Care Home: Chestnut Court Rest Home

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Chestnut Court Rest HomeDS0000011777.V376295.R02.S.docVersion 5.2Chestnut Court offers a comfortable and homely place to live where bedrooms with private en-suite facilities are appreciated. The residents enjoy a homely, domestic environment with reasonable furnishings and fittings. `Chestnut Court has a comfortable, non-regimental, homely feel.` Visitors and care professionals are welcome at any time and a variety of activities take place. With a chiropodist and a hairdresser and two activities happening during the day the home had a `busy` feel. Residents engaged well with the staff and at times with each other and there were ready smiles from both staff and residents in response to the inspection. Comments include `the staff seem to genuinely care,` `all are very kind. I think there is a shortage of staff.` `Cheerfulness of the staff is very good.` We were given the invitation to go wherever we wanted, unsupervised or unescorted. The manager and the provider expressed complete openness and transparency with records, and in discussion. Accessible training for carers has always been a feature of the home, and with a recent turnover of staff this remains a strength and also a high priority. What has improved since the last inspection? The manager has been able to invest more time and focus in forming and maintaining detailed and personalised care plans to specify for the carers the particular needs of individual residents. Assessments are thorough to make sure the home is right for each new person and that the home can meet their needs. Risk assessments are also in place to alert staff to vulnerable areas and to help with monitoring aspects of personal care. The provider`s commitment to monitoring the home`s performance and raising the rating of the home has brought about a detailed and rigorous audit visit each month by a specialist who reviews and reports on different aspects of the service. Attention to detail in the processes of drug administration has produced a well ordered system so that people are well supported and receive what they are prescribed. The provision of a hoist means the home is no longer a `no lifting` home. What the care home could do better: Maintenance of a well trained and consistent staff team is a priority for the home to ensure that all care needs are well met, and that staff morale in some quarters is improved. Regular support and supervision by the manager for all staff would help promote communication about aspects of the work that should be discussed, so averting unnecessary frustration. Some staff expressedChestnut Court Rest HomeDS0000011777.V376295.R02.S.doc Version 5.2 positive views about the role of the manager, ``we have good support from the owner and the manager. They provide all the training needed for our job roles.` Another said `we can go and see the manager if we need help and support at any time, and `I enjoy working at Chestnut Court.` However, others said to the question about what the home does well, `I cannot think of anything, no support from the manager at any time,` and another said, `unfortunately, nothing comes to mind-no support at any time, no confidentiality within the home.` Management leadership, modelling and instruction of good practice to a new staff team, particularly in acceptable ways of supporting people with meals is necessary. A faster focus on attending to maintenance needs will lessen staff frustrations. Regular maintenance of the paintwork that is constantly damaged through wheelchair movement is needed to ensure the environment is seen to be cared for and to indicate the value the home places on resident satisfaction. Attention to the tripping hazard in the lounge leading to the patio has been made a requirement of this report. We were told by care professionals that the provision of more specialised equipment e.g. profile beds and a more consistent staff team could lead to more referrals and consequently a higher occupancy. Key inspection report CARE HOMES FOR OLDER PEOPLE Chestnut Court Rest Home 9 Copse Road New Milton Hampshire BH25 6ES Lead Inspector Joy Bingham Key Unannounced Inspection 7/07/09 09:30 DS0000011777.V376295.R02.S.do c Version 5.2 Page 1 This report is a review of the 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. 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 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 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. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnut Court Rest Home Address 9 Copse Road New Milton Hampshire BH25 6ES Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01425 620000 01425 627707 chestnutcourt-care@yahoo.co.uk Goldenpride Ltd Mrs Patricia Harrison Care Home 25 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) 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). The maximum number of service users to be accommodated is 25. 2. Date of last inspection 12th March 2009 Brief Description of the Service: Chestnut Court is set in a residential area close to local amenities and the town centre. It provides residential care for up to 25 elderly residents, some of whom may have dementia. The home is on ground and first floors and there is a passenger lift between these. There are a variety of aids and adaptations to enable residents to move about more independently, including a hoist. Twenty three of the bedrooms are single and one is a double, with all these having en suite toilets and some with baths and showers. There are two communal toilets on the ground floor and an assisted bathroom on the first floor. There is a large garden to the rear of the property. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 7 July 2009. All core standards and a number of additional standards were assessed. The visit to the home commenced at 09:30 and was completed at 18:30 following feedback to the manager and a representative of the Company, with very positive discussion. The inspector was able to spend time with the provider, manager, all staff on duty and was provided with free access to all areas of the home. The records we requested were readily provided. These included care plans, staff records, medication records, policies and procedures, accident and incident records and those to do with the general running of the home. We met and spoke with nearly all the residents, and with a number of people who were visiting. Prior to the visit the provider completed an annual quality assurance assessment (AQAA) which is the home’s internal review of their service. This was fully completed and information from this is included in the report. Fifteen confidential comment cards were sent to the home for distribution to people who live at the home and eight were returned. The majority had been completed by a family member on the residents’ behalf. Ten staff surveys were sent out and eight were completed and returned. Three care professionals’ comments were requested and one was returned. Information was also gained from the Care Quality Commission’s service file containing notifications of incidents in the home, safeguarding referrals to the local social services department and any formal complaints. During the visit to the home the inspector was able to observe interactions between staff and residents, speak with many of the people who live at the home, a doctor, a visiting chiropodist, singer and musician, hairdresser, arts and crafts presenter and two visitors. What the service does well: Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 6 Chestnut Court offers a comfortable and homely place to live where bedrooms with private en-suite facilities are appreciated. The residents enjoy a homely, domestic environment with reasonable furnishings and fittings. ‘Chestnut Court has a comfortable, non-regimental, homely feel.’ Visitors and care professionals are welcome at any time and a variety of activities take place. With a chiropodist and a hairdresser and two activities happening during the day the home had a ‘busy’ feel. Residents engaged well with the staff and at times with each other and there were ready smiles from both staff and residents in response to the inspection. Comments include ‘the staff seem to genuinely care,’ ‘all are very kind. I think there is a shortage of staff.’ ‘Cheerfulness of the staff is very good.’ We were given the invitation to go wherever we wanted, unsupervised or unescorted. The manager and the provider expressed complete openness and transparency with records, and in discussion. Accessible training for carers has always been a feature of the home, and with a recent turnover of staff this remains a strength and also a high priority. What has improved since the last inspection? What they could do better: Maintenance of a well trained and consistent staff team is a priority for the home to ensure that all care needs are well met, and that staff morale in some quarters is improved. Regular support and supervision by the manager for all staff would help promote communication about aspects of the work that should be discussed, so averting unnecessary frustration. Some staff expressed Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 7 positive views about the role of the manager, ‘‘we have good support from the owner and the manager. They provide all the training needed for our job roles.’ Another said ‘we can go and see the manager if we need help and support at any time, and ‘I enjoy working at Chestnut Court.’ However, others said to the question about what the home does well, ‘I cannot think of anything, no support from the manager at any time,’ and another said, ‘unfortunately, nothing comes to mind-no support at any time, no confidentiality within the home.’ Management leadership, modelling and instruction of good practice to a new staff team, particularly in acceptable ways of supporting people with meals is necessary. A faster focus on attending to maintenance needs will lessen staff frustrations. Regular maintenance of the paintwork that is constantly damaged through wheelchair movement is needed to ensure the environment is seen to be cared for and to indicate the value the home places on resident satisfaction. Attention to the tripping hazard in the lounge leading to the patio has been made a requirement of this report. We were told by care professionals that the provision of more specialised equipment e.g. profile beds and a more consistent staff team could lead to more referrals and consequently a higher occupancy. 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. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Potential residents are supported and informed by the information the home provides about the service, and by their pre-admission assessment process. EVIDENCE: On the inspection visit to the home we saw that the up-to-date service user guide and the home’s statement of purpose were pinned to the notice board in the entrance hallway, available for any visitor to look at. A more comprehensive file of information about the service was held in the ground floor office. The manger told us that this file is given to everyone who is considering moving into the home to look at. The file includes a sample contract and copies of the most recent inspection reports as well as informative summaries of quality assurance interviews with other families who have been living at Chestnut Court. These give perspectives on the strengths and weaknesses of the service. We advised the manager that, as they are being Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 10 read by anyone requesting access to the file, comments should be made anonymous, unless the interviewee has given permission to be used for their publicity. We sampled the pre-admission assessments of four residents. The number of new admissions since the last inspection was limited. However, information was recorded, included the family/advocates, and was sufficient for the home to assess the full care needs of the elderly persons. They were dated and signed. We observed and spoke with the newest resident and noted that they were relaxed and engaging with other residents. The person told me they were comfortable and had what they needed, and responded with ready smiles. The AQAA informed us that a comprehensive pre-admission assessment is carried out; a trial visit is always offered for prospective service users to visit the home and to enable them to get a feel of what it is like living at the home. Through surveys, we asked the residents and their families about their experience of admission and induction to the home. Surveys were returned by eight service users. Seven had been completed by the resident themselves or assisted by a family member. Most confirmed that they had received enough information about the home to decide if it was right for them before they moved in. Three were unable to racall if they had. Six confirmed they had received a contract about the terms of living at Chestnut Court. One was uncertain. A staff member said, ‘Chestnut Court has a comfortable, non-regimental, homely feel.’ Although the home offers respite, short stays, it does not provide intermediate care. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 residents’ health needs and personal care are supported and provided by detailed care planning, including relevant risk assessments, and well managed drug administration. Some hands-on working practices need adjusting through proper training and leadership that models good practice. EVIDENCE: We sampled four care plans during the inspection, looking at the personal care needs, health issues and social history with identified likes and dislikes. The care plans were fully documented, dated and signed by the resident or their families. Written specific assessments were in place with the care plans for aspects of care which present higher risk for each person, including moving and handling, continence, anxiety traits, eating patterns etc. Where possible, a personal life history had been provided by the family/advocates giving Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 12 helpful indicators of significant relationships, dates and traumas, work history, personality traits and likes and dislikes. We saw that the care plans were reviewed each month and any changes had been noted. The home’s care plan included records of health concerns, action taken and instruction from care professionals. We drew to the manager’s attention that not each recorded episode of care was brought to conclusion in the records and gave her specific examples where this would be helpful e.g. skin treatment where the district nurses had suggested changing creams after a set period of time if the irritation had not been resolved. We saw evidence in the files of involvement of specialists where necessary and support by the district nursing service. A doctor visited while we were present and we took the opportunity of speaking with them about the homes’ service. We also received a survey response from a local General Practice. We were told that the home does call doctors appropriately and that good interaction between the staff and the clients was usually observed. In their view the service respects people’s right to privacy and their dignity is upheld; the manager and staff ‘usually’ have the right skills and experience to support people’s health care needs. We were told that referrals of more frail residents to the service may be limited by the lack of specialist equipment (e.g. profile beds) and the perceived absence of consistent management leadership, i.e. a different member of staff to communicate with, and changes of staff faces, when visits occur. We noted that surveys from service users indicate people receive the care and support they need. Six out of eight said ‘always’ and two said ‘usually’. There was unanimously positive response about receiving the medical care they require. To the question what the home does well we heard, ‘individual care and attention’, ‘the staff look after me and keep me safe’ and ‘care and cleanliness of clients is very good’. A staff member said the home does well because they have ‘very focussed care and concentrate on the client’s health, choice, rights, medication, privacy and dignity, supporting all clients according to their needs.’ Another said ‘it caters to the residents’ needs by discussing how the resident lived prior to their dementia with close family members, so that to a degree, some form of routine can be followed.’ We saw that the residents were coming into the lounge at various times of the morning, getting up at their pace and in an unhurried way. They were well presented with cared for hands, hair and fresh clothing. One resident who was presenting challenging behaviour was responded to kindly on a number of occasions and the staff members diffused the tension this raised with nearby residents. We saw that some of the residents were communicating with each Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 13 other and not just with the staff, which is positive and worthy of note, for a home with high frailty and many residents with various degrees of dementia. We noted that a chiropodist was attending during the morning. People were treated in their own rooms. We were told that a resident’s bedroom was borrowed for treating staff who needed their feet doing. This is not good practice and it is recommended that alternative provision be made e.g. using the designated hairdressing room, provided both practitioners are not visiting simultaneously. We saw the provision of continence aids and moving and handling equipment, including a new hoist. We were told that a screen is provided and is used when two people are occupying the double bedroom. We expressed concern to the manager about feedback from surveys that some first floor baths and showers do not work properly when the system is in high use, causing a detrimental effect on residents. Both the provider and manager noted the need for action in this respect. We noted that residents’ weight gain and losses were monitored and recorded regularly. We commented to the manager that some poor practice exists in the staff’s methods of feeding residents. This included staff members moving from resident to resident and giving them a mouthful at a time, not one to one attention for their comfort and dignity; standing over them from behind to feed them and not on a level with them; limited