Care Home: Chestnut Court

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What the care home does well Chestnut Court provides newly built accommodation and facilities to a very high standard for the residents living here. A welcoming atmosphere for visitors is provided, and there is a good amount of information about the home, its services and facilities to assist residents and their families. Residents are admitted here on the basis of an assessment of their individual needs. Upon admission each has their own personal documented plan of care to address the identified needs. Care is provided here on the basis of good care planning and risk assessment, with residents confirming they are satisfied with their care. We met some visitors who also expressed their complete satisfaction with the care the home provided for their relative. We saw evidence of consistent monitoring of residents` health status, with regular medical interventions and reviews sought in order to meet individuals` needs. Staff were working collaberatively with external health care professionals to improve the health and lives of the residents, and there were safe arrangements for managing residents` medications. Care is provided in a way that respects individuals` levels of independence, with their privacy, dignity and choice respected. There are regular opportunities for residents to remain socially active, with a coordinated activities programme available, and with residents able to puruse their chosen interests where possible. The quality and choice of food served to residents is good, and residents told us that they enjoyed their food very much. People are assured that the home takes any complaint seriously, and there are sound policies and procedures in place for the protection of the vulnerable residents. Some of the residents and visitors spoke of `having confidence in the home` and of `feeling safe here`. Staff work cohesively to meet residents` needs in a timely way, and residents and their visitors speak well of the staff here. The home is well managed, and has very good arrangements for monitoring the quality of its service to residents. The AQAA was very well completed and provided us with the information we required. What has improved since the last inspection? Levels of staffing have been improved, with the home reducing the use of agency workers through increased recruitment of permanent workers. What the care home could do better: There was an isolated concern in an otherwise very sound recruitment procedure when the home had failed to seek a reference from a worker`s previous employer, choosinginstead to seek references from other sources. The home should also keep a more complete record of interviews with prospective employees. A good training and development programme is provided for staff, however monitoring and management of the programme needs tighter control to ensure its delivery in a more consistent and timely way. The home acknowledges its failure to implement and sustain a formal staff supervision programme, but now has suitable plans to rectify this. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chestnut Court St James Quedgeley Glos GL2 4WD     The quality rating for this care home is:   three star excellent 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: Ruth Wilcox     Date: 0 6 0 4 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 32 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 32 Information about the care home Name of care home: Address: Chestnut Court St James Quedgeley Glos GL2 4WD 01452720049 01452722583 manager.woolstrop@osjctglos.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) : The Orders of St John Care Trust care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 40. The registered person may provide the following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP Date of last inspection Brief description of the care home Chestnut Court (previously known as Woolstrop House) is a purpose built care home that has recently been constructed on the same site to a high standard. The home is situated within easy reach of a large retail area, approximately 5 miles from the centre of Gloucester. The home provides nursing and personal care to 40 older people, and is managed by The Orders of St John Care Trust. Accommodation for residents is provided in single bedrooms, all with en-suite facilities, and there are a number of spacious communal rooms situated on both floors of the home. There is level access throughout and a passenger lift is provided. Information about the home is available in the Service User Guide, which is issued to all interested parties, and a copy of the most recent inspection report is available for Care Homes for Older People Page 4 of 32 Brief description of the care home anyone to read. The fees range from 551 pounds to 800 pounds, and the home also accepts the local authority contract rates for care. Hairdressing, chiropody and any personal items are charged as extra. The costs of these services are readily available in the home, as required. Care Homes for Older People Page 5 of 32 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: three star excellent 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 Key Inspection of this service was on the 10th April 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service, and takes into account the views and experiences of people using the service. One Regulatory Inspector carried out this inspection on one full day in April 2009. Care records were inspected with the care of four residents being closely looked at in particular. The arrangements to manage residents medications were inspected. Care Homes for Older People Page 6 of 32 We met and spoke to a number of residents and visitors in order to gauge their views and experiences of the services and care provided at Chestnut Court. Some of the staff were interviewed. Survey forms were also issued to a number of residents, staff and visiting health care professionals to complete and return to us if they wished, but none were received prior to this inspection report being completed. