Care Home: Chestnut Grange Care Home

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What the care home does well Information about the service is made available in a variety of formats such as pictures and graphics, to aid peoples understanding. People are consulted on an ongoing basis about all aspects of their lives at Chestnut Grange and these views are listened to and acted on. People are supported to accessthe local community and to maintain relationships with family and friends as well as develop new friendships. Equality and diversity is recognised and celebrated throughout the service. Staff provide appropriate support to enable people to make choices and take (assessed) risks and staff levels are calculated to afford people as many opportunities to live their chosen lifestyle as possible. The service benefits from an experienced manager who ensures the Health and Safety of people is managed effectively and alongside the staff team, ensures that the service is run in the bestinterests of the people who live there. Staff at Chestnut Grange have achieved an award at the Care Choices Care Excellence ceremony that was held in London in December 2006. The award, `Training and Innovation for Learning Disability` is in recognition of some of the work that is done at Chestnut Grange. It recognises that people who live at the service are supported and encouraged to take on new challenges and if something cannot be achieved in one way, new approaches are explored. Evidence seen at our inspection supports this and identifies that the work continues, to enablepeople to live fulfilling and meaningful lives. What has improved since the last inspection? The service continues to implement the areas of good and excellent practice that were identified at the last key inspection. Constant monitoring of quality and the satisfaction of people living at Chestnut Grange, enables the staff and management team to continue to make improvements and changes in all areas. This means that the service evolves and supports the identified changing needs of the people who live there. What the care home could do better: The service would benefit from having two of the bathrooms re-fitted and decorated. Key inspection report Care homes for adults (18-65 years) Name: Address: Chestnut Grange Care Home Main Street Weston Nottinghamshire NG23 6ST The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Angela Starr Date: 1 0 0 2 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 40 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Chestnut Grange Care Home Main Street Weston Nottinghamshire NG23 6ST 01636821438 01636822642 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) : Voyagecare.com Voyage Ltd care home 10 Number of places (if applicable): Under 65 Over 65 10 0 learning disability Additional conditions: Service Users shall be within category LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 40 A bit about the care home Chestnut Grange is a privately run care home for up to ten adults of both sexes. They are all over the age of 18 years and have with a learning disability and additional special needs. It is a large, detached, Edwardian country home situated in a rural village, surrounded on all sides by gardens. These are well-maintained to provide a secure, attractive outdoor area. In the rear garden, there is a sensory area and decking for eating outside in summer weather. At the front of Care Homes for Adults (18-65 years) Page 5 of 40 the house, a summerhouse is being built, the funds for which were donated. There are no shops or a pub in the village, the nearest being in Tuxford and Sutton-on-Trent. The village boasts a good Chinese restaurant, which the residents use occasionally for a takeaway meal. The Anglican church is used by several of the residents and the vicar calls to visit from time to time. The home has two goodsized vehicles to transport the residents to shops, college, leisure facilities and Care Homes for Adults (18-65 years) Page 6 of 40 entertainments. One is a minibus seating up to nine people, with room to store a wheelchair and the other is a five-seater estate car. The nearest towns for these are Newark and Retford. The home provides all single bedrooms, three of which have their own ensuite toilets and one its own full bathroom. Communally, there is a lounge and an activities lounge, a large dining room, three bathrooms, one of which has a separate shower cubicle, and six toilets. A passenger lift gives access to the upper floor. Inside, the home has Care Homes for Adults (18-65 years) Page 7 of 40 been going through an ongoing decoration programme and is pleasantly decorated. There is car parking for five vehicles to the front of the property. The fees range from £1200 per week and rise according to assessed need. Care Homes for Adults (18-65 years) Page 8 of 40 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 9 of 40 How we did our inspection: This is what the inspector did when they were at the care home The focus of Inspections undertaken by the Care Quality Commission is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We ask managers to fill in a questionnaire called an Annual Quality Assurance Assessment, Page 10 of 40 Care Homes for Adults (18-65 years) which tells us about how well their service provides for the needs of the people who use it and how they intend to improve their service. We received this back from the manager within the required timescale and the form was completed in a satisfactory manner, providing us with information to assist in planning our visit and deciding what areas to look at. We also reviewed all the information we have received about the service since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of Inspection we use is called case tracking which involves us selecting a Care Homes for Adults (18-65 years) Page 11 of 40 number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading their records and asking staff about their needs. We also sent Have Your Say questionnaires to a random selection of people