Care Home: Chestfield House Nursing Home

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What the care home does well Service users are only offered a place at the home if the manager is confident the home can meet the individuals needs. Service users have detailed care plans enabling staff to meet their needs. The health needs of residents are well managed. Service users feel respected and valued by the staff. Service users enjoy the quality of the meals cooked at the home and have a pleasant dining room to eat in if they wish. The manager deals with complaints positively, service users feel confident and comfortable that any complaint they made would be dealt with appropriately. The manager and staff are aware of their role and responsibility in relation to any allegations of abuse. The staff receive regular training to enable them to carry out their jobs. Many staff have NVQ and more have enrolled recently. The service users, relatives and staff spoke very positively about the manager. The home has a number of quality assurance systems in place. What has improved since the last inspection? The home continues to implement its refurbishment plan, and the sluices and bathrooms are due to be refurbished next. What the care home could do better: The service users enjoy the activities arranged by the home but say they would like more of them. There were no planned activities during the week the inspection took place. A number of health and safety issues were identified in the homes garden, and a requirement made to make the area safe, the issues were, broken paving causing uneven surfaces, no handrails to sloped pathways, low walls in areas of restricted space, all presenting trip hazards. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chestfield House Nursing Home The Ridgeway Chestfield Whitstable Kent CT5 3JT     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: Justine Williams     Date: 0 5 0 5 2 0 0 9 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. 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. 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 24 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Chestfield House Nursing Home The Ridgeway Chestfield Whitstable Kent CT5 3JT 01227792281 01227792281 espringett@njch.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Unique Help Group Limited care home 31 Number of places (if applicable): Under 65 Over 65 0 31 dementia old age, not falling within any other category Additional conditions: 31 0 The maximum number of service users to be accommodated is 31. The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Chestfield House is a large detached property situated in a quiet residential area in Chestfield, near to the seaside town and amenities of Whitstable. The home can easily be reached via the M2 motorway, and the Thanet Way. It is part of the Unique Help Group of nursing homes and the group have another 4 nursing homes in the area. The house has been extensively renovated and provides accommodation for up to 31 residents. Accommodation is situated on two floors and comprises 23 single and 4 shared bedrooms, 14 of which have en-suite facilities. There is a passenger lift, which Care Homes for Older People Page 4 of 24 0 4 1 2 2 0 0 8 Brief description of the care home provides easy access to all rooms on the first floor. There are communal areas on both floors and gardens at the rear of the property. Car parking is available for several vehicles. The current fees for the service at the time of the visit range from £328.68 to £620.00 (a shared room used for single occupancy) per week. Information on the Homes services and the CSCI reports for prospective residents will be detailed in the Statement of Purpose and Service User Guide. The e-mail address of the home is espringett@njch.co.uk Care Homes for Older People Page 5 of 24 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: An unannounced inspection was carried out on 5th May 2009 between 10:15 am and 2:30pm by regulatory inspector Justine Williams. During that time residents, staff and the manager agreed to speak with the inspector both in public and privately. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises, and information from the AQAA sent in by the homes manager. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GPs, health care professionals, care managers and relatives of residents. Care Homes for Older People Page 6 of 24 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. 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 Older People Page 7 of 24 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 8 of 24 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. Service users have their needs fully assessed prior to moving into the home. Evidence: Each service user has their needs fully assessed by the manager prior to being offered a place at the home. The manager obtains copies of any assessments made by social services. If the service users were in hospital before moving to the home the manager discusses their care needs with ward staff. The assessments are sufficiently detailed to clearly identify service users needs, and to create a plan of care. Service users and their families are invited to look around the home and meet staff and residents and stay for a meal prior to deciding to move in. Relatives spoken with said the staff were welcoming and made them and feel more confident to leave their relative in the homes care. The home will not admit service users unless they are confident they can meet their needs. Chestfield house does not provide intermediate care. Care Homes for Older People Page 9 of 24 Care