Care Home: The Chestnuts

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What the care home does well People living in this home told us they were well cared for by a committed and competent care team. Those residents and visitors who we spoke with were very satisfied with the care, approach of staff and the overall service provided by the home. The management take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. There is a weekly activity programme available that people can choose to join in with and that they said they enjoy. Residents said they enjoy their food, which is fresh, varied, well presented and nutritious using fresh ingredients. There was a system to show regular reviews of care are carried out, which fully involved individuals and their family carers when it was right to do so and wherever possible. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. What has improved since the last inspection? Improvements have taken place in the way the home is managed. This has lead to more people focussed care with the introduction of a key worker for each resident. In addition new care records, policies and procedures have been introduced. The decorative state of the home has improved with the corridors and toilets having been repainted, the front and back lounge redecorated, new armchairs have been provided, the dining room repainted and a large 50-inch television provided. A new weekly activities programme has been introduced to offer more choice and stimulation. The catering service was awarded 4 stars (very good) by North Kesteven District Council in recognition of its catering service. CARE HOMES FOR OLDER PEOPLE The Chestnuts 29 Station Road Ruskington Lincs NG34 9DR Lead Inspector Tobias Payne Unannounced Inspection 22nd April 2008 08:10 X10015.doc Version 1.40 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 DS0000002439.V362863.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 Older People. 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 DS0000002439.V362863.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address 29 Station Road Ruskington Lincs NG34 9DR 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) 01526 832174 Mr George Eric Stafford Mr Graham David Stafford Karen Ann Stafford Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (14) The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP. Mental disorder, excluding learning disability or dementia - Code MD and MD(E) (maximum number of places: 1). The maximum number of residents who can be accommodated is 14. 2. Date of last inspection 26th April 2007 Brief Description of the Service: The Chestnuts Care Home is family owned and has been adapted and extended from a former domestic house to provide the present accommodation. It is situated close to the village of Ruskington, which contains a range of community facilities including shops, Post Office and churches. There are also rail and bus services close by. The home provides personal care for up to 14 people over the age of 65. On the day of the inspection visit the home was fully occupied. It is a detached two-storey building with a stair lift serving the first floor. All the rooms provide single accommodation but none of them are en-suite. Communal rooms consist of 2 separate sitting areas as well as a dining room adjacent to the kitchen. There is a small car parking area to the front of the home with more car parking space at the rear. There is a garden area at the rear of the home. The fees charged by the home for care support on the 22/4/2008 ranged from £365 to £405 each week. Extra charges are made for hairdressing which range from £7 to £26, chiropody £10, personal toiletries and magazines. Newspapers and external activities are included in the fees. Additional information can be obtained from contacting the manager direct. The Chestnuts DS0000002439.V362863.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 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and started at 8.10 a.m. It was done using a review of all the information available to us about The Chestnuts Care Home. The inspection visit itself took place over 4 hours. We spoke with 5 staff members and the manager. We also spoke with 7 residents and 4 visitors to the home. The main method of inspection used on our visit was called “case tracking”. This involved selecting 2 residents and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined the annual quality assurance assessment (AQAA) that was sent to us by the manager before this key inspection. The AQAA is a selfassessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear and detailed. Before making our visit we asked the people who live there to send us comments about the support they receive. We received 6 comment cards. All comments were very positive. During our actual visit we also looked at records, spoke to staff, residents and visitors and walked around the home. What the service does well: People living in this home told us they were well cared for by a committed and competent care team. Those residents and visitors who we spoke with were very satisfied with the care, approach of staff and the overall service provided by the home. The management take care to ensure that each persons needs are assessed before entering the home. The assessment fully involves the resident and their family. There is a weekly activity programme available that people can choose to join in with and that they said they enjoy. Residents said they enjoy their food, which is fresh, varied, well presented and nutritious using fresh ingredients. There was a system to show regular reviews of care are carried out, which fully involved individuals and their family carers when it was right to do so and wherever possible. There was a comprehensive programme of education and training provided for staff, which ensured that staff knew how to care and support the people who live at the home. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 DS0000002439.V362863.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2, 3, 4 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents coming into the home receive an assessment and know their needs can be met. They are also involved in this process. There is information to enable them to make a decision about whether or not to come into the home. EVIDENCE: Since the last inspection the way new residents are assessed had been changed. 