Care Home: Chestnut View Care Home

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What the care home does well Residents are supported in a way that protects their rights to privacy, respect and dignity. Residents are able to make some choices about their daily routines. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. Residents generally live in a safe and well maintained, clean and hygenic environment. Staff in the home were in sufficient numbers on the day of the inspection to support the residents. The recruitment practices of the home support the protection and safety of residents. The health and safety of all persons in the home is promoted through general health and safety checks. What has improved since the last inspection? Written information regarding the services and facilities provided by the home was up to date to provide prospective individuals and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. The admission and assessment procedures have been improved to ensure that prospective residents needs are fully identified to ensure staff have the skills and abilities to meet the individuals needs. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. Residents are generally supported in a way that protects their rights to privacy and dignity. Residents can enjoy and choose from a range of improved activities offered by the home. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. The home has improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely.The improved management of the home ensures the safety and wellbeing of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home and their financial affairs safeguarded. What the care home could do better: Several residents commented that they would like to take more advantage of walking and it has been recommended that the home consider incorporating the services of a physiotherapist in order that residents could benefit from professional support regarding their mobility, self esteem and to promote and maintain independence. The standard of hygiene and safety in a residents private accomodation and the laundry of the home need to be improved. Key inspection report Care homes for older people Name: Address: Chestnut View Care Home Chestnut View Care Home Lion Green Haslemere Surrey GU27 1LD     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: Suzanne Magnier     Date: 0 1 1 0 2 0 0 9 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 36 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) 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 Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Chestnut View Care Home Chestnut View Care Home Lion Green Haslemere Surrey GU27 1LD 01428652622 01428651145 admin@chestnutview.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St Cloud Care Plc Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 60 The registered person may provide the following categories of service only -Care home with Nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home Chestnut View is a large detached property owned and managed by St Cloud Care plc. The service is registered to provide twenty four hour care for up to sixty older people. The home has three floors which provide private accomodation for 28 residential and 20 nursing rooms and a 12 bedded reminiscence unit for individuals with dementia Care Homes for Older People Page 4 of 36 Over 65 0 60 60 0 0 2 0 4 2 0 0 9 Brief description of the care home which also includes a separate enclosed garden for residents to use. All rooms are single occupancy and there are separate lounges and dining areas on each floor, a hairdressing suite, training and meeting rooms, a large laundry area and a spacious and welcoming reception area. There are areas within the home that offer a quiet space where individuals can meet with relatives and friends. The home has well maintained gardens and ample parking arrangements. The property is close to the local town centre and a large supermarket and is within walking distance for those who are able to walk short distances. Care Homes for Older People Page 5 of 36 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 star. This means that the people who use this service experience good quality outcomes. The last inspection of the service was completed on the 2nd April 2009. This inspection of the care home was an unannounced Key Inspection. Ms S Magnier Regulation Inspector carried out the inspection and arrived at the service at 08.00 and left the service at 18.00. As part of the inspection the commission invited an expert by experience from Help the Aged to be part of the visit in order to speak with residents and people visiting the home about their experience of the home. The expert by experience produced a report and the findings have been included within this document. The service was represented by the newly appointed day to day manager, referred to in the report as the person in charge, and the homes Deputy Manager. The inspection Care Homes for Older People Page 6 of 36 was a thorough look at how well the service was meeting the Key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. For the purpose of the report the individuals using the service are referred to as individuals or residents. The person in charge and the operations manager of the home had completed the Annual Quality Assurance Assessment AQAA which had been received by the commission within the timescales set. The information within the AQAA was well recorded and formed part of the inspection process and references from the AQAA have been included within this report. The information contained in this report was gathered from speaking with a number of residents, care staff, visitors and health care professionals during the inspection. The commission received responses to questionaires sent prior to the inspection which included three from residents, two from health care professionals and three from staff. The responses to the questionaires have been included within the report. A tour of the premises was undertaken with the person in charge and documents sampled during the inspection included some residents care plans, daily records, risk assessments, medication procedures, health and safety records, staff training records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the person in charge about the findings of the visit. The commission are not aware of and have not received any current safeguarding vulnerable referrals or concerns or complaints regarding the home. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. The commission have noted that all requirements made during the last inspection in April 2009 have been complied with in order to improve the services to the residents receiving care and accomodation at the home. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? Written information regarding the services and facilities provided by the home was up to date to provide prospective individuals and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. The admission and assessment procedures have been improved to ensure that prospective residents needs are fully identified to ensure staff have the skills and abilities to meet the individuals needs. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. Residents are generally supported in a way that protects their rights to privacy and dignity. Residents can enjoy and choose from a range of improved activities offered by the home. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. The home has improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely. Care Homes for Older People Page 8 of 36 The improved management of the home ensures the safety and wellbeing of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home and their financial affairs safeguarded. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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. Written information regarding the services and facilities provided by the home was up to date to provide prospective individuals and their representatives the appropriate information in order that they could make an informed choice about receiving care and support from the homes staff. The admission and assessment procedures have been improved to ensure that prospective residents needs are identified to ensure staff have the skills and abilities to meet the individuals needs. Intermediate care is not currently offered. Evidence: The homes Statement of Purpose and Service User Guide sampled during the inspection were up to date and contained the required information to inform prospective residents and their representatives about what services and facilities the home offers. Care Homes for Older People Page 11 of 36 Evidence: Residents care plans sampled during the inspection provided evidence to support that the individuals needs had been assessed by a competent member of staff with the ability and qualifications to undertake the assessment. The AQAA confirmed that health needs assessments are always obtained for prospective residents who have been referred through the care management services and following this a pre admission assessment is undertaken prior to the prospective residents admission to the home. If a prospective resident is admitted from hospital a full assessment is requested from the hospital and the person in charge or deputy manager of the home will visit the prospective resident in hospital in order to ensure that the homes staff could meet their care and support needs. The person in charge advised that prospective residents and their representatives are encouraged to visit the home prior to admission. The person in charge advised that improvements had been made to the pre admission assessment documentation which has proved to be successful in ensuring that a prospective residents needs can be met within the home, and has ensured that inappropriate admissions to the home do not occur. As part of the admission process the staff undertake a documented dependency analysis which, in addition to the the initial assessment ensures that the residents needs are monitored and reviewed each month to ensure that the staffing levels in the home are appropriate for the residents current needs. The AQAA advises that a care plan is started on admission and is completed within 7 days, and the second part of the pre-admission assessment is completed within 48 hours of admission. The information gathered through the residents pre admission assessment ensures care plans are person centred and highlights any specialist equipment that may be necessary prior to admission and any specific fears or concerns that the resident may have, which can then be passed to the allocated key worker so that additional emotional support can be given. No intermediate care is currently offered by the home. Care Homes for Older People Page 12 of 36 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. Residents are offered an improved provision of health care and personal support by the home which is more robustly monitored. The care planning system, monitoring of risk assessments and medication procedures of the home have significantly improved to ensure that residents health, safety and wellbeing is robustly promoted. Residents are generally supported in a way that protects their rights to respect, privacy and dignity. Evidence: Six care plans were sampled which related to residents residing in the nursing, residential and reminiscence unit. It was evident whilst sampling the care plans that the documented information was based upon information obtained during the pre admission assessments and the staff assessments of the residents needs. During the previous inspection it was highlighted that staff were finding the new care planning system difficult to use within the nursing unit as the care plans were are more complex than the plans within the residential and reminiscence unit. Whilst sampling two nursing care plans during the inspection it was noted that there had Care Homes for Older People Page 13 of 36 Evidence: been a significant improvement in the care planning recording and the documentation evidenced was clear and concise in recording the residents care needs and the way in which staff should support the resident in their daily life. There was evidence to support that the care plans were kept under review and the daily records stored within the care plans were well recorded to detail the care and support provided to the resident. All of the six care plans were well written and comprehensive and covered the residents activities of daily living through a twenty four hour period. The care plans included how the resident preferred to be addressed, how they liked to receive their care and support, their likes and dislikes, their communication and sensory abilities, their mobility and any mobility aids used, their medication requirements, specialist