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Archived: The Chestnuts Nursing and Dementia Care Home

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Inspection report

Date of Inspection: 18 July 2011
Date of Publication: 29 September 2011
Inspection Report published 29 September 2011 PDF | 81.68 KB

Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by competent staff.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 18/07/2011 and observed how people were being cared for.

Our judgement

The level and quality of staff supervision including that of the manager is inadequate to ensure that people receive safe and appropriate care at all times.

User experience

We did not ask people directly about the support that staff received in the home. However, most of the comments we received indicated that people felt safe in the home and that their needs were met. We spoke to relatives who also felt that the staff knew what they were doing. Relatives also told us that the manager was seen walking the floor when they visited.

Other evidence

We spoke to staff about the support they received in the home. They told us that the manager was very supportive and that they could approach her. They told us that they received supervision and appraisals from their manager. We saw that the manager, who does not have a deputy, carried out all the supervision and appraisals for a staff compliment of around fifty. The manager showed us records of three-monthly supervisions that were carried out with staff and there was evidence that appraisals were also carried out with them. There was little evidence that clinical issues were addressed as a matter of course, in these meetings.

More importantly, the manager told us that she received no formal supervision or indeed clinical supervision and so it wais difficult to see how she would develop and lead the team to clinical excellence. One example of this was where she informed us that she was not familiar with the operations of the pressure relieving equipment in the home. The impact of this meant that people requiring pressure area care were not receiving the best possible care in the home. There was little evidence to show that this concern was identified internally for improvement. This meant that people were put at risk of receiving unsafe and/or inappropriate care.

We looked at the training records of the staff and saw that training was regularly provided to all levels of staff. What was unclear was the mechanism for ensuring that staff were applying their knowledge to their practice. This was an issue that the provider and manager needed to address. We saw at least two examples in which staff had training in end-of-life care and the Mental Capacity Act, without actually transferring what they gained to their practice. In speaking with staff they had some knowledge of the two areas identified. There was a training plan set out for the year on most of the key areas that were relevant to the service provision. There were some gaps in peoples’ knowledge relating to ‘managing people with contractures’, which we were told were now being addressed. Improvements are required to this outcome.