Care Home: The Chestnuts Care Home

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What the care home does well Chestnuts is a small home so residents have the opportunity to get to know each other and the staff well. During the inspection most residents were in the large L-shaped lounge. This overlooks the village green and provides a place for residents to congregate during the day, meet their visitors, and join in the social life of the home. All the residents we spoke to said the food was wholesome and the menu varied. Comments included, `The meat is generally good quality`, and `The foods OK for me.` We also saw that all areas were clean and tidy. Residents and relatives told us this was always the case, and that the cleaner did a good job. What has improved since the last inspection? Staff training is ongoing and in the last three months has included Moving and Handling, Fire Safety, and Catheter Care. A relative told us that one member of staff has been on a course to deal with a residents specific health issue, and then provided in-house training for other staff. The relative said this had been reassuring for the resident in question who felt confident that the home could now care for them properly. What the care home could do better: Better care plans must be put in place for residents whose weight and nutrition needs monitoring. Medical advice must be sought concerning a resident who continually refuses their medication. Activities in the home were limited and mainly consisted of music and movement once a week, and outside entertainment once a month. Following consultation with residents, an improved programme of activities must be put in place. Efforts should be made to improve the way soft diets are prepared and served to make them more attractive to residents. Some items of soft furniture were in a poor state of repair and potentially hazardous to residents. The Registered Persons were instructed to remove these and replace them, where possible, within 24 hours of the inspection. Concerns were raised about staff attitudes in the home. The Registered Persons were instructed to take immediate action to resolve the problem. Not all staff had two satisfactory references in place. This must be addressed so residents are safeguarded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chestnuts Care Home St Peters Road Arnesby Leicestershire LE8 5WJ     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: Kim Cowley     Date: 2 2 0 9 2 0 0 8 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. the things that people have said are important to them: They reflect 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 © (2008) 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.csci.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 Care Home St Peters Road Arnesby Leicestershire LE8 5WJ 01162478672 F/P01162478672 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Priscilla Hazel Squires Type of registration: Number of places registered: Chestnuts (Arnesby) Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Where there are 15 people accommodated in the home within the category of OP, no further persons may be admitted under this category. Date of last inspection Brief description of the care home The Chestnuts is a 15-bedded home for older people situated in the village of Arnesby. The accommodation is a detached period property. On the ground floor there is a large beamed L-shaped lounge and dining room. There are 11 single bedrooms and two doubles on the ground and first floors. The home overlooks Arnesby village green and is close to the local post office. Patio gardens with seating areas surround the home. Weekly buses run through Arnesby to Leicester and Market Harborough. Current fee levels at the home range from #325 to #455 per week depending on care needs. Inspection reports are available at the home, or can be accessed via the CSCI website: www.csci.org.uk. Further information about the home is available from the Registered Manager. Care Homes for Older People Page 4 of 28 Over 65 15 0 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection that included a visit to the home and inspection planning. Prior to the visit, we (throughout the report the use of we indicates the Commission for Social Care Inspection) spent half a day reviewing information relating to the home. During the course of the inspection, which lasted six and a half hours, we checked the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means we looked at the care provided to three residents living at the home by meeting them, talking with the staff Care Homes for Older People Page 6 of 28 who support their care, checking records relating to their health and welfare, and viewing their personal accommodation as well as communal living areas. Other issues relating to the running of the home, including health and safety and management issues, were examined. We also talked to five residents, three relatives, the Manager, Owners representative, and two carers. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 28 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. Residents needs are assessed prior to admission to ensure the home is suitable for them. This judgment has been made using available evidence including a visit to this service. (Standard 3 was inspected.) Evidence: Residents and relatives talked to us about how they chose to come to Chestnuts. One resident said, My daughter chose this home for me, she found out about it from my GP. A relative told us, My relative came for a week first to see if she liked it here. Potential residents and their families/representatives are invited to visit as often as they like to help them decide if the home is right for them. People who are interested in coming to live in the home are assessed by the Manager Care Homes for Older People Page 11 of 28 Evidence: to ensure their needs can be met. We looked at three assessments belonging to the case tracked residents and saw they were clear and detailed, covering all potential areas of need. Staff use these when residents first move in to make sure they get the care they need.We talked to the Manager about the categories of residents admitted to the home. We found out that the home does not admit residents with dementia, but if a resident develops this condition while at Chestnuts efforts are made to keep them for as long as possible, providing their needs can be met. Standard 6 was not inspected, as this home does not provide intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. Not all residents health and personal care needs are documented in their care plans. One residents medication is in need of review. This judgment has been made using available evidence including a visit to this service.