care being provided, day and night time choices and preferences, dietary requirements and documentation regarding complexities in residents behaviours which may test the service. It was noted that some residents, where possible, or their representatives had signed their care plans to agree with the care and support to be provided by the homes staff. The care plans also included each residents health profile, their nursing and dietary requirements including up to date body weight charts to monitor weight loss or gain, nutritional screening assessments, skin integrity, safe moving and handling procedures, safe use of mobility aids, appropriate written risk assessments and agreements to use bed rails and bumpers, written consent for the use of photographic evidence, wound charts and continence management. The person in charge advised that since the previous inspection the home have introduced a system of mapping to enable a specific need that a resident may have to be tracked throughout the care plan in order to ensure that residents needs are routinely monitored and met. The named nurse and key worker system has been reintroduced which will promote and encourage effective accountability for care planning. Staff confirmed that they had received further training to assist them in being part of the care planning process. There was robust evidence to support that weekly care plan auditing is being undertaken by the person in charge and the deputy manager. There have been improvements which have involved requesting that visiting health care professionals document the support and care they have provided to residents within the residents care plans to ensure continuity of care and good communication within the home. This was evidenced during the inspection as the visiting community dentist and continence advisory nurse were seen to be documenting their Care Homes for Older People Page 14 of 36 Evidence: consultations within residents care plans. The visitors book and care plans sampled confirmed that the home receives regular support from a variety of health care professionals which include weekly visits by the homes general practitioner and consultations from opticians, dentists, chiropodists and district nurses. The homes staff have continued to have professional relationships with visiting health care professionals and the AQAA advises that specific training has been provided to staff for the residents within the residential unit who may have extended care needs. The training has included workshops provided by the Clinical Diabetic Nurse Specialist on the administration of insulin, the continence Advisory Nurse has provided training on catheter care and the District Nurses have provided training on skin care and early detection of pressure areas. Three visiting health care professionals were in the home during the inspection and all spoke favourably of the home and the response by the staff. One professional stated that The home is very pro training and has a good rapport with the doctors, staff take into account the advice given by the professionals and are prompt in reporting when outside support is required. Strong links with the Macmillan service and other outside agencies assisting in the provision for end of life care have been maintained and the person in charge advised that the home have introduced their own End of Life Care Pathway Documentation. The home have purchased their own syringe driver and the registered nurses have been provided with syringe driver training by the visiting Macmillan Nurses. The programme of training in palliative care and dementia care for all staff through a local college remains ongoing in order to ensure that staff have appropriate training to meet the needs of residents in their care. The AQAA identifies that the management team have recognised where more improvements in the homes practice need to improve. These include supporting care staff to be more confident in reporting changes in residents condition to the management of the home, improvement in communication with external agencies and stakeholders regarding individual residents hospital admissions and incidents, improved communication at staff hand overs and an improved working diary needed in residential unit. Written comments received by the commission from two health care professionals stated we always find the staff well organised for our visits with all the information we need at hand. Following the last inspection the owner asked me if I had any concerns and what they were and he explained what he was planning to do to make the Care Homes for Older People Page 15 of 36 Evidence: changes. I still have concerns about catheter care and pressure sores. What the service do well is that they liaise with other services and are starting to plan ward rounds so that there is time to carry out routine reviews and medication reviews. The sampled care plans contained completed risk assessments which had been documented following the identification of hazards in the residents daily life. The risk assessments were well documented and evidenced that they had been reviewed in order to ensure that the measures in place promoted residents independence whilst ensuring their safety and wellbeing. The expert by experience from Help the Aged, who was in the home for three hours and who took part in the inspection in order to speak with residents and people visiting the home about their experience reported that at all times during the inspection, staff were seen to be caring for the residents in a friendly, demonstrative way with positive social interaction. The staff showed courtesy, discretion and respect to residents with good rapport. A resident said, People are very kind we are all friends together. A carer was seen kneeling down to talk to a resident in a wheelchair and spoke kindly and cheerfully. Another carer was overheard saying caringly to a resident, Have you got enough of these, Do you want another one, A nurse who had to attend to a residents personal care, announced herself in a friendly way and closed the door after her. On one occasion, a carer did not knock on a residents door, and she immediately recognised her error and apologised. The carers and the cleaner seemed to have good knowledge of the residents. A carer found a residents glasses tucked down her side saying, X is missing her glasses. She has a lovely smile, dont you, X. The resident, who could not communicate