reassuring conversation and eye contact; blowing on a spoonful of food to make sure it was cool enough; and in bending over people occasionally staff’s hair fell into the food. We observed that the carer’s questioning of residents about their choice in relation to the teatime meal was confusing and incorrect. Chicken kiev, with salad, was stated as chicken ‘cue’, which was not understood by the residents, and the alternative given (instead of dessert) was fresh fruit salad. The residents did not understand and some just opted for the fruit salad. Another said anxiously, ‘I don’t know’. This choice finding exercise was not successful and had to be subsequently redone but with clearer instruction. We discussed staff support practices in relation to eating with the manager who gave an immediate and cooperative response to this issue. We noted that the residents whose care files we reviewed had been asked whether they wished to accept or decline flu injections. We observed the lunchtime administration of medication and checked the drug records. The home has two mobile drug trolleys and a fixed drug cupboard, including a controlled drug cabinet, within a locked room. A small drug fridge was in use for storing prescribed eye drops. A monitored dosage system is followed and the medicines and records were found to be generally well ordered. We noted that the regular monthly visit by the provider’s nominated Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 14 person monitors the drug recording and administration in detail and by detecting minor errors and drawing these to the staff’s attention, had produced improvement in this important area. We discussed with the manager the absence of individual written guidance for staff where residents are prescribed ‘as and when needed’ medication by the doctor for pain control or mood altering drugs. This is necessary to ensure it is not left to individual staff to determine whether the administration is appropriate or not. The manager agreed to put this in place. One area that the home could do better that was recorded in the surveyed comments was to keep family members informed more promptly of any changes in medication. We discussed this with the manager who agreed communicating with family regularly is an important aspect of care. The home’s AQAA told us that all the new service users’ care plans are reviewed independently as part of the monthly provider monitoring visit to ensure completeness and compliance to procedures and policies. The home also follows an internal quality assurance process using the Registered Nursing Homes Association’s self assessment tool. An external consultant reviews the working practices and procedures using this tool and any identified weaknesses, or areas of non compliance are rectified by the management team. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 meets the residents’ lifestyle, social, cultural interests and needs, supporting contact with their families. They exercise some limited choice in the shape and content of their day. Residents are provided with regular, home made meals with alternative choices to suit them. Training for staff in how to provide appropriate assistance with feeding would benefit residents, add to their dignity and ensure that people always eat well. EVIDENCE: We noted that the care plans recorded any special interests, of sport, leisure or religion that residents had followed. We noted that this can make for meaningful conversation, even when residents have lost the skill to engage directly with the activities. We saw that a weekly programme of activities was pinned on the notice board at the entrance. These included a wide range of art and crafts, exercises and music events. During the morning a sing-along was provided by a young key board player who was familiar with the older tunes. This was enjoyed by the residents in the lounge who joined in with the songs they knew. In the afternoon an arts and craft lady came and was encouraging Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 16 the residents to be involved. The manager told us that an activities’ organiser had been appointed and shared this role with the owner’s other Goldenpride homes. Christian services at the home had been periodically organised for those who wished to join in. No other religious persuasions were identified. We saw that the home welcomes visitors at all reasonable times and during the inspection two family members came. We spoke briefly with one of them in the lounge as the resident wished to benefit from their time. They confirmed that they are always made welcome and come most days. The service user guide states that residents may bring in with them any article of memorabilia or furniture of their choice provided its condition and material it is made of meets safety standards. Surveys told us that five out of eight people think there are ‘always’ activities they can engage with and three said ‘usually’ there are. One person said about what the home does well, ‘getting activities-singers. Makes sure we are happy with no worries. Celebrate birthdays’. Another said ‘Contented being here. I have nothing against the home.’ A relative said, ‘My mother is happy here as far as I can tell. She is well. Her appearance is always neat and tidy.’ However, one suggestion for improvement from a resident is ‘You need another activities person.’ Two staff felt there were insufficient activities to stimulate the residents, and ‘more activities including trips out would avoid residents sleeping all day in the lounge.’ In relation to the meals four people said they ‘always ‘liked the meals; three said they ‘usually’ did and one said ‘sometimes.’ One commented ‘meals and snacks are served at regular times. This I consider important to health.’ The serving of the lunchtime meal was observed. The television was put on hold but no-one noticed that the freeze picture was of an explicit nude female, that could have been offensive to some people. We pointed this out to a carer who then switched it off. Some more independent residents stayed at their seats and were provided with a table to use. Most sat up together at a long dining table. The meal consisted of a starter of a small dish of lettuce and a piece of deep fried scampi. Most of the residents did not eat this and did not seem to know what it was. The main meal, nicely presented and served on warmed plates, was beef casserole with carrot and dumplings, mashed potatoes, cauliflower and broccoli, followed by rhubarb crumble and custard. One vegetarian resident was given a quorn casserole alternative but declined this saying it was too salty. She was provided with tomato soup and bread and butter but declined this also, finally eating a few mouthfuls of a cheese sandwich, using a dessert spoon. One very slight lady ate nothing and slept most of the time. Her care Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 17 plan stated that she disliked meat and does not wear her teeth, so we questioned that this was a reasonable meal for her. The manager told us that her appetite is variable, she will eat meat and that some days she eats adequately. We checked that her weight was being recorded and monitored. In relation to the meals four residents said they ‘always’ liked the meals; three said they ‘usually’ did and one said ‘sometimes’. One commented ‘meals and snacks are served at regular times. This I consider important to health.’ Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Chestnut Court are aware their comments/complaints will be listened to and taken seriously. They are protected from abusive practice. EVIDENCE: We saw that the comprehensive complaints procedure was incorporated into the service user guide and a simple pictorial procedure hangs on the back of each bedroom door. A procedure is also included in the contract of residence. We drew to the provider’s attention that these three are not all the same. Three procedures raised at different times have been used for different purpose and we agreed they need to be reviewed and clarified. However, surveys told us that all the residents knew who they could talk with if they were unhappy about anything, and they all said they knew how to make a formal complaint should that be necessary. We saw the complaints log and noted one complaint had been received in the home in the last twelve months. It was dealt with promptly by taking remedial action and brought to a satisfactory conclusion. No formal complaint about this service has been received by the Care Quality Commission and pre-April 09 by the Commission for Social Care Inspection. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 19 The home has informed the CQC, as required, of every notifiable event, and has appropriately processed and fully co-operated with two incidents of safeguarding that has occurred in the last 12 months. The training matrix supplied by the manager indicates that training in the detection and intervention of abusive practice is part of the programme for all staff. We spoke with one staff member in private and they expressed good values in relation to advocacy and responsibility towards the residents. No referrals have been made by the home to POVA (Protection of Vulnerable Adults). However, all potential staff are checked through the POVA register before commencing employment. We saw that procedures in respect of people’s personal money are regularly audited during the monthly monitoring review by the provider’s representative when a brief report is produced. The inspector did not check the process on this occasion having found it very accurate and well maintained previously. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the 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 residents enjoy a homely, domestic environment with reasonable furnishings and fittings. They would benefit from more regular upgrading of the paintwork in communal areas. Chestnut Court offers a comfortable and homely place to live where bedrooms with private en-suite facilities are appreciated. EVIDENCE: Chestnut Court has mainly single rooms with en-suite toilet and shower or bath facilities. All rooms have a staff call system. The house is a large family home that has been extended and adapted. It is located in spacious grounds. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 21 A full passenger lift operates between the ground and first floor. There is a lounge/ dining room on the ground floor and an alternative one on the first floor. As the home has low resident occupancy at present only the ground floor dining room was in use. We noted that a selection of chairs and sofas are provided in the lounges, of various sizes and shapes to suit different needs. A large, wide-screen television in the ground floor lounge gives a clear well defined picture. The hallway has a colourful, bright fish tank that is interesting to look at and appreciated by the residents. We spent most of our time in the ground floor lounge/dining area where most of the residents and activities took place but also looked around the home, including the first floor lounge/dining room, kitchen, laundry, about ten bedrooms with their en-suite facilities, the first floor assisted bathroom and the drug room. The home was clean and largely odour free. A couple of bedrooms had detectable but not really ‘poor’ odour. What reduced the overall impression of a clean home was the badly chipped paintwork around some door frames and along corridors. Surveys told us that the residents believe the home is ‘always fresh and clean’. No suggestions of improvements to the physical environment were made by them. However, some staff drew attention to the poor décor, inadequate plumbing, lots of things broken or not working, and poor laundry/linen changes. We therefore addressed these issues. The home has a maintenance book and we were told that all staff can either add issues of damage or things that are broken to it, or inform the member of staff with the lead on maintenance. We suggested that a simple dating when the entry is made and another when completed would help to audit progress as we saw three occasions where a request had been made and carried forward from the initial request as the need had not been attended to. The provider noted this fact and spoke of engaging a part time person to deal with maintenance issues. In relation to the staff’s understanding of limited bedding changes the manager confirmed that laundry is changed twice a week or more frequently if necessary. We were told that sometimes residents will only have their own recognisable duvet covers put back on their beds so the washing and drying turnaround is very quick, and staff on later shifts would not be aware a change had been made. The laundry is small and cramped, and lacks a hand wash facility. It is fitted with a commercial dryer and two washing machines. One has a sluice facility. Alcohol gel is provided at various parts of the building for use by all attending the premises. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 22 All items of equipment are serviced regularly by suitably qualified persons and there are service contracts for critical items such as lift, heating boiler, hoists, baths etc. The AQAA provided information on the dates of servicing and tests. The fire log book was checked. Routine fire training to staff is given every three months. Fire fighting equipment and emergency lighting is checked every month. Records of fire alarm checks and fire door releases should be done each week, and normally are, but none had not been recorded since 6th June 09. A false alarm at the home when the Fire Service was called out in January 09 should have been notified to the CQC. We were disappointed to note that a hazard identified during the last key inspection had not been dealt with. The door-latch on the floor leading from the lounge to the garden patio is raised above carpet level and presents a clear tripping hazard. The manager said that residents are always supported by staff in this area, but we emphasised that the floor hazard presents a risk to staff and visitors as well as residents. The provider agreed to attend to this urgently so that people can benefit from using the garden and outside seating and pagoda on sunny days. The back garden is attractively laid out with mature shrubs and colourful plants. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a largely new and caring staff team who need a high level of training and management leadership. EVIDENCE: We learned that the home has experienced a number of staff changes for various reasons recently and a relatively new staff team has been formed. A small number of staff have worked at the home for a few years. There were six staff members on duty at the start of the inspection. These included the manager, cook, housekeeper, senior carer, and two care assistants. The senior carer and two care assistants had all commenced working at Chestnut Court within the last month. The cook was also quite new to the home. One carer lacked a criminal records clearance (CRB) and so was only able to work under supervision. In the afternoon another carer came on duty and she also lacked a CRB clearance and could only work under supervision. The manager acknowledged the huge demand on the home to give new staff a thorough induction and provide mandatory training. On the positive side we noted that the new staff were already registered at colleges on care sandwich courses and were aiming for National Vocational Qualifications (NVQs). One was studying for NVQ Level 4. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 24 We noted from observation that the home upholds the practice of diversity and equality. We discussed the home’s induction with a new carer and we were told it had been conducted over three days. It had been informative and helpful but still left some gaps for them in procedures and processes and understanding all the needs of the residents. The new staff confirmed their desire to learn and expressed a clear appetite for training. In the past the amount of accessible training for staff has been one of the home’s strengths and we discussed the need to bring in this training and staff leadership quickly. We discussed the importance of the manager working at least some time on the floor with the team modelling good practice while they are at a critical learning stage. We sampled four staff recruitment records. They were all available, comprehensively completed and up-to-date. One application form lacked a clear Rehabilitation of Offenders ‘yes’ or ‘no’ declaration; however a clear CRB had been received for this person. Surveys from the eight residents told us that four felt there was ‘always’ staff available when they needed; three felt there ‘usually’ was, and one felt there was ‘sometimes.’ Four felt that the staff listen and act on what they say ‘always’. Three said staff listen and act ‘usually’ and one said ‘sometimes’. Comments include ‘the staff seem to genuinely care,’ ‘all are very kind. I think there is a shortage of staff.’ ‘Cheerfulness of the staff is very good.’ Because of the timing of CQC’s collection of the comment cards, surveys from eight staff were likely to have been completed by staff members who may have left the service recently. However, they told us that four staff felt there was ‘always sufficient staff to meet the needs of all the people who use the service; one felt there was ‘usually’ and three felt there was ‘sometimes’. All felt they had been given a good induction and relevant training and up-to-date information to meet the healthcare needs of the residents and had enough experience, knowledge and support to meet the diverse needs of the residents. They felt that communication channels between the staff work well. Staff comments include ‘I think the home is doing better because the staff members are very cooperative with team building.’ We observed the staff interaction with the residents and they were kind and helpful. Some of the staff members had limited fluency with the English language, or lacked confidence to speak out clearly. We spoke with the manager who acknowledged the importance of clear communication with elderly people who may have poor hearing and confusion/anxiety that comes with dementia. Staff meetings are held every two months to provide training opportunity and a chance for staff to express their perspectives and ideas on the running of the home. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Chestnut Court‘s residents benefit from having a whole-time and experienced registered manager and regular audit and monitoring by the registered person and their representative. The service undertakes internal quality assurance in order to keep people and their belongings safe. They are assured that confidentiality is protected by secure storage of information. Some staff members would benefit from constructive supervision given directly by the manager to raise the level of support and confidence in management leadership. EVIDENCE: Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 26 The certificate of registration was clearly displayed in the entrance and the home is providing a service that meets this and the home’s Statement of Purpose. The registered manager who assisted throughout the inspection has many years of experience in care, mainly in the field of learning disability. This is her first home where she has been registered to manage care for the elderly. She is qualified to NVQ level 4 in Management and Care and she has obtained the Registered Manager’s Award. She has attended the Alzheimer’s Society training in dementia and she expresses a high commitment to training. The registered Company has two other properties in another county that provide care services. The responsible individual attended during the afternoon and we had very positive discussion about the areas where the home has developed its service and where further improvements can be made at Chestnut Court. The AQAA told us that as the home is part of a small group the manager participates in quarterly management meetings/ workshops where other home managers also attend. These meetings foster cross fertilisation of ideas, innovation and knowledge to enable improvement. These are held three or four times per year at out of workplace venues. The provider’s commitment to monitoring the home’s performance and raising the rating of the home has brought about a detailed and rigorous audit visit each month by a specialist who reviews and reports on different aspects of the service. We were told that the provider has recently moved forward with a changed staff structure, removing the role of deputy but providing for three senior carers who can take a lead in different aspects of the care home. This has yet to be fully introduced, depending on the skills of some of the new staff. We discussed internal quality assurance procedures with the provider and viewed records relating to quality assurance. The home processes regular questionnaires, as a result of which there have been changes to the daily routines of the home to accommodate individual preferences on getting up in the morning; going to town, arranging meal for a visiting relative. Throughout the inspection visit a range of records were viewed. As detailed in the relevant sections of this report these were readily available and up-to-date. They were appropriately maintained and stored such that people’s confidentiality could not be compromised. While walking around the home we did not observe any substances hazardous to health inappropriately left around in bathrooms or bedrooms. Alcohol disinfection gel dispensers featured at the entrance and around the home for people to use as needed. We saw from records that not all staff have undertaken all mandatory training including infection control, manual handling Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 27 and safeguarding adults. However, the training matrix supplied by the manager demonstrates that this is organised for each staff member. Confidential surveys received by the eight staff told us that four staff ‘always’ receive enough support and supervision from the manager; one said they ‘usually’ do. However, three said they ‘never’ do. One said, ‘we have good support from the owner and the manager. They provide all the training needed for our job roles.’ Another said ‘we can go and see the manager if we need help and support at any time, and ‘I enjoy working at Chestnut Court.’ However, to the question about what the home does well, one said ‘I cannot think of anything, no support from the manager at any time,’ and another said, ‘unfortunately, nothing comes to mind-no support at any time, no confidentiality within the home.’ We discussed this level of discontent with the provider and the manager who both agreed the importance of a collective team that pulls together and is mutually supportive is an important contributor to positive outcomes for the people who are receiving the service. They agreed to prioritise staff morale and take action over the frustrations identified by staff in the surveyed comments. Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x x x 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 2 3 3 Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13(4) Requirement The registered person must ensure that the route from the lounge to the garden is made free from hazard, and that a ready supply of hot and cold water is available throughout the home so that people are not placed at risk. 2 OP27 18 (1)(a) and 18 (2) The registered person must 30/09/09 ensure that at all times there are suitably competent and experienced persons working at the care home, and that they are appropriately supervised, to ensure a satisfactory level of care is consistently provided. The registered person must ensure that all parts of the home are kept reasonably decorated and well maintained so that people can enjoy a safe and pleasant environment. The registered person must provide individual care plans DS0000011777.V376295.R02.S.doc Timescale for action 31/08/09 3 OP24 23 (2)(d) 31/08/09 4 OP9 13 (2) 30/09/09 Chestnut Court Rest Home Version 5.2 Page 30 on the use of medicine to be taken only as and when needed so that all staff treat this medicine in the same way. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnut Court Rest Home DS0000011777.V376295.R02.S.doc Version 5.2 Page 31 Care Quality Commission The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 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. 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