Care Home: The Chestnuts

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. People`s health and social care needs are assessed before they move to the home, to ensure they can be met and they have the opportunity to stay at the home for a trial period to see whether they like it. Residents` diverse personal, health and medication needs are met in a manner which protects their dignity, promoting their wellbeing. Each resident has a care plan which is updated regularly and residents said they were happy in the home and that their care needs were met. People can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents` social and nutritional needs. Special diets to meet people`s healthcare or cultural needs are available. There is a programme of activities which residents can choose to join if they wish. Families said they were made to feel welcome at any time. People who live at the home are protected from harm and their concerns are listened to and addressed. There are complaints procedures in place and staff have had training in safeguarding vulnerable people. We have not received any complaints and have not been notified of any safeguarding referrals made to the local authority, which is the lead agency in these matters, since the last inspection. The home is a modern building which is accessible to people with disabilities. All rooms are single and have ensuite facilities. It is well kept and there is an ongoing programme of redecoration. Residents are encouraged to personalise their rooms and many had chosen to do so. People receive care from kind staff in a timely way. Recruitment procedures are thorough, protecting residents from unsuitable carers. The home is well managed in the interest of the residents. What has improved since the last inspection? The activities programmes have improved and better records of people`s life histories and hobbies are kept. More outings have been arranged as the home has access to a minibus and driver. The staffing skill mix has improved with the appointment of senior carers and staff training now includes training in dementia care. What the care home could do better: Residents must have a contract or copy of their terms and conditions to ensure that there is absolute clarity about the terms and conditions of their stay and who is responsible for the fees. Controlled drugs must be stored in a designated CD cupboard which meets the requirements of the Misuse of Drugs Regulations 1973 as amended in 2007. To ensurethat they are stored securely. Care plans should contain detailed information about medication prescribed `as required` including why it has been prescribed and when and how it should be given. To ensure that they are given when a residents needs them. The home should review the infection control procedures to ensure that they are in line with the latest Department of Health`s guidance. Hand washing facilities for staff should be available at the point of care and residents should not share hoist slings. The training programmes must be maintained and all new staff must complete an induction programme if they are to have the knowledge and skills to care for vulnerable people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chestnuts Lavric Road Aylesbury Bucks HP21 8JN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 0 5 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Chestnuts Lavric Road Aylesbury Bucks HP21 8JN 01296414980 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Heritage Care The registered provider is responsible for running the service care home 64 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 0 64 dementia old age, not falling within any other category Additional conditions: 64 0 The maximum number of service users who can be accommodated is: 64 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia - DE Date of last inspection Brief description of the care home The Chestnuts is a purpose built home owned by Heritage Care who have homes nationwide. The home is situated on the Southcourt Estate in the market town of Aylesbury, which has a variety of shops and other amenities. The Chestnuts is registered to accommodate sixty-four service users, thirty-two of whom have dementia care needs. All bedrooms are single, spacious and have en-suite facilities. The home is Care Homes for Older People Page 4 of 28 Brief description of the care home divided into four groups, each with its own lounge, dining room and small kitchen. The home has two passenger lifts and a range of moving and handling equipment. The home has its own mini bus which enables residents to travel to Aylesbury town centre and surrounding areas. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection was on the 31st May 2008 This inspection was conducted over three days and included a review of the information we hold about the service and an unannounced visit to the home of six hours. The key standards for older peoples services were assessed. Information received about the home since the last inspection was taken into account in the planning of the visit. The manager completed an annual quality assurance assessment and questionnaires were sent to the home for distribution to residents, families and staff. Residents were spoken to on the day of the unannounced visit. Discussions took place with the manager, deputy manager, care and ancillary staff. Care Homes for Older People Page 6 of 28 Care practice was observed and the care of a small number of residents was followed through in detail. A tour of the building and examination of records was also undertaken. The homes approach to equality and diversity was considered throughout. The fees at the time of this inspection ranged from £455 to £579 What the care home does well: What has improved since the last inspection? What they could do better: Residents must have a contract or copy of their terms and conditions to ensure that there is absolute clarity about the terms and conditions of their stay and who is responsible for the fees. Controlled drugs must be stored in a designated CD cupboard which meets the requirements of the Misuse of Drugs Regulations 1973 as amended in 2007. To ensure Care Homes for Older People Page 8 of 28 that they are stored securely. Care plans should contain detailed information about medication prescribed as required including why it has been prescribed and when and how it should be given. To ensure that they are given when a residents needs them. The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths guidance. Hand washing facilities for staff should be available at the point of care and residents should not share hoist slings. The training programmes must be maintained and all new staff must complete an induction programme if they are to have the knowledge and skills to care for vulnerable people. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information available and the opportunity to visit the home to help people decide whether they wish to move to the home. Peoples health and social care needs are assessed before they move to the home, to ensure they can be met. Not everyone has a contract or copy of the terms and conditions of their stay, which may lead to a lack of clarity for residents and their families. Evidence: There is information available to prospective residents in the form of a statement of purpose, which describes the services provided by the home and a home brochure. Prospective residents and their families are welcome to visit the home and stay for a trial period before deciding whether the home is for them. The care files of four residents who have moved to the home since the last inspection were checked. They had copies of the care managers assessments where appropriate and had been assessed by the manager or team leader to identify with them their needs and wishes Care Homes for Older People Page 11 of 28 Evidence: for care. The assessment documentation does not have a section to prompt staff to ask about and record peoples cultural needs. There is a section to record peoples faith needs in the financial part of the documentation but little other detail of cultural diversity is recorded. This should be reviewed. The files of three residents were checked at random to see whether they had been given contracts or terms of conditions covering their move to the home. One funded himself and had a contract which both he and the manager had signed. The second was partly funded by the local authority but made a contribution himself. He did not have a contract or terms and conditions of his stay. The third appeared to have been funded initially by the local authority but was now privately funded. He had no contract or terms and conditions in his file. This must be addressed. Residents should have a contract or terms and conditions of their stay irrespective of their funding source. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents diverse personal, health and medication needs are met in a manner which protects their dignity, promoting their wellbeing. The storage of controlled drugs must be reviewed to ensure that they are stored safely in line with the latest legislation. Evidence: The care of four residents was followed through. All had support plans which had been updated regularly with them and with their families. Residents diverse healthcare needs were recognised and recorded. Not all entries to care plans were signed and dated and some of the standard documentation does not have a space for staff to sign and date when they made the assessment or planned the care. This should be addressed. Risk assessment were variable. All had falls risk assessments, one had a moving and handling risk assessment and none had a nutritional risk assessment. All those seen had maintained their weight on moving to the home or put on weight. There was evidence in all the files to show that residents see a general practitioner and other members of the local primary healthcare team regularly and are supported to visit hospital outpatient departments when necessary. Care Homes for Older People Page 13 of 28 Evidence: There are medication policies and procedures in place and the staff spoken to were aware of these. Records are kept of medication delivered and disposed of by the home. Residents individual medication administration records were completed in full and appropriate steps were taken to ensure that supplies were received regularly and new medication started promptly. Appropriate procedures were in place to deal with variable dose medication such as warfarin. All dose changes are faxed to the home to ensure that mistakes are not made. The medication files held generic risk assessments for most medicines although the care plans did not contain individual prn protocols to guide staff as to when and why to offer medication which is not given regularly but only when needed. These should be developed. There is information on our website, www cqc.org.uk, about medication which is prescribed to be taken when required None of the residents managed their own medication at the moment although there are policies and procedures in place to support this if residents wish. The residents spoken to said that they received their medication regularly and were happy for the home to manage this on their behalf. The staff spoken to said that medication was never given covertly. If a resident did not want to take their medication, this would be recorded. If the medication was essential and the resident lacked capacity, the doctor and family would be told and a way forward agreed. Controlled drugs are stored in a medicines trolley attached to the underside of a wall cabinet. This is not in line with the latest guidance on the storage of controlled drugs and must be addressed. The stock levels of controlled drugs were checked and found to be correct. Two people sign when a controlled drug is given although not when controlled drugs were received in the home. This should also be addressed. There is information on our website, www cqc.org.uk, about the safe storage of controlled drugs. Residents said that care staff were discrete and that all care is given in residents rooms. They are addressed by their preferred name and had been supported to maintain their personal hygiene, to wear their own clothes and to have their hair dressed as they wished. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can choose how they spend their day and are supported to take part in activities in the home if they wish. The standard of food is good meeting residents social and nutritional needs. Evidence: Residents spoken to said that they had a choice as to when they got up and when they went they went to bed. There are two activities coordinators in post and they arrange a programme of activities and 1:1 sessions with residents. Most people, although not all, said that there were activities on offer and that they had a choice as to whether they joined in. A number of family members were spoken to and all said that they could visit at any time and were made to feel welcome. They said that they were kept up to date with the relatives needs and were told of any untoward event. The chef is knowledgeable about residents likes and dislikes and said that he can provide menus to meet residents cultural wishes. There is a varied menu and all food Care Homes for Older People Page 15 of 28 Evidence: is home cooked. There is a choice of menus at each meal. Most residents eat in the dining rooms attached to the lounges. These were pleasantly laid with tablecloths, cutlery and glasses and mealtimes were a sociable occasion. Carers were observed to be supporting residents, who could not eat unaided, discretely. The chef was knowledgeable as to whether residents needed special menus on health grounds and provided soft and pureed food for those who had difficulty swallowing. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are protected from harm and their concerns are listened to and addressed. Evidence: There are complaints policies and procedures in place. These are well advertised and there is information in the home about local advocacy services. Those spoken to said that knew how to make a complaint although they had not had occasion to do so. The complaints records were checked and showed that verbal and written complaints are recorded. Some complaints information had been archived and the records of two complaints received since January were in the files. These had been responded to within the timescales set by the companies policy. The response showed that action had been taken to address the concerns. The home has a copy of the local multi agency safeguarding policies and procedures and staff have a received training in safeguarding vulnerable people. There are whistle blowing policies and procedures in place and the staff spoken to said that would have no hesitation in reporting any concerns. The manager said in the annual quality assurance assessment that they have not made any safeguarding referrals since the last inspection. We have not been notified of any safeguarding referrals made to the local authority, which is the lead agency in these matters, since the last inspection. Care Homes for Older People Page 17 of 28 Evidence: Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and homely environment for residents. Measures to minimise the risk to residents of acquired infection are in place although they should be improved if they are to meet the latest guidance from the Department of Health. Evidence: The home was built approximately six years ago and is accessible to people with disabilities. It is set in well maintained gardens. There is an ongoing programme of maintenance and redecoration. All rooms are single and have ensuite facilities. Residents are supported to personalise their rooms with small items of furniture and personal mementos. Many had chosen to do so. The home was clean and tidy on the day of the unannounced visit and there were no offensive odours. There are infection control policies and procedures in place. The laundry is well organised and the washing machines have programmes to deal with soiled linen and clothing. Staff were observed to be wearing protective clothing correctly. There is no soap and paper towels in residents ensuites for the use of staff and visiting professionals. The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths (DH) guidance. Hand washing facilities for staff should be available at the point of care. Further information about infection control is available on our website www.cqc.org.uk and the DH website Care Homes for Older People Page 19 of 28 Evidence: www.dh.gov.uk Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care from kind staff in a timely way. The training programmes must be maintained and all new staff must complete an induction programme if they are to have the knowledge and skills to care for vulnerable people. Recruitment procedures are thorough, protecting residents from unsuitable carers. Evidence: There is a duty rota in place which shows that there are 2 staff members on duty in each 16 bedded unit and 3 in the dementia care units during the day. There is one member of staff in each unit at night and an additional floater. The manager said that she is reviewing staffing levels and skill mix on an ongoing basis and has appointed 2 additional team leaders. She was hoping to fill the remaining vacancies shortly. The atmosphere was relaxed and the residents spoken to said that staff were very kind. They said that they came when they called and that the night staff also came when they rang the bell. There is an ongoing training programme. The manager and deputy manager are in the process of updating the training records. Each member of staff has an individual portfolio which showed the training that they had undertaken. Most staff were up to date with their training in safe working practices. The manager said that she hoped all would be up to date by the end of August 2009. The homes training computer is not functioning at present which means that new staff have not completed Care Homes for Older People Page 21 of 28 Evidence: their induction programme. This must be addressed. All new staff must have an induction programme which meets the skills for care training specification. The manager said that twenty of the forty six carers hold the National Vocational Qualifications in Care at Level 2 or above. The home does not yet meet the standard that fifty per cent of staff hold this qualification. The recruitment files of four members of staff who had started at the home since the last inspection were checked. All had the required documents although not all files had an up to date photograph of the employee. There was evidence of the staff members identity. Criminal Records Bureau disclosures and two references had been sought before the staff member started work. The application form showed the staff members work history and interview records were kept. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed in the interest of the residents. Evidence: The manager has been in post since March 2009. She holds the National Vocational Qualifications in Care and Management at Level 4 and has applied to register with us. She said that she had an open door policy and staff confirmed that she was very approachable. There are regular resident, family and staff meetings. Heritage Care has commissioned a specialist trust The Guidepost Trust to undertake an audit of the care of people with dementia. This will include seeking the views of residents and families as well as staff. Records of untoward events are kept, including accidents and are monitored by the organisation. A manager undertakes a regular visit to the service to monitor the quality of care and a record of these visits is kept. The home does not manage Care Homes for Older People Page 23 of 28 Evidence: residents financial affairs. A small amount of personal allowance may be kept at the home. This is banked separately and individual receipts are given and records kept. There are health and safety policies and procedures in place and health and safety matters are discussed at staff meetings. Maintenance records were up to date and there was evidence that essential safety checks of services and equipment are undertaken. Water temperatures are tested regularly and there are window restrictors to upper floors to reduce the risk to residents of falling. The fire risk assessment had been updated and fire safety checks were made. The training records showed that most staff members had had training in safe working practices, including moving and handling, fire safety and infection control. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 All residents must have a copy of the appropriate contract or terms and conditions of their stay. To ensure that they these are absolutely clear. 31/07/2009 2 9 13 Care plans should contain detailed information about medication prescribed as required including why it has been prescribed and when and how it should be given. To ensure that they are given when a residents needs them. 17/07/2009 3 9 13 Controlled drugs must be stored in a designated CD cupboard which meets the requirements of the Misuse of Drugs Regulations 1973 as amended in 2007. To ensure that they are stored securely. 31/07/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The pre assessment documentation should be reviewed to include greater detail about prospective resident cultural and faith needs. All entries to care plans should be signed and dated. The home should review the infection control procedures to ensure that they are in line with the latest Department of Healths (DH) guidance. Hand washing facilities for staff should be available at the point of care and residents should not share hoist slings. 2 3 7 26 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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