verbally, responded with a big smile. One carer said to a resident, Thats a cheeky smile and the resident beamed. Several carers spoken with showed understanding about dementia. One said, It is important to get to know the clients and what they did prior to coming to the home. One resident used to own a shop and we have little jokes about whether they can get us discount! One carer, when asked about working in all the units of the home said, It helps to work on all floors, so that we can get to know all the residents. One resident said they were supposed to have walking practice every day but didnt. One carer did say, Id agree, theres not enough walking. There was some evidence of some movement with residents walking along corridors and in the enclosed garden off the reminiscence units lounge. Several residents commented that they would like to take more advantage of walking and it has been recommended that the home consider incorporating the services of a physiotherapist in order that residents could benefit from professional support Care Homes for Older People Page 16 of 36 Evidence: regarding their mobility, self esteem and to promote and maintain independence. The home has a medication policy and procedure which includes guidance for the recording , storage, handling, administration and disposal of medicines to ensure the safety and well being of residents receiving medicines in the home. The home continues to be supplied with a monitored medication dosage system. Two medication procedures were observed during the morning and afternoon periods. The two staff members administering medicines were methodical and took time to support residents with their prescribed medicines. The medication administration charts sampled were well documented and contained no gaps in signatures. Each resident had a section within the medication folder which contained their up to date photograph, their known allergies and how they liked to take their medicines. It was confirmed that residents have a right to refuse their medication and that the home promotes residents rights to independence, and where possible, following appropriate risk assessments and signing a disclaimer form residents would be supported to manage their own medication. The staff training matrix sampled during the inspection evidenced that staff receive appropriate training to administer medicines in the home. The registered nurse on duty informed how agency staff, where needed, would administer the medicines following an in house assessment of capability of the homes procedures in order to ensure the safety and well being of the residents. During the inspection it was noted that residents and visitors were addressed in a polite and courteous way by staff and privacy and dignity requirements were highlighted within residents care plans. In general staff were observed to be mindful of residents rights to dignity and respect however it was observed on one occasion that two staff did not seek permission before entering a residents room on the reminiscence unit and proceeded to go through the residents clothing in the chest of drawers without consulting the resident beforehand. This lack of thought was brought to the person in charge attention who has assured the commission that all staff will be reminded of their duty to respect residents rights to respect, privacy and dignity at all times. Care Homes for Older People Page 17 of 36 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. Residents are able to make some choices about their daily routines and enjoy and choose from a range of improved activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. Evidence: The AQAA advises that the home have significantly increased the programme of activities and now provide two activities most days during the week. A second activities organiser has been employed and activities are planned a month in advance and residents are involved in the planning of activities. It was observed that details of forthcoming events were documented and displayed on the notice board in the front hall and other areas of the home including residents bedrooms. Some further improvements were suggested during the inspection which included the activity plans being in larger print displayed on the notice board which could be less cluttered and also reminding staff what activities were going to be held that day in order that they could remind residents during their morning routines. The expert by experience from Help the Aged who was in the home for three hours and who took part in the inspection in order to speak with residents and people Care Homes for Older People Page 18 of 36 Evidence: visiting the home about their experience of the activities provided by the home reported the on the day of the inspection the activities coordinator was coping well considering her assistant was off sick. She was seen to talk with residents on throughout the home and said she makes a determined effort each morning when she arrives to say hello to every resident. Two scheduled activities were carried out during the day of the inspection which were one to ones and a newspaper review which was attended by some 15 residents. This was followed by an impromptu listening to music session. On the day there was also a Communion Service which is held monthly for about 15 residents led and assisted by 3 local church ladies. There is also a monthly church service held alternately by the local Church of England minister and the Methodist Pastor and the Roman Catholic religious sister visits the home regularly. The coordinator advised that she was learning all the time and seeking ideas by looking at various websites and other care homes activities. She said that she sees the residents care plans to see their interests for example gardening which then can be included in activities and individual residents needs are listened to. One resident told the coordinator that she wanted a party so with the help of the coordinator a guest list was drawn up food and drink purchased and a party was held. The coordinator advised that We play darts with a real dart board as the residents dont want the Velcro ones. We have a cocktail hour with a quiz and sherry once a week which the residents love. We do some fund raising and use the money for the residents. Sometimes we go and buy some special cheese for some of the residents which they like. A youth group visits once every three to four months to help