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Archived: The Chestnuts Nursing and Dementia Care Home

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All reports

Inspection report

Date of Inspection: 18 July 2011
Date of Publication: 29 September 2011
Inspection Report published 29 September 2011 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

While some aspects of peoples’ care and welfare were met, the lack of specialist knowledge, skills and care practices in relation to pressure area care and its management, did not always make it safe for people using the service. Appropriate action must also be taken to effectively manage peoples’ non-compliance with their care packages.

User experience

People told us that they were well-cared for and that the staff were good at meeting their needs. We saw that staff were continuously engaged with people delivering care and support to them. All the relatives we spoke to during the course of our visits were happy with the care, treatment and support that was provided to their loved ones. They also told us that they were involved in the care plan processes of their relations. We saw evidence that referrals were made to various professionals for example the dietician, tissue viability nurse, dentist and the GP to promote peoples’ health and welfare.

Other evidence

We looked in detail at four care plans. Prior to our visit, the local safeguarding authority notified the Commission about concerns relating to three peoples’ care, which we examined. We found that in all cases the care plans were fairly detailed and in most, they reflected peoples’ wide ranging needs. In one case we found that a person was non-compliant with their care plan. We were concerned that a risk assessment was not in place to ensure that risks to the person and others in the home were kept to a minimum. This was particularly important as the person concerned carried a health bug, which required specific actions to make it safe for the individual, staff and other people using services in the home. We spoke to several staff in the home and the manager who had an understanding of the risks involved, but did not set down the risk control measures to keep people safe in the home. Some of the risks were particularly around the person’s behaviour which staff felt powerless to deal with.

We had other concerns with the three other cases we looked at, as it became clear that peoples’ specialist needs were not always met. People that required, effective pressure area care did not always receive it. There were examples where peoples’ food intake and fluid balance charts were not properly maintained. Recordings were inconsistent and values were not tallied and used to evaluate peoples’ nutritional and fluid intake. As a result, the care provided did not always meet peoples’ needs as there was little connection between the monitoring charts and the care plans. Nutritional and fluid monitoring and their provision are key factors in providing good pressure area care, particularly, where people had reduced mobility and in this case some of the people were bed-bound. There was also evidence that turning charts for people were not properly maintained and for people with contractures, there were no clear plans in place to support and manage them. We were also concerned to have found that the issues we identified had not been fully addressed as they were reportedly raised by the tissue viability nurse and the community matron prior to our visit.

We spoke to the manager about the pressure area practices in the home and she informed us that they had started acting on the recommendations made by the tissue viability nurse and the community matron. We were told that the manager and staff did not know how to operate the pressure relieving equipment in the home and that some were found in June 2011, not to be working properly. This placed people in need of pressure area care at risk of coming to harm. The community matron reported that the manager and staff at the home did not always take up training to update their skills and clinical knowledge in the area of good pressure area care. The manager showed us an action plan dated 7/7/2011 which was devised to improve of the quality of their service delivery. Some of the areas identified included; having turning and ‘pressure mattress’ monitoring charts in place, providing training for staff in areas such as pressure management, the use of pressure relieving equipment and wound management.

The provider carried out monthly provider monitoring visits to the service, but we saw little evidence that the clinical aspects of the service provision were being robustly monitored. The manager conducted the bulk of the clinical monitoring in the service and would need to do more to ensure that people received safe and appropriate care at all times. This is important as there was evidence that guidance for involving the tissue viability nurse was not always followed by staff in the home. Staff were not always accurately recording the specifics of pressure area damage to people and so people were not in a position to receive the best possible care and treatment. These areas of concern were not overtly picked up by the manager. We were concerned to have learnt that the manager did not receive clinic