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service, and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, provision, training and supervision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to the new environmental facilities and standards. We required an Annual Quality Assurance Assessment (AQAA) from the home which was provided, the contents of which informed part of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: There was an isolated concern in an otherwise very sound recruitment procedure when the home had failed to seek a reference from a workers previous employer, choosing Care Homes for Older People Page 8 of 32 instead to seek references from other sources. The home should also keep a more complete record of interviews with prospective employees. A good training and development programme is provided for staff, however monitoring and management of the programme needs tighter control to ensure its delivery in a more consistent and timely way. The home acknowledges its failure to implement and sustain a formal staff supervision programme, but now has suitable plans to rectify this. 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 9 of 32 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 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Access to good information and a very thorough and comprehensive assessment process prior to admission to the home gives prospective residents an assurance that their needs can be met. Evidence: The homes AQAA confirmed that a copy of the homes information brochure was issued to all interested parties. A copy of the Service User Guide and Statement of Purpose was on display in the entrance hall and there was a Guide in each residents room. One particular family confirmed to us that they had been provided with an information brochure prior to their relative being admitted to the home. The AQAA also confirmed that all prospective residents and their families are encouraged to come to visit and view the home as part of the pre-admission process and to meet other residents and staff. Care Homes for Older People Page 11 of 32 Evidence: We inspected two examples of pre-admission assessments, each of which were for residents more recently admitted to the home. Each assessment had been carried out prior to admission being agreed and had been comprehensively and fully recorded on the homes designated tool for the purpose. The assessments had been signed and dated, with the location where it was conducted identified. They also identified if the persons family or representative was present. The assessments took account of their personal details and their past medical history; their health and care needs; their medications; their socialisation and cultural needs; their understanding and legal status. There was also a manual handling assessment; a pressure sore vulnerability and overall skin assessment; a nutritional and a falls risk assessment. Pre-admission assessment forms recorded the persons ethnicity and whether they would require the help of an interpreter with language and communication. Confirmation letters regarding residents admission to the home were issued. Chestnut Court does not provide intermediate care. Care Homes for Older People Page 12 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can expect to have all their health and care needs met in a consistent way that is mindful of their privacy and dignity. Evidence: Residents had their own well documented care plan, which had been drafted in consultation with them on the basis of a detailed assessment of all their health and personal needs. Four care plans were selected for case tracking. Each was well written in a fully detailed and comprehensive way and provided very good guidance for staff when delivering the care. Care plans had been regularly reviewed. In each case the practised care delivery was in full accordance with the recorded plan of care, with recorded monitoring charts and support equipment fully observed as well. We found that each person had been medically reviewed on a regular basis and saw that a wide and comprehensive range of health care interventions had been provided Care Homes for Older People Page 13 of 32 Evidence: where necessary to meet their health needs fully. Recorded risk assessments in each case included pressure sore vulnerability, falls, nutrition, and moving and handling. Where other risks existed, such as with personal safety and challenging behaviours for example, these too had been taken fully into account. Regular checks were made on residents weights, and appropriate risk monitoring arrangements were in place where necessary to meet their nutritional needs. Appropriate measures were in place for those who were at risk of falling. All of the residents with whom we had contact confirmed their complete satisfaction with their care and the way in which they were looked after. We received comments such as they really look after me, and nothing is too much trouble. Visitors we met were also complimentary about the way in which their relative was cared for. One visitor told us that their relatives health had improved since coming into the