Care Home: The Chestnuts

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What the care home does well The Chestnuts provides a welcoming, bright, clean and airy home. It has an experienced team of staff who enjoy their work at the home and who were observed to have a good relationship with those living here. The ladies and gentlemen presented as being relaxed and comfortable with staff indicating they feel safe and secure at the home. The ladies and gentlemen access a range of activities, both inside and outside the home. Those spoken with stated that they enjoyed going to sensory sessions, trips into town and visiting local places of interest. The ladies and gentlemen living here feel well supported and encouraged by staff to be involved in all aspects of their daily lives to the best of their ability. The ladies and gentlemen are supported with their personal routines and this support was seen to be offered and carried out with dignity and respect. There are good relationships with other professionals and G.P to ensure up to date assessments, health care, guidelines and equipment is assessed and made available to promote a safe and supportive lifestyle. What has improved since the last inspection? Residents have benefited from new carpeting being fitted to the hallway and stairs. Residents are benefiting from staff development and use of `active support` in their daily lifestyle and activities. Financial commitment has been made by housing association to replace and refurbish the kitchen. CARE HOME ADULTS 18-65 The Chestnuts The Chestnuts Vines Lane Hildenborough Tonbridge Kent TN11 9LT Lead Inspector Lynnette Gajjar Key Unannounced Inspection 19th April 2007 09:37 The Chestnuts DS0000024012.V336714.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 DS0000024012.V336714.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 DS0000024012.V336714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Chestnuts Address 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) The Chestnuts Vines Lane Hildenborough Tonbridge Kent TN11 9LT 01732 834178 F/P 01732 834178 chestnuts@theavenuestrust.co.uk The Avenues Trust Limited Mrs Judy Morgan Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th October 2005 Brief Description of the Service: The Chestnuts provides personal care and accommodation for up to four adults with a learning disability, some of whom may also have a physical disability. Avenues Trust Limited owns the home. The Chestnuts is located in a rural area on the outskirts of Hildenborough (a few miles from Tonbridge) some distance from local shops and other general amenities. The home has four single bedrooms, a kitchen, lounge, dining room and utility room. There is a secluded garden. Car parking is available in a small drive and by the roadside to the front of the house. The home has a vehicle for the benefit of residents. The registered manager is a trained nurse (RNMH) and has completed the Registered Managers’ Award. The home employs care staff, working a roster, which gives 24-hour cover. The current fees ranges are 1067.53 to £1266.87 per week. A copy of the home’s last inspection report is available at the home. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, the first in the year running from April 1st 2006 to March 31st 2007. The visit lasted from 09:37 to 16:00 pm. The Chestnuts currently has four people at the home and no vacancies. The visit was spent talking directly with those living at the home, both privately and collectively, with staff, visiting relatives and the registered manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of those living at the home in the report. Some judgements about quality of life and choices were taken from limited conversation with those living at the home, and much direct observation followed by discussion with care staff, relatives and evidencing records held at the home. A tour of the premises was undertaken, with time spent assessing various records and case tracking. Information was also gathered through a pre inspection questionnaire completed by the manager and ‘Have your say’ questionnaires returned to the Commission. Three questionnaires were returned all stating they were overall satisfied with the service. “(Name) has no real communication skills but we visit weekly and are kept up to date with any care issues.” “Chestnuts provide exceptional care for (name) over and above what is expected.” “Excellent food and comfortable interactive lifestyle” “In the time my (relative) has been at chestnuts, the care given to her has been impeccable & exceptional & I have nothing but praise for the devotion to their jobs which far exceeds the normal call of duty.” “I have witnessed an improvement in my relatives since she has been at chestnuts and I am very happy with the staff and level of care that they give.” “They are considerate of my clients needs and care about her mental /physical needs. Their excellent care has prolonged my clients life and continues to do so.” “They work closely with the family and care management and health at all times.” “The care and support they provide my client cannot be improved on” The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Safer access to the rear garden would be achieved through the assessment and advise from an occupational therapist regarding grab railing to stepped areas, fire doors and ramps, and the, levelling of uneven paths making a large proportion of the garden unsafe for those with limited mobility and wheelchair users. Through the review and refurbishment of current kitchen facilities, this would ensure effective infection control management and cleaning of wooden units, wooden door handles, broken and cracked tiles being replaced, which would guarantee residents a safe and accessible food preparation area and continue to promote personal aspiration and development needs. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 7 Serious consideration should be given to refurbishment of current bathroom facilities, broken tiles, flooring, seals and consideration of a shower facility, this would ensure effective infection control management and cleaning and guarantee residents a safe and accessible bathing area and continue to promote personal aspiration and development needs. Serious consideration should be given to the office and storage space available to staff, office equipment and filing cabinets that are slowing moving into the hallway and dining room and residents communal space. 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 DS0000024012.V336714.R01.S.doc Version 5.2 Page 8 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 DS0000024012.V336714.R01.S.doc Version 5.2 Page 9 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): 1,2,3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and representatives have access to the information needed in making a decision as to whether the home can best meet their needs and personal aspirations. EVIDENCE: A Statement of Purpose and a Residents Guide are available for prospective residents and their representatives. Alternative formats are currently being explored. These give details about the home and the service provided. This is to enable a decision about the suitability of the home for the prospective resident. Residents are helped to understand the information, as it is presented in a suitable format. No new admission has occurred to assess this area fully. However files seen, held joint assessments from health professionals. The Avenues Trust has a detailed admission and discharge procedure to follow if a vacancy did occur. Individual plans seen evidenced that any restrictions on choice, freedom, services or facilities were as a result of risk assessments conducted by the multi-disciplinary team and included the resident where possible. Staff feel well supported by their good relationships with the local community teams learning disability nurses, district nurses and General Practitioners surgery supporting residents in their daily lives. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 10 Resident’s guides seen today contained a written tenancy agreement/contract, which gives the persons’ security and rights of residency to The Chestnuts. This document clearly lays out the tenants and landlord’s rights and responsibilities. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 11 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): 6,7,8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Person centred care plans, and guidelines continue to develop offering good information to ensure consistent support by staff to meet the individual health and social care needs of those living here and to track the care provided. EVIDENCE: Through discussion with staff and assessing two current care plans in detail, it is clear that those living here are given full support and encouragement to maintain personal contact with health and social care professionals, to maintain good standards of health and social care. Due to the complexity of care and communication needs, personal involvement with their care planning can be restricted and requires staff skills and interpretation to ensure those living here are involved at a pace suitable to them. Reviews take place at least six monthly or as and where care needs alter. Photographic, pictorial and object referencing is being explored to aid communication and better understanding by the ladies and gentlemen living here. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 12 Daily writes ups are kept for each person each day, with topics including the time they get up and go to bed, the activities they have taken part in, what they have eaten, GP and other appointments plus other details of their day. Giving good summary of the active care and support given and reciprocated. Interaction between the ladies and gentlemen and staff continues to be good showing genuine respect, friendship and appropriate familiarity with each other. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 13 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): 12,13,14,15,16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The ladies and gentlemen living here are given encouragement and support to make choices about a range of local social and recreational interests at a pace suitable to them. The menus and food provided offers the quality, nutritional value and healthy fresh products. Affording them the right to exercise choice and control over their diet. EVIDENCE: The home helps residents towards the maintenance and development of social and communication skills. Residents are treated as individuals who have different interests and preferences. Opportunities are provided accordingly. Members of staff support residents to become part of the local community and to have access to leisure activities. Residents’ activities and access to the community is recorded in their care plans. The general lifestyle of residents was discussed. Examples of activities offered to residents include Aromatherapy; hand and foot massage and DVDs. Sensory The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 14 equipment is available. The home has it’s own vehicle and outings are organised, such as Hydrotherapy, meals out, cinema and theatre trips, parks and steam trains. One resident enjoys shopping for clothes. Residents are very much part of the local community. Residents are encouraged to maintain relationships with their friends and families. They are able to see their family and friends as often as they want to. Residents’ relatives and friends are invited to join in activities within the home. Residents enjoy privacy in their rooms and staff respect this. Staff talk to residents in a friendly and polite way. Because of their higher dependency needs, residents do not generally have the capacity to undertake household and personal tasks, although staff encourage them to be involved as much as possible using ‘active