with the garden and other activities. Residents go regularly to a Centre opposite the home for various activities such as indoor bowling and bingo. There are also farm visits word games number games and weekly sing a longs which residents enjoy. Birthdays are celebrated with a helium balloon and a cake and card. It was also suggested that music should be played more often in the reminiscence unit. A hairdresser comes in once a fortnight. Residents are encouraged to be independent. One resident uses her wheelchair to go shopping at the supermarket opposite. The coordinator encourages the residents to partake in activities by giving them a monthly handout together with reminding them on the day what activities there are. Future events include a candlelit dinner for families in aid of Help for Heroes, a Christmas evening buffet with a raffle and the Salvation Army and a show Old Winters Tale. The AQAA advises that the activities programme now includes all residents in the home and includes planning activities with external agencies on occasions for the Care Homes for Older People Page 19 of 36 Evidence: residential unit. It has been reported that this has not suited all residents and their representatives within the residential unit but ensures that the home does not operate any practise which is not inclusive and could be viewed as discriminatory to a particular resident group. The person in charge acknowledges that some residents prefer not to take part in organised activities and prefer a quieter approach to life and are offered one to one interaction to provide for their needs, and to respect their wishes. Small quiet rooms that residents can use are available throughout the home if they wish for privacy and all residents can have their own telephone in their rooms upon request. It was observed that visitors to the home were free to come and go and those spoken with during the inspection spoke highly of the trained staff and care staff stating how hard they worked. Visitors advised that the trained staff keep them informed of any changes in their friends or relatives care and condition and that the home offers a good standard of care which has improved over several months. On arrival at the home some residents were having their breakfasts and some were waiting to go into the dining room to have their breakfasts. Residents confirmed that they like to sit and wait in the hallway reception area on the middle floor so they could catch up with each other and have breakfasts together. The residents within the reminiscence unit were sitting at dining tables. Some residents were enjoying a cooked breakfast and some porridge or cereals. It was noted that there had been improvement in the deployment of staff and that three staff were available to support the residents with their meal time. The arrangements of the serving of the breakfast were observed to be difficult for staff with regard to the lack of space for them to manoeuvre in the preparation of the breakfasts and this was addressed with the person in charge during the inspection. Staff were proactive to offer the person in charge some alternative arrangements which were swiftly implemented and which staff stated benefited them during the serving of the midday meal. During the last inspection concern had been raised regarding the dining arrangements for the residents on the reminiscence unit and although there have been some improvements the person in charge and the inspector discussed further improvements which would assist in the mealtimes being more stimulating and meaningful to residents during their mealtimes. The inspector met with the hospitality manager whose responsibility also includes ensuring that the meal service is monitored and a high standard maintained. The expert by experience from Help the Aged, who was in the home for three hours and who took part in the inspection in order to speak with residents and people Care Homes for Older People Page 20 of 36 Evidence: visiting the home about their experience of the meal times and meals provided by the home reported that there are four weekly menus which are displayed on the main notice board in the entrance hall. However the menu did not indicate which was the current week. It was suggested to the home that either a menu board or menus on the tables be displayed so that residents could be reminded what was being served and be a talking point between themselves. The dining room tables were all laid up with table mats and cloth or paper napkins as in the reminiscence unit. Lunch was served promptly at twelve thirty with a carer serving the food from a heated trolley. Residents on one table in the first floor dining room remarked that the food was not hot and that that had happened before. The carer said that the plates were hot and the trolley was at fifty four degrees but maybe that the residents had been served last. It was suggested to the person in charge that consideration be given that serving dishes for the vegetables could be put out for each table for residents to help themselves to promote and maintain independence and support residents to interact and help each other. All residents spoken with enjoyed the food. Lunch was sausages and mash or vegetable flan with brussels sprouts or a ham salad followed by chocolate cheesecake with fresh fruit yogurt or ice cream as options. Comments from residents included Quite nice. Ate as much as I could. I enjoyed the salad. One resident who left their food said they were not really hungry. One resident who ate meals in her room said The meals are quite nice, but not a lot of choice but we can always have an omelet and fresh fruit. There is plenty of meat, beautifully cooked. The food is hot and comes on time. A carer said We try to encourage residents to eat in the dining room. Supper at five thirty was going to be soup, pate and toast or jacket potatoes or omelets. One carer said One resident does not like the pate and toast so she has asked for bread and jam. Care Homes for Older People Page 21 of 36 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. Improved procedures and policies are available in the home to promote the protection of residents from harm and to promote an open culture of raising complaints or concerns about the home. Evidence: The complaints procedure sampled during the inspection was dated and contained information for a person to contact the home and commission regarding any concerns