Care Home: Chestnut Lodge

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What the care home does well There are good quality and easy to follow care plans and assessments in place. People have good access to local District Nurses, General Practitioners and specialist health care when required. Staff treat people with dignity and care, respecting their individual choices and preferences and activities are centered around the person`s abilities. There is a varied menu on offer and people are supported to maintain a balanced diet. People should be confident that complaints will be listened to and acted upon. People live in homely, clean and comfortable surroundings. There is a sound management structure in place and good management of people`s finances and health and safety. What has improved since the last inspection? Pre admission assessments are fully completed. People`s health and well being is is well monitored, with records appropriately completed and health professionals contacted as necessary. Daily notes reflect how people choose to spend their time. Medication is appropriately managed, including risk assessments for self medication and reviews sought when necessary. All staff have received training in the safeguarding of vulnerable adults and all mandatory training required. An appropriate staff duty rota has been implemented. What the care home could do better: The full names of all people working at the home should be recorded on the staff rota, to give an accurate record of is on duty and when. Any risk assessments carried out for potential staff members as part of the recruitment process, should be discussed with the individual, recorded in the their file and signed and agreed by them. Key inspection report Care homes for older people Name: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Joanne Pasker     Date: 2 6 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 23 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for 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. 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 Older People Page 3 of 23 Information about the care home Name of care home: Address: Chestnut Lodge 43 Glenwood Road West Moors Ferndown Dorset BH22 0EN 01202892116 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): janetravers@chestnutlodgecare.com Mrs Jane Travers Name of registered manager (if applicable) Mrs Jane Travers Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 10. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Chestnut Lodge is situated in a residential area of West Moors, local shops, churches, pubs and a library are available close by following a level walk. It is a detached property with a pleasant front garden and summerhouse. It is registered to provide residential care only for up to 10 male and female residents over the age of 65yrs.There are 5 bedrooms on the ground floor rooms all of which are single Care Homes for Older People Page 4 of 23 Over 65 10 0 1 1 0 1 2 0 1 0 Brief description of the care home occupancy and most with en suites. On the first floor there are a further 5 bedrooms, 2 of which are double size and communal bathroom facilities.It is privately owned by Mrs Jane Travers, who is also the Registered Manager and manages the home on a day-today basis, together with her son, who is deputy manager. The service aims to provide individualised care to people in a friendly, family atmosphere and tries to encourage residents to continue with the lifestyle and interests they had prior to moving into the home. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that people who use this service experience GOOD quality outcomes. This was a statutory unannounced inspection required in accordance with the Care Standards Act. We looked at information sent by the home before we visited. We spoke to people who live in the home as well as people who work in the home. We also spoke to people who visit the home. During the site visit we looked at a variety of care records to find out how people were being supported, we also observed care in the home. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 23 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into or staying at the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. Evidence: The care files of two people recently admitted to the home were seen. Both contained evidence of pre admission assessments and were comprehensive, providing sufficient details of all care needs. All assessments are carried out by the registered manager or deputy and confirmation given as to whether their assessed needs can be met. The Statement of Purpose and service user guide also give a good account of the services Chestnut Lodge offers. We spoke to both people who had recently moved into the home. They both said they were happy with the pre admission process and felt that the home was suitable for them. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: Two peoples care records were looked at. The plans are clearly based upon the initial information gained during the pre admission process, are person centered and give clear instructions to staff as to how to meet these needs. Appropriate assessments are completed and updated as needs change and all documentation showed evidence of regular reviews. Daily evaluation sheets completed by the staff, demonstrate a good awareness of individuals needs and preferences and record details well, showing how people were spending their day and how their care needs were being met. A clear record is kept of when healthcare professionals visit a person or are involved in their ongoing care and these included GPs, chiropodists, opticians and community mental health nurses. It was clear that the home sought professional advice and treatment when changes or concerns in peoples health needs were noticed. There was also evidence that GP advice had been sought regarding a review of a persons Care Homes for Older People Page 11 of 23 Evidence: prescribed medicine and that this was an on going process. Clear medication records were seen to be kept for each person with details of any allergies noted and no gaps seen in the MAR charts. Medicines and records seen, including the controlled drugs, were safely and appropriately stored and recorded. No person was self administering medicine at the the time of the visit. Staff were aware that anyone who chose to, would need to be appropriately assessed as being able and safe to self administer and that all individual medicines and their effects should be recorded on the risk assessment. Staff observed had good relationships with the people living at the home and were patient and encouraging. There was a calm atmosphere within the home with staff observed chatting with people and providing assistance where needed. Peoples privacy and dignity was also seen to be respected, with staff knocking on bedroom doors and asking permission for us to visit the room. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able to participate in social activities and are given choices to maintain their quality of life. Evidence: Chestnut Lodge is a small, homely residential home and as such, people are encouraged to spend their time as they wish. Some people were seen in their room reading or with visitors, the manager sat with another person encouraging them to knit, whilst a more independent resident had been out for a walk. A bingo game was planned for the afternoon and people spoken with, said they were looking forward to it and the prizes on offer, provided by the home. All people living in the home were spoken with and appeared content, several saying that they were very happy living there and felt well looked after. Visitors spoken with agreed and spoke very highly of the home and staff team. Lunch on the day of the visit was gammon, potatoes, beans and carrots and most people all sat in the dining room together to eat, with a visitor who was also welcomed to join them. Staff are aware of individuals needs with regard to food and drink and were seen to be assisted where needed with specialist diets and drinks. Records seen Care Homes for Older People Page 13 of 23 Evidence: showed that nutritional needs, such as high calorie diets, were clearly identified and gave information on what food and snacks were appropriate. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints procedures make sure that peoples, relatives and representatives Concerns and complaints are listened to and acted upon. A staff team who have a good knowledge of how to respond to any suspicion of abuse and to keep people safe from harm, support the people living at the home. Evidence: The complaints book for the home was seen, with none received since the last inspection visit. All previous complaints had been appropriately recorded and included evidence of investigation, outcome and a copy of response to complainant. No complaints about the home have been received by the Commission since the last report. There have been no safeguarding referrals made since the last key inspection. All staff have now attended training in the Protection of Vulnerable Adults (POVA) and are aware of the different ways vulnerable people are at risk of abuse and how to respond. Certificates were seen in staff files. Staff also indicated they were confident on how to whistle blow and how to report any allegations of abuse. People living in the home were sure who to speak to if they had any concerns or problems and felt that staff were very approachable. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished so that people live in a relaxed, homely and comfortable environment. Evidence: A tour of the premises found the home clean, tidy and well maintained, with no offensive smells. Rooms were seen to be personalised with peoples belongings and bright and fresh. A random inspection carried out on 19 March 2010, found that most of the requirements made in the last key report of January 2010, regarding the environment and health and safety had been met. It was noted during this visit that all bedrooms and bathrooms had appropriate radiator covers and window restrictors in place, except one room that was currently empty. It was discussed with the manager that this will need to be considered if the room is to be occcupied. The manager advised us that all beds have also now been replaced with the larger single size in all rooms. Appropriate infection control measures were seen to be taken around the home, with lidded foot pedal bins and disposable hand towels in bathrooms. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home are protected by robust recruitment practices and supported by a competent and well managed staff team. Evidence: On the day of the inspection there were 8 people living at the home. Two staff are on duty during the day and night to meet the needs of people living at the home. An improved staff rota was seen which now shows staff on duty week by week and identifies the senior person working. However it is recommended that full staff names are written on the rota as an accurate record of who was on duty and when. The recruitment file of one recently recruited staff member were looked at and found to contain all the required documentation, including 2 references and evidence of identity. The staff member had also received a POVA First and enhanced CRB check prior to starting work and detailed interview notes were also kept. It is recommended that any risk assessments made regarding staff following information received during the recruitment process, should be agreed and signed by the staff member and management. The staff training records demonstrated that staff complete an induction programme. Care Homes for Older People Page 17 of 23 Evidence: A detailed training matrix kept, showed that staff had attended mandatory training as required and other specialist training to help them meet the needs of people living at the home. This included training on the Mental Capacity Act. People spoken to in the home, including visitors, felt that staff provided good care and were always available when needed. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a well managed home, centred around their needs, which provides a safe and comfortable environment. Evidence: The registered manager is Mrs Jane Travers, who is a registered nurse and has more than 30 years experience of working in the care sector. She is assisted with the day to day running of the home by her son. All people spoken with, including staff, residents and visitors thought both were very friendly, approachable and that Chestnut Lodge provided a good standard of care. Surveys are sent out annually to people living at the home and their relatives, with returned and completed forms seen from the previous year. Regulation 37 visits are submitted appropriately and regular staff supervision is held, with practical observations being part of this. The finances of two people were sampled and seen to be well managed, with all paper Care Homes for Older People Page 19 of 23 Evidence: receipts kept correctly. Health and safety records were sampled, including the fire safety log and these showed that health and safety matters were well managed. Regular testing of equipment and services was seen and routine maintenance checks well recorded. Staff training in mandatory areas, including fire safety, health and safety, moving and handling, emergency aid, and basic food hygiene, was up to date. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 2 27 29 The full names of all people working at the home should be recorded on the staff rota. Any risk assessments carried out for potential staff members as part of the recruitment process, should be discussed with the individual, recorded in the their file and signed and agreed by them. Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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