home. Assessments took account of individual wishes in relation to the medication aspects of their healthcare. One person had chosen to manage her own medications, and this was done within a risk management framework, with secure storage provided for her. Medications were stored safely on each floor with portable trolleys, wall mounted metal cupboards, and a secure medication refrigerator for those medications requiring cold storage. There was also an air conditioning unit in the storage area. The Controlled Drug store cupboard was fixed securely, and a bound and well documented Controlled Drug register was maintained. Random checks on arrangements in this area were entirely accurate. Stock levels of medications were well controlled. Medication rounds were conducted in a calm and methodical manner. Medication administration records were printed by the supplying pharmacist and were well maintained by staff. There were clear instructions for medication usage and clear records of administration. Medications prescribed for use when needed either orally or topically featured in an associated plan of care, which gave very clear indications for its usage. Apart from the Controlled Drug checks we conducted four other separate audits on boxed medications and in each case the results were accurate, showing that Care Homes for Older People Page 14 of 32 Evidence: medications were being given in accordance with prescribed orders. We were told that all nurses had attended medication study days and that all had received a competency check by the homes Head of Care Nurse. Residents care plans reflected their personal dignity, individual levels of independence, and personal choices and preferences. We met one particular resident, who was very independent. She said she particularly liked the privacy that the new room and ensuite provided. Residents themselves confirmed that staff knocked on their door before entering, and a number said that staff were respectful towards them. Although each resident had their own private room, a treatment room on the ground floor allowed certain care and treatments to be given in the privacy of this room if needed. We were told that the organisation was developing an End of Life pathway, and the manager said she would like to introduce the Gold Standards Framework and source additional training for staff in this area. The nurses were scheduled to attend a conference on End of Life Care and care staff had already attended specific training as well. Residents special wishes regarding their death were ascertained at the assessment stage wherever possible, as were their religious beliefs, spiritual needs and culture. We saw an End of Life care plan in one case, which reflected the persons particular Advanced Wishes in the event of their death. Care Homes for Older People Page 15 of 32 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 living in this home have the opportunity to remain socially active, exercise choice, and have a nutritious diet that offers choice and variety. Evidence: The home employs two designated social activities coordinators. The AQAA told us that The home endeavours to provide a varied social programme for residents, which includes cognitive, communicative, physical, sensory, creative and therapeutic activity for them. Residents had been consulted about their views and ideas for social opportunities, and records were kept regarding events held and of those participating. Personal care plans included a record of their past life and their interests. A social programme was displayed, which showed the current months events and activities. These included a variety of interactive group or one to one based activity sessions and an outing. The coordinator told us that she made a point of spending time with those residents who may not choose to join in group activity, preferring to spend time in their room or time more quietly. Care Homes for Older People Page 16 of 32 Evidence: Interdenominational religious services were held regularly in the home and links for residents were being developed within the local community. Some residents had been to see the local schools Easter play and were going to attend their sports day as well. The home had also linked with a community church for their craft mornings. Large print library books were provided in the home. Close links were being developed for the benefit of residents with a sister home, which is destined to merge with this one as part of the redevelopment programme early next year. We met one particular resident who was pursuing her life hobbies and managed to remain very occupied with meaningful activity. The AQAA told us that the home had an open visiting policy, with visitors able to stay for a meal with their relative if they wish. Quiet communal areas were also provided for residents to receive their visitors if they wish. Residents confirmed to us that their visitors could come in an out as they please. We met four regular visitors to the home and each indicated that staff were helpful and that they were made welcome here. One said that they were always offered refreshments. Some of the residents were moving freely around the home according to their choice. Some were more reliant on the staff to help them. Whatever their circumstance staff appeared mindful of peoples choices and they were evidently free to exercise choice within an open and friendly care home. Some had formed friendships among their group and clearly enjoyed spending time together. One resident told us that she still followed her lifetime habit of getting up early in the morning. This person, and others, told us that they were never