Care Home: The Chestnuts

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What the care home does well The Chestnuts provides comfortable and homely accommodation for up to 15 service users with enduring mental health needs. The focus of the service is to provide a relaxed environment whilst enabling residents to develop independent living skills. The home maintains records well in relation to health and safety, recruitment and medication issues. There is also a positive quality assurance programme in operation. The needs of service users are clearly assessed prior to admission to the home. Residents said that they enjoy living at The Chestnuts stating that it is a friendly and comfortable home and that the quality of food is good. The home has established good links with local community metal health teams and reportedly receives good support from care managers and Community Psychiatric Nurses. What has improved since the last inspection? The acting manager has affected a number of changes in the home since coming into post in July 2007. These include moving away from, what were considered to be, institutional practices and promoting alternative activities and a greater emphasis on empowerment. All requirements and recommendations from the previous inspection have been addressed. Service user plans and risk assessments have improved in detail dramatically, although there is still some scope for development in this area. The quality and frequency of staff training, including induction and mandatory courses, has improved. The range of available activities and opportunities for service users has also increased. There are now more staff on duty throughout the week allowing greater flexibility to support residents out in the community. A new computer system has recently been provided by the organisation. What the care home could do better: No requirements and 6 recommendations have been made as a result of this inspection process. Although practices with regard to care planning and risk management have improved, it is advised that these plans and assessments provide more detailed levels of guidance to enable staff to meet the needs of service users. In some circumstances the recording of healthcare information and the outcome of consultations and appointments could be improved. Recruitment application forms should be amended to include a request for a full employment history. The organisation should provide fire safety training through an external and recognised provider on a periodic basis. The acting manager has been in post for approximately 10 months and should now be put forward for registration with the Commission for Social Care Inspection. CARE HOME ADULTS 18-65 The Chestnuts (Welcome House) Watts Avenue (10) Rochester Kent ME1 1RX Lead Inspector Joseph Harris Unannounced Inspection 19th May 2008 10:00 The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts (Welcome House) Address Watts Avenue (10) Rochester Kent ME1 1RX 01634 842084 P/F01634 842084 Lindallewellyn@welcomhouse.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Dr Toqeer Aslam Manager post vacant Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2007 Brief Description of the Service: The Chestnuts provides accommodation for up to 15 people with mental health needs. The home is a large detached property with accommodation over two floors. Communal areas include a large lounge, a dining room and kitchen. There is one double bedroom and the remainder are single occupancy. The home is close to Rochester town centre and has a selection of local shops and services nearby. The current fees for the service at the time of the visit were £580.00 per week. Information on the Home and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection process culminated in a site visit to the home on 19th May 2008. The site visit commenced at approximately 10am and concluded at 3.30pm, lasting for around 5.5 hours. During the course of the visit a tour of the premises was undertaken and discussions were held with the registered manager, staff members and service users. A range of documentation was examined relating to the residents, staff, medication, health and safety and the day-to-day running of the home. What the service does well: What has improved since the last inspection? The acting manager has affected a number of changes in the home since coming into post in July 2007. These include moving away from, what were considered to be, institutional practices and promoting alternative activities and a greater emphasis on empowerment. All requirements and recommendations from the previous inspection have been addressed. Service user plans and risk assessments have improved in detail dramatically, although there is still some scope for development in this area. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 6 The quality and frequency of staff training, including induction and mandatory courses, has improved. The range of available activities and opportunities for service users has also increased. There are now more staff on duty throughout the week allowing greater flexibility to support residents out in the community. A new computer system has recently been provided by the organisation. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. Prospective service user’s needs and aspirations are assessed prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 3 individual service user’s files were examined during the site visit. These included information relating to two people who have recently moved into the home. In all circumstances the home had obtained relevant information from the health and social care services including Care Programme Approach (CPA) care plans and risk assessments. In the majority of cases, following referral the prospective service user is invited to visit the home and is subsequently offered longer stays including overnight visits. The manager completes an inhouse assessment of needs linked to the CPA documentation and following discussion and time spent with the individual. The pre-admission assessments are used to inform the care plan. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. Resident’s needs are assessed and planned for. People who use the service are able to take decisions affecting their daily lives within a risk management framework. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 3 individual service user files were examined during the course of the site visit. In all cases a plan of care had been developed, which was linked to the assessment of needs and CPA documentation. The current manager has developed the systems for planning care and support. Whilst the plans address key areas of need it is advised that guidance and actions to meet assessed needs are developed further. Refer to recommendation 1. This principle also applies to the risk assessments. The home uses organisation-wide tools based on CPA risk management methods. This includes a preliminary risk assessment that identifies significant risks, which are followed up with a detailed risk The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 10 management plan. The manager was advised to ensure that each detailed risk management plan addresses one area of risk and that the guidance to minimise the risk is clearly identified. Refer to recommendation 2. Service users are enabled to make decisions affecting their day-to-day lives and the new manager has done much to expand this area of support. Where restrictions are in place these are discussed with health and social care professionals and the service user to ensure that they are in the best interests of the individual. The home does not act as appointee for any service users. This role, where required is taken on by someone independent of the service. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users have a lifestyle that is suited to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most of the service users currently living in the home are able to access facilities in the local community independently. The number of staff on duty has increased providing an additional 4 hours per day to ensure greater levels of support for residents who need it. A member of staff also visits the home 3 times per week to arrange activities such as hairdressing, nail care, bingo and arts and crafts sessions. The home has established good links with local community mental health resources including a day centre and drop-in centres and the manager has been proactive in helping individuals explore new opportunities. A new drop-in The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 12 centre has recently opened and the manager has referred a number of residents who would like to attend to this service. One resident said that she is now able to go out every day and staff sometimes accompany her. Another resident said, “I’ve started going out a lot more, but I still prefer staying in sometimes.” Visitors are able to visit at reasonable times and there is sufficient space in the house for people to meet in private should they wish to do so. The involvement of residents in menu planning and preparation has also increased. Menus are discussed and altered at resident meetings to suit the individual and collective tastes of the service users and there are more opportunities available to assist with food preparation. Residents spoken to said that the food is of good quality and confirmed that if they don’t like what is on the menu choices are available. Menu records are maintained and suitable food products appropriately stored. The kitchen is domestic in size with all equipment in good working order. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. Service user’s personal support and healthcare needs are met. Medication systems are appropriately managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of service users require minimal assistance with personal support and hygiene needs. Support needs are adequately addressed within individual plans. Residents stated that they are supported in a respectful and dignified way by staff in the home. Healthcare records are maintained and visiting professionals are encouraged to make entries in the notes regarding their visits to the home where possible. It was noted, in one case, that salient information had been omitted regarding the outcomes for some visits/consultation. The manager was advised to crosscheck all entries made by professionals and ensure that there is adequate information entered and any outcomes or actions noted. Refer to recommendation 3. Records are kept to demonstrate that residents maintain The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 14 their physical and complimentary health needs through visits to the GP, optician and dentist, etc. There are policies and procedures relating to medication issues and the home maintains administration records to a good standard including MAR sheets. A record of medication that is returned or destroyed is maintained. All staff receive medication training prior to administering and they also undergo an inhouse competency assessment. The home does not have the facility to store controlled drugs. No controlled drugs are in use and the storage facilities are adequate for the needs of the home. The manager stated that she feels some service users are capable of self-medicating or being assisted to do so. A plan of stepped self-administration was discussed and the manager said that she is keen to empower residents in this area. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. There is a complaints process in place and residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints process in place, which is on display and a copy given to each service user when they move in. Discussions were held with service users who said that they would feel comfortable raising any issues or concerns with staff. It was reported that there have been no complaints since the last inspection. The manager aims to manage concerns and complaints informally in the first instance with reference to formal processes if required. All staff have attended training covering adult protection issues and the mental capacity act, which is also covered at induction. The manager and staff demonstrated a good working knowledge of adult protection processes and what to do if they suspected abuse. Policies and procedures are in place and copies of key documentation including ‘No secrets’ and Kent and Medway adult protection protocols available in the home. It was reported that there have been no safeguarding vulnerable adult alerts since the last inspection. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The home is comfortable and suitable for the needs of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Chestnuts is situated on a residential road near to Rochester town centre. There are good public transport links nearby. Arranged over two floors, the house provides spacious and comfortable accommodation meeting the needs of the service users. The home benefits from a large lounge and a dining room with a reasonably sized garden to the rear. The environment is well decorated and maintained to a good standard with comfortable and homely furniture throughout. There is a piano in the lounge that is regularly played by one of the residents, which has now been tuned. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 17 Toilets and bathrooms are located conveniently throughout the building. All of the residents spoken to stated that they like the home’s environment. One service user said, “It’s a lovely house, I’ve got a nice, big bedroom that I like.” There is one double room,which is unoccupied at the present time. The kitchen and laundry facilities are domestic in size and it was reported that the requirements of the local fire and environmental health departments are met. Policies and procedures are in place relating to the control of infection. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is good. There is a competent and well-trained staff team. Sufficient numbers of staff are on duty at all times. Service users are protected by the recruitment process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussions were held with staff members on duty who all demonstrated a good awareness of the needs of the home and individual service users. 2 members of care staff have recently enrolled on National Vocational Qualification (NVQ) Level 2 in care and 2 other staff have achieved relevant qualifications in excess of this. All staff work through an induction process that incorporates the Common Induction Standards. The home manager underpins the knowledge and skills of the staff team through competency assessment in key areas of care. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 19 The organisation has reviewed the staff training programme and is now providing mandatory training through external providers. Additional training is also provided including medication, adult protection and the mental capacity act amongst other topics. It is advised that the organisation provides periodic fire safety training through a recognised, external training provider to ensure current practice and up dates are communicated. Refer to recommendation 5. Staffing numbers have been increased and there are now 2 staff on duty from 9am to 10pm on weekdays. At weekends an additional 4 hours crossover period between staff has been introduced to enable residents to go out with staff if need be. There is 1 member of staff on duty at all other times and at night a member of the team sleeps-in. 2 staff personnel files were examined during the course of the inspection. All relevant information was in place including evidence of CRB and POVA register checks, two written references and proof of identity. The application for employment form requests the past 10 years of employment history, which should be amended to a full employment history. Refer to recommendation 4. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The home is well run and in the best interests of the service users. The health, safety and welfare of service users is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current manager has been in post since July 2007 having moved from another home in the organisation where she was the deputy manager. The previous registered manager had reached retirement age. It is advised that the acting manager should now apply for registration with the Commission for Social Care Inspection. Refer to recommendation 6. She has completed her Registered Manager’s Award/NVQ 4 at a local college. She has had a positive impact on the home extending the opportunities and promoting the The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 21 independence of the residents and in addressing the previous requirements and recommendations made at the last inspection process. Staff and service users spoke in complementary terms about her influence on the home and it was evident that she has developed good relationships with everyone in the home. The operations director for the organisation has, over the past two years, developed a robust quality assurance programme that include regular visits to the home, managerial supervision, monthly monitoring reports and stakeholder questionnaires. The quality monitoring process has continued to be improved over this period of time and continues to be regularly reviewed and updated. All documents relating to health and safety issues in the home were seen to be up to date and well maintained. Fire safety logs, accident records and service certificates of safety were examined. Environmental fire safety and risk assessments have been completed and are in the process of annual review. Staff receive all required mandatory training and safe working practices are underpinned through policies and procedures and competency assessments. The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA9 YA19 Good Practice Recommendations To continue to develop individual service user plans providing clear guidance to meet assessed needs. To continue to develop risk assessments ensuring that clear guidance to minimise perceived risks is in place. To ensure that healthcare records are accurately completed and provide details of actions and outcomes of consultations. To amend the application for employment form to include a full employment history. To provide fire safety training to all staff periodically through a recognised external training provider. The manager should be put forward for registration with the Commission for Social Care Inspection. YA34 YA35 YA37 The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Chestnuts (Welcome House) DS0000028336.V363305.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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