Homes for Older People Page 10 of 24 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. Service users health and personal needs are well managed by the home. The privacy and dignity of service users is upheld. Evidence: Service users each have a detailed care plan written by trained staff, with the involvement of the service user or their relative, depending on what is appropriate. The care plans are regularly updated and reviewed on a monthly basis. Unfortunately the daily records did not give a detailed picture of the care given or how service users had spent their day, the records contained statements such as took food and fluids well and slept well. The manager agreed to address this and a discussion took place as to the possible benefits of health care assistants writing in the daily record where they gave the care, or interacted with the service user. The health care needs of service users are well managed and the home enjoys a productive working relationship with the local GPs and other health care professionals. Each service user has detailed assessments for risk of pressure sores, nutrition, continence, psychological health, etc. these assessments are then acted upon with Care Homes for Older People Page 11 of 24 Evidence: referrals to other agencies, provision of equipment or changes to the care plans. All service users are weighed regularly and any significant weight loss is acted upon. The cook has started to make smoothies for some of the residents whose weight is falling, and build up drinks are supplied by GPs. Medication is appropriately dealt with, the home has a secure room where medication is kept. Clear records are kept of medicines administered to residents and medicines entering and leaving the home. Only the registered nurses administer medicines. Service users and visitors to the home said they feel they are treated with respect and with due regard to their privacy and dignity. Service users may have their own personal telephone line installed if they wish or can use the homes cordless phone. Service users are called by their preferred name. Care Homes for Older People Page 12 of 24 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. Service users find that whilst activities are enjoyable they are not frequent enough. Visitors to the home are made welcome. Service users enjoy wholesome and nutritious meals. Evidence: The home employs an activity coordinator for 12 hours over 2 days, the manager plans to increase the hours to 15 over 5 days in the near future. The activity coordinator keeps a record of service users personal history and interests, and a record of activities they participated in. Many service users are confined to their bedrooms due to their illnesses and the activity coordinator spends time with them individually. This leaves little time for group activities and the activity plan for May shows only holy communion and a visiting singer. Service users and relatives spoken with said that activities are limited and there is not much going on. Care staff said they try to do puzzles or play games with service users in the evenings when there is more time but this is not recorded. This was discussed with the manager who agreed to review the activity program and how it is recorded. Visitors said they feel welcomed to the home and are usually offered a drink and on occasions a meal. Service users may use the quiet lounge on the first floor if they wish Care Homes for Older People Page 13 of 24 Evidence: to see visitors privately. Service users are helped to exercise autonomy and choice but this could be recorded more clearly in the care plan. For example service users preferred times for rising and retiring are not recorded. Most service users ask the home to look after small amounts of cash for them, but they are encouraged to manage their own finances for as long as they are able. Service users enjoy a varied diet and all those spoken with said they were very happy with the food. Service users have 3 full meals per day with one or two being a hot meal. Fruit is always available and the cook prepares special diets such as pureed, diabetic and vegetarian, other diets can be catered for. Service users who require help eating are offered this in a unhurried way by the care staff, and meals are kept in a hot trolley until staff are ready to assist. Care Homes for Older People Page 14 of 24 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. Service users can feel confident that any complaint they have will be listened to and dealt with appropriately. Service users are protected from abuse as far as possible. Evidence: The complaints policy is clear and accessible. The home keeps a record of any complaints received and action they have taken to address the complaint. The home received its first complaint since the last inspection that morning, the issues raised were all around the physical environment and the manager had already involved the maintenance person. Service users and relatives spoken with felt confident that if they had a complaint or issue that the manager would deal with it. The staff and manager had good knowledge of what to do in the event of a safeguarding allegation, and the home has a clear procedure and policy in place. The home has not received any allegations of abuse for some time. Care Homes for Older People Page 15 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users do not have a safe well maintained environment in which to live. Evidence: The tour of the home and the garden showed that many areas of the home have become worn with damaged paint and woodwork from wheelchairs and hoists. The laundry was in need of a