told what to do by staff and could do as they chose. Residents rooms, although uniform in many ways, were full of personal belongings and consequently appeared very individual. Advocacy, Fee and Mental Capacity information was available if wanted. Residents had a good degree of choice with their meals. Menus and lists of individual choices showed a number of different requests from the menu, plus some that were not on the menu. Special diets were catered for and staff were on hand to provide assistance where needed in each of the dining rooms. The dining rooms were laid attractively for the meal and were conducive to peaceful mealtimes for residents. The lunch time meal looked very appetising, balanced and nutritious, with good portion sizes, which were well presented. Care Homes for Older People Page 17 of 32 Evidence: Resident comments about the food were all very good, and all whom we met seemed to enjoy their meal. The kitchen facilities are currently provided in temporary accommodation adjacent to the home. These temporary arrangements have been inspected by the Environmental Health Officer and deemed to be satisfactory. A full range of good quality catering equipment has been commissioned for use in here. Residents meals were delivered from here to the satellite kitchens in each dining room in hot trolleys ready for serving. Care Homes for Older People Page 18 of 32 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 living in this home can be reassured by the homes complaints procedures and the policies regarding the prevention of abuse. Evidence: The home had a clearly written and accessible policy for dealing with any concerns or complaints that arise. We have not received any complaints about the service, but the homes complaint records contained evidence of one complaint that had been received addressed and resolved satisfactorily through the homes own complaints procedure. The AQAA demonstrated that complaints and concerns were addressed in a positive way, telling us that the home used any concerns received as a way of improving the service development. The residents and visitors we spoke to had no concerns to raise but had confidence in the home to address any should the occasion arise. The home had clear policies and procedures for safeguarding the interests, wellbeing and safety of the residents. Safeguarding training was provided for staff, although we met at least one person who had yet to undertake this specific training. Staff had received training in the Mental Care Homes for Older People Page 19 of 32 Evidence: Capacity Act 2005 (MCA), and all had been issued with an easy read version of the Act. Senior members of staff were scheduled to undergo Deprivation of Liberty Safeguards (DoLS) training with the County Council, the content of which was to be cascaded to other staff afterwards. Staff we spoke to were able to demonstrate a good understanding of what constituted abuse, and of safeguarding procedures. In recent months there has been an incident of concern affecting the safety of one particular resident. As soon as this arose the home took all the necessary measures to safeguard where necessary, and informed all the relevant agencies in accordance with local safeguarding procedures. Two of the residents mentioned feeling safe here. One visitor said she had every confidence in the safety of her relative. Care Homes for Older People Page 20 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home are provided with accommodation to a high standard, which is very suitable and safe to meet their needs. Evidence: The accommodation is brand new and is provided on two floors with similar facilities on each floor. The ground and first floors are named Ash and Beech respectively. The new environment and facilities are of a high standard. Each floor has a large main lounge and two smaller quiet lounges. There is also a large dining room on each floor, each of which has a kitchenette integral to it. The amount of communal space provided for residents is slightly in excess of the National Minimum Standard expected. Furniture is solid and supportive and is provided in a domestic style with varying styles and colours. There is level access to the garden and raised flowerbeds are being constructed for the residents. Spacious and easily accessible toilets are situated close to the lounge and dining areas. There are raised level toilets, with grab rails, hand basins, liquid soaps and paper towels. Residents rooms have an en-suite bathroom with level access to a shower. Care Homes for Older People Page 21 of 32 Evidence: There is a sink, a mirror, a cupboard, a call bell, toilet, and grab rails. There are two communal bathrooms on each floor, each of which provides assisted facilities. All areas of the home are airy and spacious and are purpose built for disabled living. Two passenger shaft lifts and wide doorways provide easy access to all areas, and grab rails and signage are situated throughout. Equipment necessary to assist with disabled living is provided. There are variable height beds and a range of pressure relieving equipment. A Loop System has been installed in all communal rooms. Call bells are provided throughout, and are designed not to be intrusive on the atmosphere of the home. The system is computerised for easy monitoring and takes the doorbell sound as well. Each bedroom size is in excess of the National Minimum Standard expected and includes an en-suite bathroom. Residents rooms are spacious and allow a good amount of room on either side of the bed. Good quality curtains are fitted to each of the windows and there is good quality carpeting. Each residents