Inspection on 14/05/09 for Tree Tops Nursing Home

This is the latest available inspection report for this service, carried out on 14th May 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tree Tops Nursing Home 18/12/06

Tree Tops Nursing Home 20/06/06

Tree Tops Nursing Home 13/10/05

Tree Tops Nursing Home 27/04/05

Tree Tops Nursing Home 11/11/04

Tree Tops Nursing Home 22/04/04

Tree Tops Nursing Home 21/01/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Tree Tops Nursing Home 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD Lead Inspector Anne Prankitt Key Unannounced Inspection 14th May 2009 09:00 DS0000028018.V375433.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tree Tops Nursing Home Address 12 Ryndleside Northstead Manor Drive Scarborough North Yorkshire YO12 6AD 01723 372729 F/P 01723 372729 tree_topsnursing@btinternet.com 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) Complete Care Homes Ltd Mrs Susan Madeline Woodcock Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD, maximum number of places: 24 2. Dementia - Code DE, maximum number of places: 24 The maximum number of service users who can be accommodated is: 24 22nd May 2007 Date of last inspection Brief Description of the Service: Tree Tops is a care home providing nursing care and accommodation for up to twenty four people with dementia and/or a mental disorder. It is a detached house located in a residential area of the seaside town of Scarborough. The amenities and the facilities of the town centre are a short distance from the home and there is easy access to local transport. There are single and double bedrooms over three floors and access to the upper floors is by either the stairs or a passenger lift. There is ramped and level access to and around the home. There is a garden area at the front. Parking is available on the road side. The home has a brochure that is given to people thinking of moving to the home, and their families, containing information about the services it has to offer. On the 14 May 2009, the general manager told us that the weekly fees range from £489 to £565.50. Additional charges are made for hairdressing, chiropody, toiletries and newspapers. The home will provide a copy of the most recent inspection report to anyone who wants a copy of it. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 5 Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards sent to ten people living at Tree Tops, all of which were returned. However, these indicated that people had found it difficult to complete many of the questions. Four were returned from staff, and three from health professionals. A site visit to the home carried out by one inspector which took place on 14 May 2009, and which lasted approximately eight hours. • • During the site visit, we spent time with several people who live at the home, although it was sometimes difficult to find out by conversation what their views were about the home, and whether they liked it. We therefore watched care practices where appropriate, and spent time observing the general activity, to get a better idea what it is like to live there. We also looked at three people’s care plans, some staff records, and some health and safety information. The visit to the home was unannounced, and it was the registered manager’s day off. But the deputy manager and general manager were available, and feedback was given to the general manager at the end of the site visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People’s needs are assessed before they are offered a place to live at Tree Tops, to make sure that these can be met when they move in. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 7 People have good care plans, which describe in an individual way their needs. This helps staff to identify that one person’s needs are very different to the next. Staff treat people with respect and good humour, and show interest in them. People are offered activities to match their interests, or based on what staff have learnt they enjoy. There are a range of activities to help make life more interesting, and one day different to the next. People’s families and friends are welcomed into the home so social links with those who are important to them are maintained. People’s welfare, and complaints about their care, are taken seriously, and action is taken to put things right. The home is warm and comfortable. There are three sitting areas to choose from, which are all different to look at, and which make the environment more interesting. Staff get a range of training so they know what good care is, and how it should be provided. The management want to make changes at the home to benefit those who live there. What has improved since the last inspection? What they could do better: People’s care plans could always include clear information about how they are to be assisted to move, and what equipment staff should use when helping them. This would help to make sure that this is always done in a safe and consistent way. Some improvements could be made to the way the medication is managed for people to make sure that the records are always correct, and to be able to confirm that people have received what they are prescribed. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 8 Although staff know that they must report abuse they may witness, they could be reminded about the role of the local authority, to whom they may go if for any reason they cannot report directly to the management. This would ensure that their concerns are always passed on to the right people quickly. Staff supervision could be more structured and could better reflect their previous practice, so that they are supported in providing a good, consistent service to 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 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. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. People get a good assessment to check the home will be the right place for them to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A senior member of staff always goes to assess people to see what their needs are, before a place is offered to them. Information is also collected from other professionals who have already been involved in their care. This could be information from the hospital, or from the person’s care manager. All of this information is used to decide whether Tree Tops will be a suitable place for the person to receive their care, and before a place is offered to them. The written assessment completed by the home, which contains good information, is shared with staff before the person arrives. This means they have the chance to see what the person’s needs are before they are admitted. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 11 This helps to make sure that the person gets the right care in a consistent way as soon as they arrive. Everyone thinking of moving to Tree Tops is given information in a brochure which tells them about what the home provides. This helps people who are unable to visit, because there are pictures in the brochure which show what the home looks like. They are also given a copy of the service users’ guide, which gives them more detailed information. A copy of this guide is kept in people’s rooms, so they and their family can refer to it whenever they wish. Before deciding whether they would like to live there, people can visit the home if they would like to. A visitor explained that they had done this, and that they had purposely called at a time when staff were not expecting them. They said that staff were very welcoming when they arrived, and had been ever since their relative moved to Tree Tops. The home does not provide intermediate care. Therefore Standard six is not applicable. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. People get good care from a staff team who understand their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People have good care plans which cover their physical, social and psychological needs. The way they are written centres around the person. This makes them very individual, and highlights the fact that the needs of one person are very different from the next. For instance, when describing how one individual communicates, they had written ‘will use facial expressions to indicate discomfort’. Hen asked about the care, a relative said ‘Brilliant – no concerns’. Another said ‘The staff are great’. They said that they had confidence in them. Staff review the care plans on a monthly basis, or more regularly if the person’s needs change. This means that the plans give good up to date information about the person. This makes it more likely that staff following the plan will work in a consistent way which reflects the individual’s current needs. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 13 The majority of staff asked agreed that they are ‘always’ or ‘usually’ given up to date info about people’s needs. A visitor said they always get asked to help staff review their relative’s care plan, and that they attend when they can. This is good, because it keeps relatives involved. They were confident anyway that staff ‘get the care right’, and that they are ‘very good’. There are assessments completed to check whether any areas of a person’s care exposes them to unnecessary risk, which staff might be able to minimise. This includes assessments to check the risk from falls, from pressure damage to their skin, and from poor nutrition. Where risk had been identified, action had been taken to try to reduce this risk. For instance, special mattresses to protect people’s skin, and referral to the dietician for advice where people were at risk from malnutrition. One risk assessment did not say how often an individual should be helped to change position whilst in bed. Nor how this is to be done. This needs to be written down as the bed is not well positioned in the room. However staff were consistent when asked how they managed this bit of the person’s care. The care plans also explained when and for what reason staff had called health professionals, such as their doctor, the chiropodist, and the nurse assessor. This shows that staff seek advice when they need help to maintain people’s health. Although they were not available to look at, people have also had an assessment done in conjunction with the local authority, to decide whether they are able to make decisions to keep them safe, or whether staff will need to make these on their behalf. This will help to make sure that people’s liberty is not deprived in areas where they can still make independent decisions and choices. People were free to move around the home throughout the day. Staff were present in each of the communal areas so that they could discreetly check that people were not coming to harm. This meant that they had the opportunity to chat to people, which people enjoyed. Staff spoke to people with respect and good humour. The atmosphere was very relaxed and people seemed to respond well to the warmth that staff showed them. A relative confirmed that the home always had a ‘friendly atmosphere’. It is difficult to ask the views of the people who live at the home, as many find it difficult to express these. Therefore staff need to have a very good understanding about what they are. A visitor commented that people were always ‘smiling’ when they arrived. They said ‘people wouldn’t smile if they weren’t happy’. A staff member said ‘I feel our staff do their best to keep the independence and dignity of our residents and offer support to them and their families’. People have been assessed as being unable to look after their own medication. Therefore trained nurses, who have also completed training in the safe handling of medication, do this on their behalf. One staff member oversees the Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 14 medication, and is responsible for ordering it each month. They also do a weekly check to make sure that it has been properly managed by staff. This is good practice, because it means that any errors can be picked up on quickly and put right. The records were generally well kept, and the storage arrangements were appropriate. The following matters were brought to the general manager’s attention though: • One newly admitted person had a hand written medication completed by staff. This was not clear enough. It did not include whether the medication was liquid or tablet form, it did not include the dose to be given, and it had not been checked, countersigned and dated by another staff member to check there were no errors. This was put right on the day of the site visit once brought to staff’s attention. Staff need to sign when they have applied prescribed creams for people. This keeps the records up to date, and gives the doctor a better idea on review about how often the creams have been needed, and how effective they have been. This is also the case where supplement meals have been prescribed. • Staff often have to make decisions on behalf of people about whether they need medication which their doctor has ordered to be given ‘when required’, because these people sometimes do not have the capacity to tell staff, for instance, when they are in pain. The care plans should clearly explain to staff what signs to look for, which will alert them that such medication may be needed. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. People’s social needs are considered an important part of their care. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There are a range of activities for people to join, and which are provided by two activities organisers, Monday to Friday. These do include some group activities, although the activities organiser spoken with said that these were sometimes not as successful as one to one activities. Although the activities are planned ahead, she has found that having a more flexible approach is better. For instance, on the day of the site visit, because it was nice weather, she took some people to Peasholme Green to feed the ducks. One person said they had enjoyed this. One of the lounges is also set up with sensory equipment, so in the afternoon, those who enjoy this, sat in the room and listened to the relaxing music and watched the lights. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 16 One visitor said that they were pleased that their relative’s love of music had not been forgotten. They said that often this was provided, and they could see, by the reaction of their relative, that they still enjoyed listening to it. Staff also spent time talking to people, who appeared to appreciate this just as much as the formal activities, although one staff said they thought more trips out for people was an area where the home could do better. The general manager is going to look at the possibility of this. There was lots of friendly banter, which people seemed to enjoy. People were included in conversation. The general manager has tried hard, and is still pursuing, her request to different religious denominations to visit people to assist in meeting their spiritual needs, with only limited success. However the Roman Catholic priest does visit to give interested people communion. Staff make sure however that people who want to, watch television church service, and one member of staff sings hymns with people. People’s visitors come and go as they please. On the day, staff were very friendly towards them, which makes the home more welcoming when they visit their relative. One said how they had been invited to spend Christmas with their relative. They said it was a good day where staff went out of their way to make this person feel at home. They said ‘It’s all the extras that make the difference’. Another said ‘It’s like my home as well’. Regular relative meetings are held, which one said were like a ‘support group’, and which they found very valuable. Relatives have been encouraged to become involved in the activities which happen at the home. It is sometimes difficult for the people living at Tree Tops to make informed choices, and to take sensible risks. But they are not stopped from moving around the home as they wish, they can sit where they wish, and join in the activities that they want to. Staff were clear that they is no rigid routine, therefore people can have a lie in if they would like to, and go to bed when they wish. An example of this was explained by a staff member, who explained that someone had intimated that they did not want a shave that morning. They were going to go back later to see whether they would like one then. This shows staff have a flexible approach to care. People are offered breakfast, the main lunchtime meal, a choice of hot or cold lighter tea, and supper. They get offered drinks in between. Changes have been made to the four weekly menu following general discussion at a recent relatives meeting, and upon people’s current needs, likes and dislikes. One relative said ‘The food is lovely’. Another said that everything seemed to be home cooked. Staff said it is very hard to offer people a choice of menu in advance, as often they are unable to recall at the time the meal arrives what they ordered. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 17 Because of this, one main meal is prepared at lunch time, but an alternative is provided if the person does not fancy the meal. Individual likes and dislikes are also considered, and staff anticipate these in advance. For instance, one person has a cooked breakfast prepared for them each morning as an alternative to the porridge, cereals and toast normally offered, because they enjoy this. The cook said that they can order what supplies they want, and that they get fresh meat, vegetables and fruit delivered regularly. They also bake every day, so there are always fresh cakes and buns for people to enjoy. People get their meals served to them in one of three communal rooms, or in their own bedroom, depending upon their needs and wishes. There were plenty of staff about so they had enough time to sit with people who needed assistance, without rushing them. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. People’s complaints, and their welfare, are both taken seriously. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaints procedure is included in the service users’ guide, a copy of which is kept in everyone’s room. This gives up to date information about who people can go to, and what they can expect to happen, if they want to complain. One relative spoken with said although they have never had to complain, they had been told that if any problems ever arise, they must go straight to the manager or her staff to get it sorted out. Another said ‘I could ring at any time and they would always listen – they are good – I have no complaints’. The home had received one complaint in the last year. This was about a staff member wearing their uniform outside the home. It was dealt with appropriately. Information was also given to the commission anonymously about the noise levels at the home. This was passed to the registered provider to look into. This was done, alongside input from the Environmental Health Officer. The situation is now resolved. The abuse policy at the home is in line with the local authority guidelines. And staff have a flow chart which tells them what they must do, and who they must Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 19 tell, if they suspect that someone at the home has been mistreated. They have all received training provided by the local authority about what constitutes abuse, and what action they should take should they witness it. Whilst staff were very clear that it was their responsibility to report abuse, no matter what, they were not entirely clear about the role of the local authority, as lead investigators. The general manager said she will remind staff of their role. This will make sure that the right people get to know and the right action taken to protect people from harm. Evidence shows that the management acted upon a concern brought to their attention about a person’s welfare, that an immediate plan was put into place to remove any risk to people, and that these concerns were referred by them to the local authority for proper investigation. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. People live in a clean and comfortable environment which meets their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is set on a quiet road near to the centre of Scarborough. From the front of the property there are lovely views of wooded parkland. The accommodation is provided on three floors, with a passenger lift giving easy access for people to each floor. There is a small garden area to the front, and a concreted area at the back, which also provides ramped access to the building for those who need a wheelchair. Although there is no garden at the rear, there are patio tables and chairs so people can sit out and enjoy the fresh air if they wish to. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 21 There are two sitting areas, and a new conservatory, which is used throughout the day. It is also used at mealtimes. It is bright and airy, and can be used all year round because although it is heated, it also has blinds to stop it from getting too hot in the summer. The home was comfortable, clean and fresh smelling. One visitor commented that it is always clean. They said ‘staff are always cleaning and hoovering – no smells’. The rooms of those seen were adequately furnished, and contained some of the person’s own belongings. One visitor said it was good that they had been able to personalise their relative’s room. Those who share their room have privacy curtains so that their dignity can be preserved when receiving care. However there was only one call bell available. A staff member said the people using the room are unable to use the call bells, and so instead, staff check regularly that they are happy and comfortable. This needs to be formally assessed as each person is admitted into a shared room, and if they are able to manage the call bell, then they should have easy access to it without having to leave their bed. The general manager said that this would be done. The laundry facilities are satisfactory and are situated away from the area where food is prepared. Soiled or contaminated washing arrives in separate bags to reduce the risk from cross infection, and there is a supply of gloves and aprons available to protect the staff who handle it. People have their own clothes, which looked nicely cared for. Action recommended by the fire officer and Environmental Health Officer has been listened to and acted upon, and there are systems in place to keep the premises maintained. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. People are cared for by a staff team who get regular training to help them do their job well. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: On the day of the site visit there appeared to be sufficient staff. Someone provided observation in each of the communal areas. At meal times, staff had enough time to spend with people individually so that their meal time was not rushed. In their surveys, one staff member said there are always enough staff to meet people’s needs. Three said this was usually the case. A comment was made that the staffing levels were different on a weekend, when the activities organisers were not on duty, and when there may be less management and ancillary staff about. The general manager took these comments on board, and is going to see how she can improve the weekend cover by looking at the way staff are allocated. Staff receive a range of training to help them in the work they do. For instance, all care staff are undertaking a dementia awareness course, which explains to them about person centred care. Sometimes, in house training will be provided by health professionals in the community, to help staff understand Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 23 the needs of specific people who are admitted. Training also includes a rolling programme towards National Vocational Qualifications in Care at level 2 and 3. Staff from different departments also get training opportunities. For instance, the cook is working towards an NVQ in catering. This shows that everyone’s role is considered when training opportunities arise. In addition to this, staff from other homes owned by the registered provider come to share their skills, and to learn from staff who work at Tree Tops. They found this a good way to gain experience in their day to day work when providing care. A good recruitment process is followed, which ensures that all necessary evidence is collected for the home to make sure that the person has not been barred from providing care, and that they are suitable to work with vulnerable people. Staff get a full induction when they first start working at the home. A relative said that the staff were good, and that there has been such a change for the better at the home. They said ‘Staff morale is brilliant – they get lots of training now’. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People using the service experience good quality outcomes in this area. The home is run in people’s best interests. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager of the home has become registered with the commission. She and the deputy manager are both in the process of completing a management course to underpin the experience and skills they have developed whilst working at Tree Tops. The manager is supported by the general manager, who visits the home regularly. Staff said the general manager gives the home a lot of support, which they appreciated. One said they were ‘quite spoilt’ when it came to getting equipment. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 25 Staff and relatives spoken with said that the management was good, and that they knew they could go to see the registered manager with any issues that they may have. The general manager said that she arranges regular staff meetings as a way of ‘team building’. And one visitor was pleased that the transition from one manager to another in the previous year had not affected the service that they and their relative get. As well as regular staff meetings, the management supervise staff so they can appraise their work, and look where further training may be needed. However, not all of the supervision records were up to date. And in the returned surveys, staff views differed. Two staff said the manager regularly gives them enough support and meets with them to discuss how they are working. One said this is often the case, but one said it is sometimes the case. When asked how the home could do better, one staff member commented that the management could ‘Listen to staff more, more hands on training (as from time to time we do have some difficult clients)’. To make sure one person gets the right amount of support in their work, the general manager agreed to look into, and rectify, an individual situation where an agreed working pattern had not been continued. A visitor confirmed that they had received quality assurance surveys to be completed on behalf of their relative. They said they always make a point of completing these. They also spoke of the relatives meetings, which are held on a regular basis, and which, they said, provide a sort of support group for people. They gave examples of suggestions that had been made to improve the home further, and were pleased that these had been taken on board by the staff. Quality assurance surveys have also been sent by the home to a number of health professionals, and the feedback was overall good. In response to the surveys sent to them by the commission, professionals answered mainly ‘usually’, and occasionally ‘sometimes’, when asked questions about whether service provides the right support for the people who live there. These results, and any comments made about what the home does well, and where it could do better, have been discussed generally with the registered manager. As well as this, each department of the home is audited. For instance, one staff member has the responsibility for overseeing that medication is kept in order. Another checks the records kept by the chef to make sure that the kitchen remains a safe place for the preparation of food. And a senior member of the company visits periodically to do their own audit of the home, to check that standards are not slipping. The home can look after people’s personal allowance if they wish. This is stored safely, and records are kept to show what has been spent, or received, on people’s behalf. People can have access to their money at any time. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 26 The health and safety records seen showed that the home is kept maintained. Staff get a range of training so that they know how to work in a safe and lawful way, and this training is kept updated as necessary. The cook is currently undertaking training so that she can update all staff in Food Hygiene. The general manager said that this would be completed by the end of the year. Infection control training is given to staff in their induction, and updated thereafter, and fire and moving and handling training is updated regularly. The staff keep a record of accidents that have happened at the home, and let the commission know about those of a serious nature. One recent incident was discussed with the general manager, who is going to give staff an update in the use of the hoist so that she is certain that the equipment is being used consistently and safely at all times. Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 13 Requirement For the individual discussed who needs help to move position in the bed, the care plan must indicate how staff are to do this, how often, and how to position the bed when doing so. This will help to make sure that it is always done in a safe and consistent way. Hand written entries on people’s medication charts must describe fully what the medication is, in what composition it has been dispensed, how often it is to be administered and at what dose. This is so that avoidable errors are kept to a minimum. Timescale for action 14/05/09 2 OP9 13 14/05/09 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 OP9 Good Practice Recommendations All hand written entries on people’s medication charts DS0000028018.V375433.R01.S.doc Version 5.2 Page 29 Tree Tops Nursing Home should be checked, countersigned and dated by someone with the skills to do so. This will reduce the risk from error due to entries being written incorrectly. Staff should sign the medication charts when they have applied prescribed creams for people. This keeps the records up to date, and gives the doctor a better idea on review about how often the creams have been needed, and how effective they have been. This is also the case where supplement meals have been prescribed. Staff should be reminded about the role of the local authority as lead investigators in safeguarding adults, so they are clear that the local authority can be approached by them should there ever be any matters they want to report outside of the home. Staff supervision should be kept up to date, and their working practice should reflect agreements made, and goals set with them. This will make sure people get a consistent service from all staff who are working the hours it has been agreed are most suitable for them. 2 OP18 3 OP36 Tree Tops Nursing Home DS0000028018.V375433.R01.S.doc Version 5.2 Page 30 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries.northeastern@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. 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