and complaints about the home should they choose to. The AQAA advises that the home have received fifteen complaints over the last twelve months all of which are considered concluded. One complaint, which had been well documented on the complaints log, had been raised since the appointment of new person in charge and which had been concluded swiftly. The person in charge confirmed that any concerns raised by people associated with the home will be addressed promptly in order that complaints do not escalate and the quality assurance processes in the home will assist in identifying any concerns people may have which will be swiftly addressed. The expert by experience from Help the Aged, who was in the home for three hours and who took part in the inspection in order to speak with residents and people visiting the home about their experience of home reported that there were very few complaints from residents spoken to and everyone looked content whether in their bedrooms or in the recreation areas. One resident who was bed bound said, They are very good to me. I dont need anything . Care Homes for Older People Page 22 of 36 Evidence: The home has a copy of the current local authority multi agency procedures for Safeguarding Vulnerable Adults and the staff training matrix sampled indicated that all staff had received safeguarding training. The person in charge of the home confirmed, following the inspection that the home has a whistle blowing policy and procedure which details staff responsibility and duty of care to report any concerns they have regarding the safety and protection of residents in their care. Two staff files of persons newly recruited to the home sampled evidenced that criminal record disclosures had been sought and POVA first checks had been obtained in order to ensure the safety and protection of residents. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents generally live in a safe and well maintained, clean and hygienic environment. The standard of hygiene and safety in a residents private accommodation and the laundry of the home need to be improved. Evidence: During the tour of the premises it was noted that the home was well decorated, clean, had a homely atmosphere and fabric and furnishings in the home were of a high standard. The communal areas, incorporating the front hall and stairs have been redecorated and the home have employed a seasonal gardener, to keep the gardens neat, tidy and accessible for residents and their relatives and friends to use. A hospitality manager has been employed who has added a different dimension to the homes management team and whos responsibility includes overseeing the housekeeping and laundry within the home. It was observed that the hospitality manager engaged with residents and staff in an open and inclusive way and worked a part of the management team in order to improve the services offered to residents. Whilst observing the laundry area of the home and speaking with the hospitality manager it was noted that staff undertake the laundering services in the home which includes the bed linen, towels and residents laundry. The laundry environment was cluttered with baskets of clothes on the floor, washing and drying were in baskets Care Homes for Older People Page 24 of 36 Evidence: ready to be put in the dryers, a clothes rail was full of residents clothes, which the staff advised were waiting for them to be free to distribute to residents in the home. It was observed that the ironing machine for sheets was by the main door which, it was agreed, was not a safe place with regard to staff health and safety when using the machine as staff were seen to come and go through the laundry room as part of their duties. It was noted that the sink in the laundry did not have hot running water and no liquid soap was available as the container was broken, a fire extinguisher was propping a door open, a high shelf above the sink contained a variety of glass vases which were also viewed as hazardous. The commission had received written comments from residents about the home and some residents comments regarding the laundry service they receive stated the laundry service and return of clothing, well, numerous items are never returned despite all items being clearly marked by us. Ive lost many items of clothing and they never get returned. It was observed, whilst touring the premises and meeting with residents that several residents relatives had left notices in their relatives rooms regarding laundry and clothing arrangements with some relatives choosing to do their relatives washing themselves. These concerns were raised with the person in charge and the hospitality manager who advised that some hazards regarding the laundry had been addressed which had included putting a key pad system on the door in order to ensure that residents did not go into the laundry due to the hazards identified, some areas of the laundry had been tidied and new baskets for residents clothes had been purchased. Whilst it is acknowledged that the hospitality manager has made some improvements in the laundry area it has been required that the laundering services of the home be reviewed to meet an acceptable standard of service and the laundry area risk assessed to ensure the safety and well being of staff working in the laundry area. The expert by experience from Help the Aged, who was in the home for three hours and who took part in the inspection in order to speak with residents and people visiting the home about their experience of home reported that in the reminiscence unit several residents were going into each others bedrooms, which happens quite frequently according to a visitor. It was suggested to the person in charge that names and photos of residents should be put on bedroom doors. A visitor stated that the carers in the Unit do not patrol the corridors and rooms enough, to keep an eye on the residents who are in their own rooms and that things go missing and other things appear instead. A sensor mat at the foot of a residents bed had gone missing and that this had been put there, as the resident had fallen several times in the home. These findings were addressed with the person in charge during the inspection and the Care Homes for Older People Page 25 of 36 Evidence: commission have been assured that the matter will be addressed without delay. During the tour of the premises within the reminiscence unit it was observed that one