room has overhead ceiling lighting and wall lighting, plus a bedside touch lamp on the bedside unit. Each room provides seating for two people and has drawer units with a table to sit at. There is an over bed table and a wardrobe. Each room has at least four accessible double electric sockets. Residents doors have a lock that will allow access in an emergency, and each has a lockable bedside cabinet with a lockable cupboard in the en-suite for medication, money and valuables. Each room allows natural window light and ventilation, which the resident is able to see out of when sitting in bed. The vast majority of the forty rooms have two windows, each of which has a restricted width opening for safety. Radiators have a low surface temperature safety feature and have accessible controls to allow the central heating to be controlled in the room by the resident. The companys Project Manager confirmed to us that hot water was stored above sixty degrees Centigrade and distributed above fifty degrees, and also that pre-set valves had been fitted locally to ensure safe temperatures of close to forty three degrees Centigrade at the outlets for residents. A sluice is situated on each floor containing a steriliser, a lockable cupboard, handwashing facilities, and a clinical waste collection point. Each was secured by the use of a door key style lock. The laundry facilities are currently provided in temporary accommodation in the grounds of the home. The laundry contains a sink, handwashing facilities, two sluicing washing machines, and driers and clothes racking. Hygienic surfaces have been fitted. Care Homes for Older People Page 22 of 32 Evidence: Due to the confined space the room afforded now it was in full use, the manager intended to request an additional space in which to carry out laundry duties more easily whilst arrangements were at this temporary stage. The home was immaculately clean and there were no significant odours noted for any length of time. Care Homes for Older People Page 23 of 32 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. Although there is room for improvement with minor aspects of the recruitment procedure and monitoring of the staff training programme, people living in this home receive care from a competent work force. Evidence: Staff rotas were maintained and there were consistent levels of staff each day. Two qualified nurses were on duty throughout the twenty-four hour period, and there were eight, six, and two carers divided between the two floors for the morning, afternoon, and overnight respectively. A new Head of Care and Nursing had been appointed who had additional supernumerary time in which to monitor and supervise care delivery. Agency staff had rarely been used and a good team morale was reported. There was a calm and organised atmosphere within the home with residents needs being met by the staff group. An ancillary team of catering, cleaning, laundry, maintenance, and administrators supported the care team. We spoke to a number of staff and each indicated that effective team working was being achieved, and that they received a good handover of information between shifts, Care Homes for Older People Page 24 of 32 Evidence: making sure that they were well informed about the needs of the residents. Residents themselves and visitors all spoke well of the staff, indicating that they were good and caring. One visitor commented on the fact that it was a busy home but that generally staff did OK. There was an expectation that care staff started a National Vocational Qualification in Care (NVQ) within six months of employment, and there were currently sixteen care staff qualified to a minimum of level two. We inspected three staff files of recently recruited carers. In each instance, the prospective employee had completed an application form, providing details of their employment history, with evidence that any gaps in it had been explained. However, in one case the most recent dates of employment were not absolutely definite, and there was no recorded evidence to confirm that this had been explored further in the interview notes. Two written references had been provided, but in the same case neither of these included the most recent employer. The previous employment had not involved vulnerable adults however, but it would have been much better practice had a reference been sought from there. Proof of identity and medical statements had been obtained. Correct Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) screening had been completed for each person before they had started work. We saw that employment contracts and job descriptions were issued, and that there was equal opportunities monitoring. The training records for staff were in dissaray at the time of inspection, reportedly due to the move to the new build. Records were both electronic and on paper, but were spread around in different locations rendering it time consuming to gain access to concise information. However, staff we spoke to confirmed that they had good training opportunities in the home, and said that they received good support and guidance. A full induction training to the new building and its facilities had taken place for all staff. New staff had gone through an induction training, but completion of the Common Induction Standards (CIS) training for Care Workers was not being followed through and completed in good time, with it being allowed to drift unchecked. At least two of the care staff we spoke to had yet to complete this important training, despite being in the home for nearly one year. Care Homes for Older People Page 25 of 32 Evidence: Carers told us that they