(Standards 7, 8, 9, and 10 were inspected.) Evidence: We looked at care plans and found that although some of them are of a good standard, others are in need improvement. Better care plans are needed for residents whose weight and nutrition needs monitoring. Records showed that not all residents are weighed on entering the home, nor is their weight consistently monitored. As a number of Chestnuts residents are at risk of weight loss, a better programme of care is needed, and this must be documented in care plans. All residents should be weighed on admission, and those identified at being at risk of significant weight loss or gain should be weighed regularly. Care Homes for Older People Page 13 of 28 Evidence: This will make it easier for staff and visiting professionals to assess if intervention is needed to improve their nutritional intake. In addition, if residents need assistance with eating and or their food prepared/presented in a particular way, this must also be written in their care plans so staff are clear about what support they need. A concern has been expressed about a member of staff using drag lifts in the home instead of the hoist. This was discussed with the Manager who said she has never seen this happening. She said staff had recent moving and handling training (July 2008) and were aware of the homes no lifting policy. However she agreed to monitor staff to ensure none were using unsafe methods when helping residents to transfer and move about the home. Medication is securely kept and administration records were up to date and showed that all medication given had been properly signed for. Staff are trained in-house by the Manager or Deputy to give out medication. It is recommended that consideration is given to enabling staff to take a certificated course in medication administration, for example the Safe Handling of Medication course available at local colleges. This will help to ensure that they are aware of current good practice in this area. Records showed that one resident (identified at the inspection) continually refuses medication, including tablets that are only effective if taken regularly. The residents GP must be informed, and if necessary a review arranged to ensure that the medication is appropriate and is being properly managed. Standard 10 - please see Staffing. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. Following consultation with residents a programme of activities must be organized. Residents are pleased with the food provided. This judgment has been made using available evidence including a visit to this service.(Standards 12, 13, 14, and 15 were inspected.) Evidence: At present activities in the home are limited and mainly consist of music and movement once a week, and outside entertainment once a month. All the residents, relatives, and staff we talked to agreed that the residents need more to do. Suggestions included quizzes, Scrabble, cards, arts and crafts, walks round the village, reminiscence, floor games, and manicures/hand massages. Following consultation with residents, an improved programme of activities must be put in place. This will help to improve the quality of life for residents living at Chestnuts. The Manager told us that families and friends are encouraged to visit at any time and are usually offered refreshments when they arrive. One relative suggested that, when staff are busy, relatives should be given the facilities to make their own drinks. Care Homes for Older People Page 15 of 28 Evidence: Consideration should be given to this suggestion. All the residents we spoke to said the food was wholesome and the menu varied. Comments included, The meat is generally good quality, and The foods OK for me. One concern was expressed about the presentation of food for residents on a soft diet. We were told that when meals were liquidized, all the separate items were put in together. If items were liquidized separately, meals would appear more attractive and residents would be able to enjoy the different tastes and flavours of their food. Therefore efforts should be made to improve the way soft diets are prepared and served. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. Residents feel able to talk to staff about any concerns they might have, but lack confidence in anything being done to resolve the issues raised. This judgment has been made using available evidence including a visit to the service.(Standards 16 and 18 were inspected.) Evidence: The home has a complaints procedure that is made available to residents and visitors and displayed in the entrance hall. We asked residents and relatives what they would do if they had any concerns. They all said they would tell a member of staff or the Manager. However some felt that although theyd be listened to, they lacked confidence in whether or not anything would be done. This was discussed with the Manager who said she accepted that in some areas it was taking a while for improvements to be made, but she said she has listened to all concerns raised and was working to address them. We have received three complaints about The Chestnuts since the last inspection. They concerned: terms and conditions; moving and handling; personal care; management of challenging behavior; activities; variety and presentation of food; management of the kitchen; numbers of staff and their competence; the cleanliness and security of the Care Homes for Older People Page 17 of 28 Evidence: premises; and fire safety. These were investigated by the Manager and were also followed up at this inspection. These were investigated by the Manager and were also followed up at this inspection. In some areas we found that Standards still havent been met and we have made Requirements because of this see under relevant sections in this report. The home has a safeguarding procedure in place which explains what staff should do if they have concerns about the way a resident is being treated. We discussed safeguarding with the Manager and staff and they were clear about what action to take and who to inform. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. Urgent improvements are needed to the environment to make it safe and homely for residents. This judgment has been made using available evidence including a visit to this service.Standards 19 and 26 were inspected. Evidence: When we toured the premises we saw that some of the homes soft furnishing were in a poor state of repair and potentially hazardous to residents. A settee in the lounge was sagging, providing little or no support to the resident using it. The cushions on it had broken zips from which bin bags which had been used to protect the foam pads inside were protruding. This was unsightly and an affront to residents dignity. In addition an easy chair in the lounge had also sagged, almost to the floor, and another in the reception area had a spring sticking out its seat. This was reported to the Manager who agreed to remove the furniture in question and order replacements. An Immediate Requirement was left to ensure this was done. The kitchen is also in need of improvement as worktops are worn and cupboard doors broken. The Manager said this is due to be refurbished and work will start in the next few weeks. Care Homes for Older People Page 19 of 28 Evidence: All other parts of the home we inspected, including bedrooms, were in a reasonable state of repair and decoration. We also saw that all areas were clean and tidy. Residents and relatives told us this was always the case, and that the cleaner did a good job. 