes for Adults (18-65 years) Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 23 of 23 - 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!