had worked under strict supervision during their induction period, and we met a new carer who was shadowing an experienced worker on the day of this inspection. One of the newer staff told us that she had not been permitted to do any practical moving and handling tasks with residents until she had received proper training. The worker confirmed that she had been given an induction training package to work through. Training records showed that staff had received training in moving and handling, health and safety, fire safety, with MCA and dementia care training planned for later this month. Other training included first aid, nutrition, abuse, and risk assessment. There was a DVD training library, which provided interactive learning for staff, and which provided an assessment of understanding and competence afterwards. Despite this there were inconsistent aspects of the training delivery programme, which needed firmer control. Care Homes for Older People Page 26 of 32 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 management systems in place here ensure that the interests, and health and safety of the residents living in the home are safeguarded. Evidence: The manager of Chestnut Court is an experienced manager, but is not yet registered for this particular service. An application to address this is currently under consideration by The Care Quality Commission (CQC). This manager had overseen the move from the previous home into the new building, and this had gone very smoothly for the residents. She commended her staff for their contribution to this success. The AQAA had been completed to a very good standard, and its contents demonstrated there was a sound knowledge of the management of the service overall. Care Homes for Older People Page 27 of 32 Evidence: An annual survey had been issued to residents and their representatives in order to gain their views and experiences of the home as part of a quality monitoring approach. The views of other stakeholders had also been sought as part of this process. Residents and their families had also had a six monthly review of their care, with their views and ideas about the home obtained as part of the ongoing quality monitoring approach here. Comments and suggestion forms were readily available in the hall for anyones use. The AQAA told us that resident meetings were to be held quarterly. Minuted records of a recent meeting were displayed in the home, the content of which demonstrated that residents were consulted and account taken of their views. The minutes were recorded in larger print for easier access. A range of internal quality auditing was being regularly carried out, and external assessors had also successfully assessed the homes standards for the ISO quality award. A number of residents had chosen to place personal money with the home for safekeeping. The systems for managing and safeguarding these arrangements were satisfactory and totally transparent, and included records and receipts for transactions. Two random checks were carried out and each was accurate. In most cases two members of staff sign the records to confirm and witness the transaction, but residents were able to sign their own records if they wished and were able. A formal and structured staff supervision programme had not been consistently delivered. The manager had developed a matrix to plan and monitor a programme and senior staff had received Supervision and Appraisal training in readiness to deliver a programme. One supervisor had been allocated a designated team of staff to supervise. We saw records of some supervisions having taken place. Care staff were aware that supervisions were being delivered more consistently. The AQAA confirmed that as a newly built home all the equipment was currently under warranty by the contractors and there were service contracts in place. A fire risk assessment had been conducted, which had been inspected and cleared by the Fire Officer. A fire safety sprinkler system has been installed. Installers certificates for the commissioning of the fire alarm panel and emergency lights were provided to Care Homes for Older People Page 28 of 32 Evidence: us. Fire exits, fire safety signage, extinguishers and fire alarm points were located around the home. Staff had received fire safety training, and there had been two fire drills carried out since the move into the new home. Individual fire safety risk assessments were recorded in each residents care plan. Electrical installation and gas safety certificates were supplied to us. A Legionella analysis safety report was also supplied. First Aid facilities were stationed in numerous areas around the home, and staff had received first aid training from an accredited training provider. Security arrangements included a keypad entry to the front door, with an all day receptionist. All external fire doors were linked to the alarm system so that staff could be alerted if one was opened. Care Homes for Older People Page 29 of 32 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 30 of 32 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 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 29 The manager should ensure that written references are always obtained from the previous employer when recruiting staff. The manager should ensure that interview notes are recorded in full detail when recruiting new staff. The manager should ensure that formal supervision is given to care staff at least six times in each twelve month period. 2 3 29 36 Care Homes for Older People Page 31 of 32 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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