thorough clean. The sluices and bathrooms are due to refurbished in the near future and will benefit from this as the sluices were smelly, and in need of a thorough clean, the flooring was stained. Bathroom floors were stained and a service users said the bathrooms were generally very uninviting, as some have no windows, and they were not like their own bathroom at home. The parking area at the front of the home has a damaged and collapsing fountain which could present a hazard to staff and visitors to the home. The garden was in need of attention, the lawns had been cut the previous weekend, but a general tidy up is needed to remove dead leaves from paths which could present a hazard if wet. Many paved areas around the garden were damaged and uneven, presenting trip hazards. Sloped paths do not have handrails fitted again presenting a falls hazard. There are low walls around shin height in areas with restricted space which could present a trip and a tissue viability hazard. With the weather improving it is likely that some residents will wish to use the garden more therefor a requirement has been Care Homes for Older People Page 16 of 24 Evidence: made to address these issues within 2 months. One bedroom has a door to the garden, the outside of this door has been extensively repaired presumably due to rot, and would benefit from being replaced. The staff adopt good practices in relation to infection control, and the bedrooms and communal areas were clean. The home has infection control policies and procedures in place. Care Homes for Older People Page 17 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are cared for by staff who receive regular training relevant to their roles. Service users are protected by the homes recruitment practices. Evidence: The home employs registered nurses and care staff who work a rota covering 24 hours a day 7 days a week. The written rota shows what staff are on duty and in what capacity. Cleaning and catering staff are employed in sufficent numbers to ensure the home is clean and hygienic and food and meals are of a good standard. However the home does not employ any gardeners and this is left to the maintenance staff. The AQAA indicates that any maintenance, decorating, refurbishment etc is carried out by a team for the group of homes owned by the company rather than employed directly by the manager therefor the manager has little influence over the order of priority of jobs. The AQAA also states that 8 of the 15 care staff have attained NVQ and a further 5 have recently enrolled. 10 staff have completed induction training to a nationally recognised standard. The manager recruits staff using the homes recruitment policy. Two written references are obtained before staff are appointed and CRB and POVA checks are carried out. The manager keeps a training matrix which assists her in identifying what training staff have undertaken and when refreshers are needed. Staff said they had received training recently in moving and handling, COSHH, Health and safety. All staff Care Homes for Older People Page 18 of 24 Evidence: undertaking kitchen duties in the afternoons must receive food hygiene training prior to undertaking this role. The manager said she would review the rota to ensure staff have the training they need. Care Homes for Older People Page 19 of 24 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. The service users benefit from living in a well managed service. Evidence: The staff, service users and visitors spoken with spoke highly of the manager. The manager communicates a clear sense of leadership and direction. The manager has been employed and registered for almost 3 years, prior to this she was deputy at the home. The Manager is a registered nurse and has attained further qualifications in managament as well as undertaking regular training along with the staff to update her skills. The home undertakes audits of documentation and annually send out surveys to residents, relatives and other interested parties, as part of its quality assurance processes. Unfortunatly there was not a report available to view on the day of the inspection. The home continues to look after small amounts of cash for service users who do not wish to or are unable to manage their own finances. The manager keeps service users Care Homes for Older People Page 20 of 24 Evidence: monies separate, and with a balance sheet for each service user, in a secure safe. A relative spoken with said he had queried the balance with the manager who happily provided him with a copy of the balance sheet and went through it with him, to his satisfaction. The AQAA states that the home is up to date with the relevent health and safety checks including PAT testing, checks and servicing of equipment. Training is provided for staff in health and safety, fire, first aid, and the home has recently enrolled staff on an indepth distance learning course for infection control. The manager undertakes risk assessment of the environment, the manager agreed to take urgent steps to address the issues found at this inspection. Care Homes for Older People Page 21 of 24 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 22 of 24 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 19 13 The registered person shall 19/07/2009 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Damaged paved areas must be made safe, sloped pathways which do not have handrails must be made safe. areas of restricted space to walk with low walls must be made safe 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 Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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