who use the service and some staff members. The information provided in the replies we received, was also a contributory factor in the focus of our inspection visit. We spoke with three members of staff and three people who use the service to form an opinion about the quality of the service being provided. We Care Homes for Adults (18-65 years) Page 12 of 40 read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who use the service. What the care home does well Information about the service is made available in a variety of formats such as pictures and graphics, to aid peoples understanding. People are consulted on an ongoing basis about all aspects of their lives at Chestnut Grange and these views are listened to and acted on. People are supported to access Care Homes for Adults (18-65 years) Page 13 of 40 the local community and to maintain relationships with family and friends as well as develop new friendships. Equality and diversity is recognised and celebrated throughout the service. Staff provide appropriate support to enable people to make choices and take (assessed) risks and staff levels are calculated to afford people as many opportunities to live their chosen lifestyle as possible. The service benefits from an experienced manager who ensures the Health and Safety of people is managed effectively and alongside the staff team, ensures that the service is run in the best Care Homes for Adults (18-65 years) Page 14 of 40 interests of the people who live there. Staff at Chestnut Grange have achieved an award at the Care Choices Care Excellence ceremony that was held in London in December 2006. The award, Training and Innovation for Learning Disability is in recognition of some of the work that is done at Chestnut Grange. It recognises that people who live at the service are supported and encouraged to take on new challenges and if something cannot be achieved in one way, new approaches are explored. Evidence seen at our inspection supports this and identifies that the work continues, to enable Care Homes for Adults (18-65 years) Page 15 of 40 people to live fulfilling and meaningful lives. What has got better from the last inspection The service continues to implement the areas of good and excellent practice that were identified at the last key inspection. Constant monitoring of quality and the satisfaction of people living at Chestnut Grange, enables the staff and management team to continue to make improvements and changes in all areas. This means that the service evolves and supports the identified changing needs of the people who live there. Care Homes for Adults (18-65 years) Page 16 of 40 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Angela Starr CQC East Midlands, Citygate, Gallowgate, Newcastle Upon Tyne. NE1 4PA Care Homes for Adults (18-65 years) Page 17 of 40 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 Adults (18-65 years) Page 18 of 40 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 19 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who want to live at the service have their needs fully assessed over an extended period to ensure that these needs can be met. People are given up to date and accurate information about the service that is provided. Evidence: The written information provided to us by the manager tells us We have a new style of statement of purpose and service user guide which is more easily accesible for service users and we have the Care Quality Commission inspection report and the current Annual Service Review available for anyone who wishes to see them. We received five completed questionnaires from people living at Chestnut Grange and all tell us that people did have the necessary support and information to make a choice about where they live. Questionnaires we received from relatives also state that they felt they were provided with all the information needed to enable them to make an informed choice. Page 20 of 40 Care Homes for Adults (18-65 years) Evidence: Some of the people we spoke with when we visited the service told us that they had felt very involved in choosing to live there. The information we saw that is given to people when they enquire about living at the service, is very informative and is produced in a format which is suitable for the people who would be using the service. We spoke with a Social Worker who was visiting the service at the time of the inspection and he told us that the person he was visiting had moved there from another service and the move has proved to be very positive. The person had been fully assessed by the manager of Chestnut Grange to ensure that their needs could be met. This assessment also considered the compatibility with the people already living at the sevice. Staff we spoke with were all very knowledgable about the people living at Chestnut Grange and their individual needs and aspirations. The manager confirmed that anyone considering moving to the service would have a full pre-admission assessment completed to ensure that their needs could be met and that they would be compatible with the other residents. Anyone considering moving to the service would also have an extended community care assessment completed by a social worker. As part of our case tracking process, we looked at files for three people living at the service and saw that they all had the documents in place to support the above statement. The information was very comprehensive and included detail about each persons expectations and how they would wish to achieve their goals. One person we spoke with told us that they would eventually like to live independently. Care Homes for Adults (18-65 years) Page 21 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in regular reviews of their needs and participate in the development of their support plans. People are supported to make decisions and take risks as part of a chosen independent lifestyle. Evidence: The manager provided us with written information which tells us We have introduced a new style of individual support plan based on an assessment of