2 senior care assistants assessed each residents needs. This helped to ensure a more thorough and person focused assessment took place. This was confirmed by one person we spoke with and the comments we received. A copy of the service user’s guide is given to each new resident. We were also told that the statement of purpose and service user’s guide could be made available in large print. They also sent written confirmation showing that based on the assessment outcome the home could meet the residents’ needs. One person who had just moved into the home told us that “the staff The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 9 came to see me and told me all about the home” and “since coming here I have been very satisfied with the home and feel that my admission was handled well”. Records showed this person’s needs had been fully assessed and staff members we spoke with showed knowledge about their needs. Each person also received detailed and clear terms and conditions so that they knew what support they could expect to receive and how the home is managed. All records and agreements were signed by the individual residents and witnessed by a member of staff. The home does not provide intermediate care. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from being fully involved in identifying their own needs and choices. Clear care plans, created from assessments of need help to ensure that people’s health and welfare needs are fully met. Medication is safely given by staff who know what they are doing. EVIDENCE: Since the last key inspection improvements have continued to the care planning in the home. As part of the inspection process we looked in detail at 2 care plans. There were clear records outlining people’s care and welfare needs. Wherever possible people had been involved in identifying their care needs and being involved in reviews of their care. Care plans were signed by people receiving care to show they agreed with them. The care plans had details of actions and timescales for meeting needs and supporting choices with review dates. The records were clear, detailed and personal. There was a daily contact sheet referring to care needs with a file note to indicate specific issues or changes. A The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 11 new system had been introduced by the manager to enable each resident to give their views about the home, their care and support offered before each monthly review of their care. In addition each resident now had a key worker. There was sufficient information to enable staff to know how to care and support each resident. Residents felt staff knew about their needs and told us they were satisfied with the care and approach of staff. Residents also said they were happy with the way staff cared for them and had confidence in them. Comments received were, “the staff are very kind”, “nothing is too much for them”, “I like all the staff and get on well with them” and “someone is always there if needed”. Staff went about their work promptly, quietly, with humour and with little fuss. Residents’ dignity and privacy were respected through observation of the sensitive way that staff provided care. Staff demonstrated they had been trained to provide support to people with their medication needs and records checked for those who need support were well maintained. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to make choices to take part in a variety of social activities, which ensures that individual, social and cultural needs are met at the home. People choose from and enjoy a well-balanced nutritious diet. EVIDENCE: Since the last inspection a review of the range of activities had taken place and there was now a programme of activities throughout the week. This was on the notice board at the entrance to the home. This showed that Monday there was Tai Chi, Tuesday, hairdresser (which was taking place on the day of our inspection visit), Wednesday, craft afternoon, Thursday, morning gentle exercise, afternoon, classical key board music, Friday, Bingo and Sunday afternoon activities. In addition, there was a communion service the 1st Wednesday of each month and escorted walks around the local village. Residents were encouraged to continue with interests and hobbies. Residents were able to see visitors in their own rooms if they wished. Comments we received included “There were a variety of interests arranged which covered the whole week for those residents who wished to join in”. We The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 13 spoke with 4 visitors who told us about the welcome they received and that they were quite satisfied with the home. There continues to be a set menu with an alternative and the menu was displayed in the dining area of the kitchen. The last inspection by North Kesteven District Council Environment Health Officer was on the 19/2/2008 and as a result of this the home was awarded 4 stars (very good) for its catering standards. The report mentioned that the records were of a high standard with no concerns. We saw lunch being prepared with fresh vegetables and ingredients. Everyone we spoke with had fulsome praise for the food. Comments received included, “he loves his meals and gets good choice and is on a diet”, “food is good and prepared from fresh ingredients with lots of variety. You can request an alternative” and “The Chestnuts is fortunate enough to have a wonderful look, the meals are beautifully cooked and well presented”. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. EVIDENCE: The manager told us about communication at the home. There were visitor’s books and signs requesting visitors to sign in and out. We spoke with 4 visitors who told us they could visit when they wish and always received a friendly welcome and were offered refreshments. No complaints had been received by the home or the commission since the last key inspection. We had been made aware of a safe guarding adult’s investigation carried out and fully concluded by Lincolnshire County Council in November 2007. The manager had fully co-operated with the investigation. Each resident received a copy of the complaints procedure. People told us they knew how to raise concerns if they have them. No resident, visitor or member of staff had any complaints or concerns during our inspection visit. All staff were correctly recruited including a check by the criminal records bureau (CRB). Staff also received adult protection training during their induction and this was expanded in the comprehensive induction standards for all new care workers. Staff confirmed this information and knew what abuse The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 15 was and what they should do if abuse was suspected. They also knew what to do if they received a complaint from a resident. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in well-maintained, comfortable, clean and safe accommodation. EVIDENCE: Since the last key inspection new signage has been provided to the outside of the home, corridors and toilets have been repainted, the front and back lounge has been redecorated, new armchairs provided, the dining room repainted and a new television provided. In addition, a new dishwasher has been purchased for the kitchen area and another one assessed as suitable for washing commodes had been purchased and installed separately. The manager employs a handyman who decorates and helps with the garden. Comments we received on the day of our visit and in comment cards were very complimentary. They included, “in our view the home is always spotless”, and they look after my clothes well and I have a lovely room”. Staff members The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 17 were observed using gloves and aprons to make sure they were providing support in a way, which protected people’s health needs. The home was clean and tidy throughout. Residents told us that they were satisfied with the accommodation and cleanliness of the home. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a safely recruited, well-trained staff team available who have the skills to meet the needs of the people living in the home. EVIDENCE: Many staff had worked in the home for many years. Since the last inspection they had introduced 3 to 4 staff in the morning to allow more time to be spent with the residents. Night care was provided by one member of staff awake and one member of staff who is available if needed at any time during the night. We spoke with residents and visitors and they had no concerns about the availability of staff. Comments received were “I like all the staff and get on well with them”, “someone is always there if needed”, “people are very good and the place is very good” and “I found the home a very friendly and caring establishment. During my stay there I was treated with respect and an abundance of TLC and felt part of the extended family”. The manager kept clear records were available for staff recruitment to show that checks were made before new staff started work. Since the last inspection a new induction process had been introduced. We spoke with a new member of staff. She spoke of receiving a supported induction where she had also shadowed staff and commented, “I really like it here”, “everyone has been very friendly” and “I received a warm welcome”. We spoke with another The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 19 member of staff who told us she “liked working in the home” and found staff “very approachable and supportive”. The manager also told us about training that is provided for staff. Training had included moving and handling, fire prevention, infection control, adult protection, supervision, stress management and equality and diversity. In addition formal training in care has been provided (National Vocational Qualifications). As a result of this, 45 of staff have obtained NVQ level 2, 18 were studying for this and a further 18 waiting to start. In addition 27 had completed NVQ level 3. One member of the management team was to start an NVQ level 4 in the near future. The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35 and 37 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from the positive leadership of the management team. Management records systems show that residents’ health, welfare, safety and choices are promoted. The manager ensures that that residents, relatives and professional visitors have the opportunity to voice their views and opinions. The manager uses feedback from questionnaires to make improvements. EVIDENCE: Since the last inspection changes have taken place to the way the home is run. We registered a new manager in June 2007. She has a management qualification and is studying for a care qualification. The manager is assisted by two senior care assistants one of whom has responsibility for administration The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 21 and the other had responsibility for legal and employment issues. The manager showed us she had introduced new policies and procedures in November 2007. Staff members told us how they are supported and confirmed they received supervision every 6 weeks. Staff members also told us that they felt confident in their roles and residents were full of praise for the staff, care, and the overall services provided by the manager. The manager told us that a quality assurance survey had taken place during the last year and that the issues raised had helped them to maintain and improve services in the way people had asked. A copy of the last survey was displayed on the entrance notice board. The management were in the process of sending out this year’s quality assurance survey. Improvements have also continued to take place with the aid of an outside consultant who had been providing support to the manager. Staff told us about how they had received training about equality and diversity. Throughout our inspection visit no one had any concerns about the staff or the home. Comments were “He spent 2 weeks in the home to see whether he liked The Chestnuts. He loved it”, “he always receives great support”, “The Chestnuts has a relaxed and friendly atmosphere, which I would not really like compromised by greater efficiency though this might be desirable sometimes” and “It’s a lovely home for persons needing the help the Chestnuts can supply”. The Chestnuts DS0000002439.V362863.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 X The Chestnuts DS0000002439.V362863.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. Refer to Standard Good Practice Recommendations The Chestnuts DS0000002439.V362863.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000002439.V362863.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. Re-publishing this information is in breach of the terms of use of that website. 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