bedroom, which was referred to in the last key inspection in April 2009 still had a malodour and despite the housekeeping and care staffs intervention it was apparent that staff were finding it difficult to address the problem. The person in charge advised that the home had purchased new chemicals which had helped and that aerosols would also be purchased. Following the inspection the commission have been advised that the homes staff are undertaking additional action and offering more support to the resident in a timely way which is monitored and documented within the residents care plan in order to ensure the residents well being. There is a daily cleaning schedule in place and the housekeeping staff were observed to work throughout the day undertaking their tasks in an orderly and safe manner whilst also engaging with residents in a polite and friendly way. The AQAA advises that the home have established a programme of ongoing interior maintenance of residents private accommodation which also includes a carpet replacement scheme and have purchased a new carpet cleaner and two new vacuums. The home has an infection control policy in place and staff are trained and aware in infection control procedures and were observed adhering to infection control measures for example wearing protective clothing, washing their hands and using hand gels to prevent the spread of infection in the home. It was observed that a window restrictor had been disengaged on a window on the top floor of the home and this was brought to the person in charges attention who promptly rectified the issue. The home are reminded that window restrictors must be in place at all times to ensure the safety and well being of residents at all times. Care Homes for Older People Page 26 of 36 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. Staff in the home were in sufficient numbers on the day of the inspection to support the residents. The home has improved the induction, training and development programme for staff to ensure residents needs are met appropriately and safely. The recruitment practices of the home support the protection and safety of residents. Evidence: The home are currently supporting 49 residents and have a total of 48 permanent care staff and 14 ancillary staff. The staff team are a multi cultural workforce and offer residents gender specific care. The staffing numbers on the day of the inspection were observed to be sufficient to meet the current needs of the residents and staff were prompt to support residents who required immediate assistance. The expert by experience from Help the Aged, who was in the home for three hours and who took part in the inspection in order to speak with residents and people visiting the home reported that only one call bell was heard during their visit and was dealt with quickly. A resident had complained that one of their pillows was missing, and a nurse dealt with this during the visit. Another resident complained about the night staff on the evening before the inspection as the resident wanted to go to bed at 9pm after a tiring day, but was left in her night-dress in her chair till 11pm. The resident said, I got very stressed and a bit cold. The resident had been told by a member of the night staff to be patient. The resident Care Homes for Older People Page 27 of 36 Evidence: said, Theres not enough staff thats the trouble. The expert by experience advised that once did they have to bring to the attention of the staff that a resident needed help as the resident was distressed and crying out from behind a bedroom door in the reminiscent unit and did not have the call bell in reach. These matters were discussed with the person in charge during the inspection and the commission have been assured that the matter will be addressed without delay and changes recorded in residents care plans. Residents spoke highly of the staff and how hard they worked. Four written comments received from residents about the staffing levels and staff at the home included that three residents felt that the staff were usually available when they needed them and one stated that only sometimes staff were available. Other comments included that staff were caring and approachable, there was concern regarding the large turnover of staff and lack of continuity, that sometimes the home is a little under staffed for those who need constant care Two staff recruitment files were sampled which evidenced that the home undertakes safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of residents. The person in charge explained that the files would be reviewed with the pending appointment of the administration manager. The person in charge confirmed that all staff, whether existing staff or new to the team, have undertaken the Skills for Care Induction programme which has assisted staff in having a better knowledge and understanding regarding the standard of care they provide and has identified any support needs that staff may have which can be addressed in their support and supervision sessions which also have improved. The staff mandatory training was sampled and discussed and the person in charge confirmed that training matrix was being updated and where gaps have been identified training for staff had been booked. The AQAA advises that 35 staff have achieved their National Vocational Qualification in Level 2 or above. Following the previous inspection staff training, training records, staff appraisal and supervision and the key working and named nurse systems have all been re introduced into the home and all the systems are being regularly monitored in order to ensure staff are well supported in providing a high standard of care for the residents. Care specific training that has taken place since the previous inspection and includes Customer Care, Catheter Care, Diabetic Care and the Administration of Insulin, Administration of Medication, Managing Teams Training, Appraisal and Supervision Care Homes for Older People Page 28 of 36 Evidence: and Safeguarding Vulnerable Adults training. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improved management of the home ensures that the safety and well being of residents is monitored and reviewed regularly. Improved systems are in place to ensure residents are consulted regarding the running of the home and their financial affairs safeguarded. The health and safety of all persons in the home is promoted through general health and safety checks. Evidence: Following the previous inspection the home has undergone a total review and the day to day management of the home has changed. A new person in charge has been appointed, who has been in post for three months and who represented the service during the inspection. As part of the review of the service the commission have been advised that the home is now considered to be operating in accordance with the Companies Policy and Procedures, and the Operations Manager, Company Directors and Finance Controller of the Company have all provided input and support to the person in charge in order to continue the improvement of the service to benefit the care and support the residents receive. Weekly heads of department meetings are Care Homes for Older People Page 30 of 36 Evidence: held to ensure that all areas of the home are reporting back to the person in charge regarding the service provision which will continue to be monitored and improvements sustained. The person in charge has advised the commission that they will be seeking to register with the commission as the registered manager of the home. A new administration manager who is pending appointment will assist with the homes administration tasks in order to ensure that the homes administration is robust. The company have identified that a review of the care staffing roles and responsibilities have been necessary as part of the overall improvement to the service provision. Written comments regarding the home included Overall the care home has good all round general care in relation to my relatives health, hygiene and caring. Overall very pleased. The home is very well run we are kept informed of our relatives progress and the running of the home is of good standard. The home always offer my visitors a coffee and tea and biscuits and most staff are welcoming to my visitors. I am looked after very well generally yet have a language problem sometimes with some staff. Staff written comments about the home included Since our last inspection in April 2009 improvements have been made and as a team all staff continue to work together to bring the standards higher. We now have a new home manager who is leading us in the right direction, all staff are being included in the changes that are taking place and we feel better motivated and morale is improving. the deployment of extra staff throughout the home has given better quality of care to our residents. It has been very difficult for the the new management to come in and take over serious problem areas that have been brought to our attention and its not a job that can be achieved overnight. Much has been done to improve all aspects and although there is still work to be done the staff team, under the recent new management and the morale of the staff has gained momentum. The home undertakes a monthly quality assurance audit which looks at all aspects of the service provided and includes a customer satisfaction survey. From each audit an action plan is documented which details any changes and improvements that need to be made in the home. There was evidence to support that residents, their friends and relatives views and opinions of the home were sought through residents and relatives or representatives meetings to discuss any problems or ideas for improvement. The home are undertaking improvements regarding the self assessment audits carried out in the home and the unannounced Regulation 26 visits have been maintained and Care Homes for Older People Page 31 of 36 Evidence: recorded. Any shortfalls in the quality of the service are noted during the visits so that appropriate action is taken to rectify the shortfalls. The practice of holding monies for residents within the home has, in accordance with company policy now been restricted to the correct level in order to safeguard residents monies. The AQAA advises that security cameras are to be installed at all exit points of the home to combat a series of thefts that had been occurring at the home which have involved the local safeguarding team and local police. The commission have been assured that the home continues to work closely with the community policing in order to prevent recurrence of the the thefts. It was observed during the inspection that all staff maintained the correct procedures that chemicals were stored appropriately and safely under the control of chemicals hazardous to health guidelines. It was noted that fire fighting and moving and handling equipment had been regularly serviced and fire and water temperature safety records had been maintained. As part of the management review of the home the person in charge advised that residents falls are being monitored each month and a falls audit completed. The information is documented regarding the residents health and environment in order to reduce the number of falls and to seek support from health care professionals including referrals to the local falls clinic in order to ensure the safety and well being of residents. Some accident and incident records were sampled which indicated that events which affect the well being and welfare of residents are reported to the commission under the Regulation 37 notifications and the service were reminded of their responsibility to report events without delay. It has been acknowledged by the commission that the review of the service has been a difficult time for the residents and the staff and that the significant improvements made reflect the hard work of the staff at all levels to improve the standard of care and support for the residents at Chestnut View. Care Homes for Older People Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 16 Arrangements must be 04/01/2010 made that the laundering services of the home be reviewed to meet an acceptable standard of service and the laundry area risk assessed to ensure the safety and well being of staff working in the laundry area. In order to ensure that the homes laundering service meets the residents needs and the laundry is a safe place for staff to work in. 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 8 It has been recommended that the home consider incorporating the services of a physiotherapist in order that residents could benefit from professional support regarding their mobility, self esteem and to promote and maintain independence. Page 34 of 36 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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