need. This clearly indicates individual support needs for each person in an easy to follow format that the person has been involved with. Key workers, family (if appropriate) and the local professional teams involved with the person may also take part in this process. This is reviewed at least every six months with identified changing needs agreed and actioned. People are enabled and supported to make decisions in all areas of their lives. We looked at care plans for three people chosen for case tracking and found them to be appropriately detailed providing staff with all the information they need to provide a high level of person centred support. All contained clear evidence of people being involved in Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: the development and people we spoke with were aware of their support plans and what was in them. People told us that they make choices about how they are supported and they decide what they want. One of the completed questionnaires includes the following comment They give me choices and help me. One person we spoke with told us We get lots of choices. Im trying to sort out another college course. All three files contained individual risk assessments as well as generic ones. People told us they do want to do things that may have an element of risk but that is their choice. Examples given were taking holidays abroad and getting involved in activities in the local community. Each care plan had been developed in a format suitable for the individual person. Some contained a lot of pictorial information whilst others had more written down. Peoples personal goals are clearly recorded and as goals are achieved, new ones are identified. These vary in degree from person to person and include such things as caring for pets, attending exercise/dance classes, swimming and a number of other activities in the local community as well as in the home. People told us I love to go out for a walk. I like to go into town with staff, horseriding and swimming. All the support plans we saw had evidence of regular reviews taking place with the person and where appropriate, their relatives. Staff we spoke with were all aware of each persons individual likes and dislikes as well the necessary support required for them to achieve their goals and enjoy the activities of daily living. People also told us that they are involved with any decisions that are made affecting their lives. This is done in the regular meetings that take place and also on a one to one basis where people speak with the staff or managers. Relatives that completed surveys for us tell us My relative is fully cared for in the manner I wish. Staff have a good understanding of their needs and problems. Care Homes for Adults (18-65 years) Page 23 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service experience a fulfilling lifestyle. The staff team are committed to promoting peoples rights and maintaining peoples dignity. Individual goals are identified and achieved and people are enabled to make choices and exercise preference. Evidence: The written information from the manager tells us We provide individual activity planners which are also written using widget symbols so that the service users more easily understand them. People attend local colleges, take part in gardening and vegetable growing at the home. Staff support service users to recycle and be as green as possible. Service users take part in activities linked with the looking good, feeling good initiative and this may include exercise as gentle or as energetic as wanted, or having beauty and makeup sessions with support from the staff either in house or using local amenities. As already mentioned, service users also take part in activities to increase their living skills, and access the community for the local pub or clubs, walks, using the local transport systems and attending local leisure centres, libraries, soft play areas with sensory areas for service users, horse riding, arts and crafts and information Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: sessions in the planning of menus, holidays and any information regarding the health and well-being, including the latest on Swine Flu. We ensure that our rotas are as flexible as possible so that service users can be supported in their chosen activities. We provide the support to access annual holidays of individual choices and/or day trips. We facilitate holidays abroad if requested. We dont have visiting times but encourage and support service users to maintain contact with family and friends, welcoming visitors in private or in a chosen communal area. The files we looked at, including the records of activities, showed us that people are pursuing activities of their choice on a daily basis. The activities are extremely varied and many people are supported on a one to one basis to ensure that their individual requirements and wishes are met. Some of the people living at Chestnut Grange have accessed college courses and have achieved qualifications in their chosen subjects. One person is currently looking at options to attend further college courses with the goal of being independent and earning their own living. The questionnaires tell us that people choose their activities on a daily basis and can usually do what they want to do. People are also supported to go swimming, bowling and a number of other activities outside the home. One person showed us photographs and told us about the holidays they have been on. Staff comments include We provide a wide range of activities and this is important to the people living here. Senior staff and managers make sure that there are enough to staff to enable people to do the activities. Peoples rights and responsibilities are fully supported and evidence of this was seen in the care plans as well as observed at the time of the inspection. On the day of the inspection we saw one person choosing to go out for a walk with a staff member, another person going swimming and we observed a craft session where people were painting masks. We observed people to be happy and occupied throughout our visit. The dining room appears to be the favoured area where people spend time interacting with each other and with the staff. The dining room is spacious and provides a comfortable area for people to enjoy their meals. The menu is varied and is produced in conjunction with the people living at the service. People told us I usually have what I want to eat. I am doing healthy eating because I want to lose some weight. People told us that the food is Great and there is plenty of it. Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: People told us they are included in the meal planning and shopping. Staff we spoke with told us This is a great place to work. We are always out and about, going swimming, to the pub and socialising. Further comments include We support peoples individual needs very well and try to ensure that they are happy in the home environment. Care Homes for Adults (18-65 years) Page 26 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are receiving personal support in the way they prefer and require, and their health care needs are met. Evidence: The written information provided to us by the manager tells us We work with the local health team to provide people with the personal support they require in their preferred way. We meet the physical and health needs of the service user and ensure service users (within their individual capabilities) understand the need for medications and ensure that all service users can access dentists, GPs and chiropodist as required. We ensure that service users are supported to attend appointments with the local CLDT and community nurses. We have provided in depth Keyworker sessions for female service users to agree to cervical screening and providing leaflets for breast care. As part of our case tracking process we looked at support plans for three people and saw that they were developed in a person centred way and the person they related to had been involved. Support plans had been agreed and signed by the person or their representative. People we spoke with were very confident that their wishes had been recorded and were being met where possible. Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: Evidence of health intervention was clear and there were records of involvement from other professionals. e.g. Doctors, specialist teams such as the speech and language therapy service, district nurse intervention, opticians, physiotherapists etc., We saw evidence that peoples emotional needs are also addressed and where possible they are met. People told us that there are regular residents meetings and they feel confident to contribute to these and to raise anything of concern. The manager told us that day to day issues are always dealt with on an individual basis. People told us that if they want to see the Doctor, they ask the staff and an appointment is made. Staff do accompany people for appointments as necessary according to peoples wishes and needs. One person said I need the staff there to explain things to me and help me remember. Another person we spoke with told us that they make their own appointments with their Doctor. Staff will accompany them if asked but they also see the Doctor alone. This person had a good awareness of their medications and chose to administer creams and lotions themselves. The support plan had the relevant risk assessment and consent in place. As part of our case tracking process we looked at the medication administration records for the people chosen. All the records were accurately completed and signed. We also looked at the risk assessments for people to manage their own medications. The storage, ordering and disposal of medication was checked and found to be in order. There are currently no controlled drugs being prescribed for people but there is a suitable storage facility and record book if this changes. Training records showed us that staff have undergone medication training. Staff we spoke with were knowledgable about the medication policies and practices and the importance of clear and accurate record keeping. Care Homes for Adults (18-65 years) Page 28 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service are protected from potential abuse and harm and their views are actively sought, listened to and acted on. Policies and procedures are understood and are followed correctly by the staff team. Evidence: The written information provided by the manager tells us We provide a clear and effective complaints policy and ensure that all service users are aware of its existence and how to use it. Complaints are dealt with in a specified time frame, usually by the manager or the operations manager, dependant upon the nature of the complaint. We have a robust procedure for responding to any suspicion, allegation or evidence of any type of abuse and have a whistle blowing policy. We ensure that staff are provided with appropriate training for any necessary physical intervention. We have a clear recording system for when we support service users with their finances following company procedure, and the Operations Manager audits this monthly. We saw the complaints procedure clearly displayed in a suitable format for the people who use the service. People we spoke with told us that they know how to make a complaint and would always tell someone if they werent happy about anything. I do know how to make a complaint and I definitely would do. Another person said I would tell my keyworker or the manager. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: Staff we spoke with were all knowledgable about the services complaints procedures as well as the Nottinghamshire County Councils Safeguarding Adults and Whistle Blowing policies. As part of our case tracking process we looked at files for three members of staff and also at training records. We saw that all staff have undertaken training in safeguarding. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse of vulnerable people and provides a framework of consistency to protect those individuals at risk. Whistle Blowing is a means for staff to feel supported to report anything of concern that they may witness. Staff were very confident that they would always report anything of concern and would always listen to anyone who was unhappy. Staff we spoke with told us If I ever have any problems or concerns about anything the office is always open. The manager is very good. Relatives told us in the completed questionnaires I have never had to raise any concerns. I do not think they could do anything better. This is an excellent place and I wouldnt wish for my relative to be anywhere else. Regular residents meetings take place to ensure that people have a forum to discuss anything of concern. Advocacy services are made available to anyone who requires this support. People spoken with confirmed this. We looked at the records of complaints and saw that none had been recorded. The manager assured us that this is because anything that is raised as a concern is dealt with immediately, therefore people do not feel they need to complain. The Key worker system also supports people to make any concerns known and enables staff to deal with things as and when they may occur. People spoken with all know who their key workers are and told us that they feel supported with their communication. I have never had to complain. They talk about everything with me. Care Homes for Adults (18-65 years) Page 30 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the needs of the people living there and is well maintained. Evidence: The witten information provided by the manager tells us We provide an accessable, homely, clean, hygienic, safe, well maintained, and comfortable environment to meet individual peoples needs. We provide a home that is well located to access local facilities and transport networks and is fit for purpose. We provide comfortable and fully accessable communal facilities that reflect service users needs and preferences, with aids and adaptions as necessary. We undertook a partial tour of the service and looked at all communal areas and some peoples bedrooms. All areas of the house were clean, comfortable and welcoming. Peoples bedrooms were furnished and decorated with colours and items of their choice making each one individual and personal to the person. The kithcen was large and well fitted with modern appliances providing a lot of space for people to prepare meals. Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: There is a quiet lounge on the top floor which can be used by anyone who wishes, but the main lounge on the ground floor appears to be the favoured room for relaxtion and socialising, along with the dining room. There is another room on the ground floor where people play games, listen to music or relax, away from the television. On the day of the inspection visit we observed that people use all the areas within the home and freely access their own bedrooms at any time of the day, each person having a key for their room. One of the bedrooms has a full en-suite bathroom but the majority of people access the three main bathrooms, one on each floor. Two of the bathrooms are in need of re-furbishment and would benefit from being brought up to the standard of the one bathroom that has been re-fitted. Chestnut Grange is an old, detached, charactful property which provides spacious and homely accommodation. It benefits from a thorough maintenance programme and the decoration is of a high standard throughout most of the rooms. Peoples comments include This is a very nice old house which needs our TLC. We need new bathrooms. Staff made the following comments We need the bathrooms re-done. Apart from that, the home is kept clean and to a very high standard. Two of the bathrooms within the home, let things down. Care Homes for Adults (18-65 years) Page 32 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment practices, training and support for staff are well managed providing good outcomes for people living at the service. The home is run in the best interests of the people living there. Evidence: The written information provided to us by the manager tells us Staff have clear roles and responsibilities. Staff are appropriately trained and qualified and we provide a robust recruitment policy and practice adhering to relevant standards and legislation. All staff are supervised and appraised on a regular basis and we pay staff to attend training. We have a very loyal and consistent core of staff at the service which helps to maintain stability for the servcie users. As part of our case tracking process we looked at files for three members of staff and observed that all relevant and necessary documents were in place. These incuded an enhanced Criminal Record Bureau and Protection of Vulnerable Adults check, a minimum of two written references and proof of identity. Staff we spoke with confirmed that these had been in place before their employment commenced. We were also told by the staff we spoke with that they had a period of induction where all mandatory training was delivered. They worked alongside an experienced member of the Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: staff team until they were competent to work independently. Staff told us that training is always available to cover anything relevant to their work and the records we saw confirmed this. All staff have had mandatory training such as moving and handling, food hygiene, fire safety and Health and Safety. Other training that has been provided has included; Autism Awareness, Non-violent intervention, Medication training, Mental Capacity Act as well as some training to enable staff to gain a better understanding of specific health conditions, such as Epilepsy. Records showed us that staff turnover is very low and this was confirmed by the staff we spoke with who all said how happy they are working at the service. Staff spoken with told us that they receive regular supervision which they find useful and it provides an opportunity for them to identify any training they wish