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. Quality in this outcome area is adequate. The Manager has recruited staff without carrying out the necessary checks. Staff attitudes are improving, but action must be taken to ensure all staff are suitable for the job they do. This judgment has been made using available evidence including a visit to this service.(Standards 27, 28, 29, and 30 were inspected.) Evidence: Prior to the inspection concerns were raised with CSCI about staff attitudes in the home. It was alleged that at times staff were congregating in the kitchen and socializing with each other, rather than spending time with the residents. It was also alleged that the poor attitude of one member of staff was causing distress to some residents and relatives. On the day of inspection residents and relatives said there had been some improvements, and that staff were now spending more time with residents in the lounge. However there was still concern about the attitude of a particular member of staff. This was discussed with the Manager who agreed to take immediate action to resolve the problem. Care Homes for Older People Page 21 of 28 Evidence: Recruitment procedures were discussed with the Manager. She told us that all staff are subject to CRB and POVA checks, and references are requested. Staff files were inspected and we found that, since the last inspection, three members of staff had been employed without the necessary two written references in place. The Manager said she had sent off for these references but had not had replies. Instead she had relied on verbal references, obtained by telephone, but had not always kept a record of these. This is unacceptable. All staff must have two written references in place, including one from their previous employer (where applicable). This will help to ensure residents are safeguarded. Staff files should also be audited and a checklist introduced. This will make it easier to determine if staff have the necessary documentation in place. Staff training is ongoing and in the last three months has included Moving and Handling, Fire Safety, and Catheter Care. A relative told us that one member of staff has been on a course to deal with a residents specific health issue, and then provided in-house training for other staff. The relative said this had been reassuring for the resident in question who felt confident that the home could now care for them properly. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. Improvements are needed to the way the home is managed. This judgment has been made using available evidence including a visit to this service.(Standards 31, 33, 35 and 38 were inspected.) Evidence: The Manager has been in post for 14 years. She has competed her NVQ Level 4 Registered Managers Award and NVQ Assessors Award (recognized qualifications for people who run care homes). Since the last inspection she has temporarily been away from the Chestnuts, helping out at one of the Owners other homes. Some residents and relatives said they thought Chestnuts had gone downhill during this time. This inspection also shows a deterioration in the service. The Manager said she is aware of this and is working hard to bring the home back up to standard. The evidence collected at this inspection suggests that, since the last inspection, the Care Homes for Older People Page 23 of 28 Evidence: home has not always been run in the best interests of the residents (see, for example, Staffing). As above, the Manager said she is addressing this issue. She must continue to do this, consulting with residents where appropriate. The Owners representative and the Manager told us that staff at the home do not look after any money for residents. If residents need services like hairdressing, the home will pay and an invoice will then be sent to the resident or their financial representative. This was confirmed by relatives during the inspection. Door wedges seen in some residents bedrooms, although these were not in use during inspection. One relative said they had sometimes seen bedroom doors wedged open, although they were not sure if they were attended or not during these times. This was discussed with Manager who agreed to investigate this issue and liaise with the Fire Department if advice was needed. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) A care plan must be put in place detailing each resident?s identified needs. This will help to ensure all needs are met. 07/10/2007 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 1 19 23 Furniture that is in a poor, unsafe state must be replaced. This will help to ensure the environment is safe and homely for residents. 23/11/2008 2 28 18 Action must be taken to ensure that all staff are suitable for the job they do. This will help to ensure residents are cared for appropriately. 22/10/2008 3 29 18 All staff must have two satisfactory references in place. This will help to ensure the people who live in the home are safeguarded. 22/10/2008 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 7 15 Care plans must include needs relating to weight loss/gain, nutrition, and assistance with eating. This will help to ensure that residents health needs are fully met. 22/11/2008 Care Homes for Older People Page 26 of 28 2 9 13 Medical advice must be sought for the resident who continually refuses their medication. to ensue it is appropriate and being properly managed. This will help to ensure medication is appropriate and is being properly managed. 22/11/2008 3 12 16 Following consultation with residents, an improved programme of activities must be put in place. This will help to improve the quality of life for residents living at Chestnuts. 22/11/2008 4 16 22 All complaints must be fully investigation and action taken to resolve any outstanding issues. This will help to ensure that any problems with the service are addressed. 22/10/2008 5 33 12 Residents must be consulted 22/11/2008 as to how they would like the home to be run. This will help to ensure that residents views are taken in account when decisions about the home are made. 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 15 The way soft diets are prepared and served should be improved to make it more attractive to residents.. Care Homes for Older People Page 27 of 28 Helpline: 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 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 © (2008) 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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