support’. “The care staff help users make the best of their disabilities and actively encourage them to participate in every day tasks.” Some residents are able to go on holiday, whilst others who don’t have the capacity are offered days out. Some residents have been abroad and plan to do this again this year. Funding is available for holidays, although residents are sometimes asked to contribute if the price is expensive. Residents are encouraged to be as involved in shopping and cooking, as they are able. Staff are aware of residents’ likes and dislikes. Residents’ nutritional needs are monitored and special diets can be provided where necessary. “(Name) is very very limited in her abilities but the staff ensure she lives a happy ad contented life.” The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health, social and personal care needs of those living here are well supported with regular contact with specialists and external professionals. The ladies and gentlemen are treated with genuine respect and dignity by care staff and are protected by good medication procedures. EVIDENCE: Staff are clearly aware as to the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Care plans indicate staff have a good understanding of individual physical and emotional needs. Good practice in relation to medication management and storage is in place. No residents are able to self medicate requiring full staff support in this area. MAR Sheets are clearly written with clear PRN guidelines of administration. All staff has been specialist trained to undertake administering stesolid medication. This is reassessed and monitored six monthly by the community learning disability team. It is strongly recommended that alternative lockable The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 16 refrigerated storage be provided for medication that requires refrigeration away from the homes main food and drink refrigerator accessed by residents. “My client at Chestnuts is in the final stages of dementia and is downs syndrome. It is impossible for her to administer her own medication. They are considerate of my clients needs and care about her mental /physical needs. Their excellent care has prolonged my clients life and continues to do so.” The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. Systems are in place to enable those living and visiting the home to raise concerns or complaints with staff. However not all relatives were familiar with this process. Protection from abuse is promoted through staff training and understanding of actions they may need to take. EVIDENCE: Copies of the complaint procedure are available in the home in formats easily understood by those living there, but also given to relatives at the time of admission. All questionnaires indicated they were aware of the procedure if required to make a complaint. Due to the nature of the service and those living here, using this system can be limiting. Residents were able to indicated through discussion, who they would talk to if they were unhappy about something talking fondly about the deputy manager and her kindness to listen. Residents can also rely on others such as relative/ advocates to identify concerns and raise them on their behalf. The home has not received any formal complaints since the last inspection. I have never had any concerns to raise but any queries/questions asked have been fully responded to. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 18 Staff spoken with continue to showed a good understanding of how to protect and prevent abuse, including reporting under the latest local procedures. There are no current adult protection alerts relating to this home. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 19 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): 24,25,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The ladies and gentlemen live in a clean, comfortable and homely environment, which would be enhanced further by the re-assessment of the garden area to make safe access and meet the assessed needs of those with limited mobility and who are wheelchair users. Refurbishment and decoration of the bathroom and kitchen to promote better food hygiene and effective cleaning management. EVIDENCE: The Chestnuts is a home that has been adapted internal to cater for those with physical care needs a safe, accessible and comfortable home. Rooms are personal to individual tastes and interests. Adaptations and specialist equipment, including an assisted bath, reclining chairs and mobile hoists are provided as, necessary, to meet the personal and physical care needs of the residents. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 20 Staff confirmed that there has been little change in the physical environment of the home since the previous inspection and standards remain good throughout. Some internal decoration is needed where paint is flaking. The ladies and gentlemen have the use of a lounge/dining room that is comfortably furnished and has a TV, video, DVD and music centre. Independence and individuality continue to be promoted within the home, as far as is practicable, and this is evident from the personalising of residents’ rooms, which clearly reflects individual tastes, preferences and interests. Infection control procedures are in place and clearly adhered to and levels of cleanliness and hygiene remain good throughout. Close monitoring of the wooden kitchen units and floor should be undertaken by the housing association and plans to replace seriously considered to offer better infection control and food hygiene management, particularly the units under the sink. Also the communal bathroom tiles are cracked, flooring seals are in need of replacement to promote more effective cleaning. Safer access to the rear garden would be achieved through the assessment and advise from an occupational therapist regarding grab railing to stepped areas, fire doors, ramps and patio and the, levelling of uneven paths making a large proportion of the garden unsafe for those with limited mobility, visual impairment and wheelchair users without staff assistance. Due to the very small sleep-in room and storage space available to staff, office equipment and filing cabinets are slowing moving into the hallway and dining room and should seriously be reviewed by managers. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 21 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): 32,34 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from the support of a confident and skilled staff team. Resulting in good morale and enthusiasm to improve the residents whole quality of life. EVIDENCE: The home continues to encourage and support care staff to completed their NVQ 2 and 3 in care. The home currently has over 50 of care staff holding NVQ 2 or 3 in Care. All staff has undertaken a thorough and comprehensive induction programme including all core training. Detailed training matrix is in place. Many staff is long term serving staff that was transferred under TUPE from local health authority staff. Files seen evidenced appropriate recruitment processes being followed with main records held at head office. Staff feel supported by the registered manager. Care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. There are clear roles and responsibilities to enable a smooth and efficient service being delivered, with good communication between staff. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 22 “ The staff at chestnuts have been in the care service for years and it shows.” “In the time my (relative) has been at chestnuts, the care given to her has been impeccable & exceptional & I have nothing but praise for the devotion to their jobs which far exceeds the normal call of duty. “ The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 23 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents living here have their personal preferences, support and care needs encouraged through the managers open leadership and the promotion of a safe home and working environment. EVIDENCE: Resident’s benefit from a well run home. The manager is a trained nurse (RNMH), has obtained the Registered Managers’ Award and is also a qualified trainer and aroma-therapist. They have extensive experience of managing care for people with learning and physical disabilities. The manager has a rota for working with the direct care of residents and management tasks. It was said that sufficient time was allowed for the management of the home. Residents and staff expressed a high regard for their management approach to the home. Resident’s and relatives continue to feel the registered manager is The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 24 approachable and staff said they felt well supported. Regular quality assurance questionnaires are circulated to residents and relatives. The manager demonstrated through discussion and practice, a very clear understanding of the needs of current residents and current issues. Good financial systems are in place to protect and assist residents with personal monies held by the home. The manager acts an appointee for three residents following discussion with relatives and placing officers who deemed this the most appropriate action. Internal audits are undertaken by the organisation to monitor expenditure. Monitoring health and safety in the home is to a good standard. Equipment is serviced as required to maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. Staff evidenced a clear understanding of accident/incident. The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 3 4 X 5 3 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 4 26 X 27 X 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 3 X The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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. 1 Standard OP30 Regulation 13(3) Requirement Health and Welfare 13(3) The registered manager shall make suitable arrangements to prevent infection and spread of infection at the care home. In that: A full review and assessment to refurbish and replace the bathroom units, cracked tiles, seals around toilet bases, sink and bath to promote better infection control and cleaning of the communally shared facilities. To be completed by timescale date. Timescale for action 30/07/07 The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 27 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 Refer to Standard OP20 Good Practice Recommendations It is strongly recommended that alternative lockable refrigerated storage be provided for medication that requires refrigeration away from the homes main food and drink refrigerator accessed by residents. Serious consideration as to how much office equipment and storage is slowly encroaching into resident communal space; this should be reviewed and addressed. Safer access to the rear garden would be achieved through the assessment and advise from an occupational therapist regarding grab railing to stepped areas, fire doors and ramps, and the, levelling of uneven paths making a large proportion of the garden unsafe for those with limited mobility and wheelchair users. Close monitoring of the wooden kitchen units and floor should be undertaken by the housing association and plans to replace seriously considered to offer better infection control and food hygiene management, particularly the units under the sink. This was stated to be in hand with the Kelsey Housing Association to refurbish in the near future 5 OP30 Advised is sought from infection control unit regarding infection control management and recommendations action taken in the bathroom and kitchen areas. 2. OP24 3. OP29 4. OP30 The Chestnuts DS0000024012.V336714.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Local 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 DS0000024012.V336714.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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