to undertake. We were told This is a brilliant place to work. Its lovely working here. People living here are very happy. I really like it here. I wish I could work more hours. People who live at the service told us I like the staff and they like me. They help me when I am upset.Twinkle died (Guinea pig) and the staff helped me bury her. A relative told us Every member of staff is lovely and wonderful. I thank them for keeping my mind at rest. We looked at the rota and saw that there are always enough staff on duty to provide the necessary support and to take people out on a one to one basis. In January 2007 staff at Chestnut Grange received the Training and Innovation for Learning Disability award at the Care Choices, Care Excellent, ceremony in London. This was in recognition of the staff teams efforts in delivering a high quality service at Chestnut Grange. Care Homes for Adults (18-65 years) Page 34 of 40 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openess and respect. There is an effective quality assurance system to ensure the service runs in the best interests of the people living there. Evidence: The manager completed the Annual Quality Assurance Assessment for us and returned it within the required timescale. It was completed in a thorough manner and provided us with a lot of useful information. This tells us We provide people with a well run home and with an effective manager who respects the individuals rights and ensures that their best interests are safeguarded. Peoples views underpin monthly monitoring and annual service reviews. Policies and procedures are in place to ensure the health, safety and welfare of the people who live at the service and we ensure that record keeping is of a standard required by the regulating body and policies and procedures of the organisation. The manager ensures that staff are led by example, and she is a fundamental part of the team work at the home, understanding and then adjusting as necessary, every role within the home. The manager is fully aware of what is happening in the home and the senior staff are trained to provide the same level of support and care in the absence of a Care Homes for Adults (18-65 years) Page 35 of 40 Evidence: manager. We spoke with the manager and found that she was very knowledgable about all the people who live at the service, all the staff and has established good working relationships with social services, health practioners etc. She has managed Chestnut Grange for five years and has achieved the Registered Managers Award, National Vocational Qualification level 4 and the Learning Disability Qualification. People told us You can always talk to the manager or deputy. The manager or deputy are always available. Day or night if needed. Staff we spoke with all said that they enjoy working at the service and feel supported and listened to by the manager. They told us This is a well run home and run in the best interests of the people who live here People who live at the home told us that they think the home is well run and the manager is very approachable. They told us that they have plenty of opportunities to talk to the manager and they feel confident to make their views known. The quality assurance system used to gather information from people living at the home and their relatives /representatives, is effective and demonstrates that peoples views are always considered. We saw that the evidence is collated and any actions that are identified are planned with a timescale by which they must be achieved. Staff we spoke with told us I have regular supervisions, staff meetings and appraisals. Support and guidance relating to the needs of all clients is given via the manager and training. We complete internal surveys for quality purposes. A relative we spoke with told us I do not think that the service can be bettered. We think this is an excellent service and would not wish for our relative to be anywhere else. We looked at the arrangements for supporting people with their finances and saw that the system is safe and all transactions are carefully documented. The fire log shows that all necessary fire safety testing and fire drills have been carried out. Servicing of equipment including gas and electricity is up to date and there are measures in place for the prevention of Legionella. The accident book was seen and ten had been recorded. The manager assured us that these had been addressed and dealt with appropriately and the recording confirmed this. The manager told us that Health and Safety of staff and people living at the service is of Care Homes for Adults (18-65 years) Page 36 of 40 Evidence: primary importance and records seen by us, support this statement. We receive regulation 37 notices (This is a regulatory process which informs us of any reportable incidents that occur at a service.)where appropriate and evidence seen told us that regulation 26 visits take place. Regulation 26 visits are completed by the registered provider or their representative on a monthly basis as part of their quality monitoring processes. In December 2006 staff at Chestnut Grange were awarded the Training and Innovation for Learning Disability award at the Care Choices Care Excellence ceremony in London. This was in recognition of the staff teams efforts in delivering a high quality service at Chestnut Grange. The manager was recognised for her lead in this as she introduced and led the strategies that enabled this achievement. Care Homes for Adults (18-65 years) Page 37 of 40 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 38 of 40 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 Description 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 Description 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 24 Two of the bathrooms would benefit from re-furbishment to bring them up to the standard of the rest of the house. Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Adults (18-65 years) Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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