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Inspection on 29/10/07 for Tree Tops Residential Care Home

Also see our care home review for Tree Tops Residential Care Home for more information

This is the latest available inspection report for this service, carried out on 29th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The people using the service were confidant that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. People using the service had their health, personal and social care needs fully met and this was set out in an individualised plan of care. Individuals were involved in decisions about their lives, and played an active role in planning the care and support they receive. Comments from surveys included "My mother is looked after sensitively and expertly" they " Give residents encouragement to make choices and be independent" and " I have no concerns about any aspect of my aunts care". People were treated with dignity and respect and their privacy was upheld. People` s lifestyle in the home met their expectations and satisfied their needs. People who used the services were able to make choices about their life style, and were supported to develop their life skills. Social, educational, cultural and recreational activities met individual`s expectations. People enjoyed an appealing, varied diet in pleasant surroundings, at a time that suited them, with support from staff.The home presented as a clean, tidy home, decorated, furnished and maintained to a good standard. Comments from surveys included; "Provides a caring and homely atmosphere" and "We are very pleased with Tree Tops" The people using the service, were supported by Staff, who were trained, skilled and competent. Staff had been subject to rigours recruitment checks Comments from surveys included; " The staff take time which is so important" and the staff are friendly and look after my mum very well People lived in a well managed home, with the management, administration and staff team, working together to provide a safe environment that respected and protected peoples` rights.

What has improved since the last inspection?

Since the last inspection the manager had continued to record complaints and how they were resolved, in a complaints booked purchased and introduced at the previous inspection visit. The manager and owner had also acted upon a recommendation made at the previous inspection and had extended risk assessments to the garden and grounds. They had also secured part of the garden to limit the risk of people falling.

What the care home could do better:

It is recommended that the service; Introduce as planned the development of an activities programme that builds on people`s strengths, and introduce more description and detail, in care plans and the service users guide, of the kind of activities that people are enjoying. It is also recommended that the manager continue with plans to refurbish the homes kitchen and fully implement the new quality assurance system.

CARE HOMES FOR OLDER PEOPLE Tree Tops Residential Care Home Overton Timber Hill Lyme Regis Dorset DT7 3HQ Lead Inspector Andrea East Key Unannounced Inspection 29th October 2007 10:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tree Tops Residential Care Home Address Overton Timber Hill Lyme Regis Dorset DT7 3HQ 01297 443821 01297 444868 richardiyavoo@btconnect.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) Mrs Belinda Davila Iyavoo Mr Richard Kirk Iyavoo Mrs Belinda Davila Iyavoo Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2007 Brief Description of the Service: Tree Tops is a large house set in its own grounds on Timber Hill on the outskirts of Lyme Regis with some views of the sea. There are well-maintained attractive gardens at the front and rear of the home. Tree Tops operates in accordance with Christian values and welcomes residents and staff of all faiths, or of none. The home provides personal care for a maximum of seventeen elderly people and also offers day and respite care. Residents’ bedrooms are on the ground and first floor. Registered providers Mr & Mrs Iyavoo live with their family on the second floor. Stair lifts operate between all floors. Communal facilities include a lounge and separate dining room, there is an additional small lounge area on the second floor of the home. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. There is a car park at the front of the home with street parking nearby. The home is close to a bus route, with a bus stop within walking distance. Fees are charged weekly; at present fees range between £350 and £420 per person. The homes service users guide and a copy of the last inspection report could be found in the homes, office and was available on request. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection site visit was carried out over a day. A range of documents including staff and individuals files, policies, procedures and the homes service users guide were examined. People were spoken to in the homes lounge and in private rooms and members of staff were also spoken with. The homes, manager and owner were present throughout the inspection. Feedback about the home was also received by post in survey questionnaires provided by the Commission and in the homes Annual Quality Assurance Assessment The service was run and managed by Mr and Mrs Ivavoo, who lived on the premises. Mrs Ivayoo acted as the manager for the home. Mr and Mrs Ivayoo, were supported in providing services, by members of the family and a small, team of staff. What the service does well: The people using the service were confidant that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. People using the service had their health, personal and social care needs fully met and this was set out in an individualised plan of care. Individuals were involved in decisions about their lives, and played an active role in planning the care and support they receive. Comments from surveys included “My mother is looked after sensitively and expertly” they “ Give residents encouragement to make choices and be independent” and “ I have no concerns about any aspect of my aunts care”. People were treated with dignity and respect and their privacy was upheld. People’ s lifestyle in the home met their expectations and satisfied their needs. People who used the services were able to make choices about their life style, and were supported to develop their life skills. Social, educational, cultural and recreational activities met individual’s expectations. People enjoyed an appealing, varied diet in pleasant surroundings, at a time that suited them, with support from staff. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 6 The home presented as a clean, tidy home, decorated, furnished and maintained to a good standard. Comments from surveys included; “Provides a caring and homely atmosphere” and “We are very pleased with Tree Tops” The people using the service, were supported by Staff, who were trained, skilled and competent. Staff had been subject to rigours recruitment checks Comments from surveys included; “ The staff take time which is so important” and the staff are friendly and look after my mum very well People lived in a well managed home, with the management, administration and staff team, working together to provide a safe environment that respected and protected peoples’ rights. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 7 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 Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service were confidant that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. The services provided did not include intermediate care EVIDENCE: The manager said that since the last inspection the newly introduced preadmission assessment, for people planning to move into the home, continued to be in use. Two files compiled for each person living at the home were examined. Both files held information about the needs of the person planning to stay at the home. These assessments had been completed before people had moved into the home. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 9 The manager said that to ensure peoples needs were assessed and discussed, before people moved into the home, she would be happy to visit people at hospital, at home, or welcome them into the home on a temporary visit. People said that they knew about the home and the care they needed before committing themselves to coming into the home on a permanent basis. The manager said that the home does not provide intermediate care. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service had their health, personal and social care needs fully met and this was set out in an individualised plan of care. Individuals are involved in decisions about their lives, and played an active role in planning the care and support they receive. People were treated with dignity and respect and their privacy was upheld EVIDENCE: Two files compiled for each person living at the home were examined. Both files held a range of information, including assessments and care plans for those people living at the home. The files included ongoing assessments, reviews of care, care plans and care information. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 11 Care plans were detailed and specific to individuals needs, showing staff how best to care for people, the way they wished to be cared for. Files also held assessment tools such as weight charts and a record of health professionals visits, such as the optician, the district nurse and the doctor. One survey from a health professionals said that the home provided “holistic – individualised care to meet the patients needs and preferences”. Surveys completed by the people living at the home and by their relatives and advocates said that, “Personal care is handled with respect and sensitivity” and they “look after my mum very well”. People said that they felt well cared for and that staff helped them to make decisions about their care. Medication administration policies, procedures and practices demonstrated how the home actively involved the people using the service in their care. People were observed being actively supported to administer their own medication safely. Staff, were observed following good medication administration practices such as staying with the person receiving medication until the medication had been taken. This ensured that medication has been taken as prescribed and that individuals have an opportunity to discuss and issues with staff. Medication administration had been an area that the home had worked on to improve and the good practices introduced at the previous site visit to the home had been continued. This included good storage, administration and recording of medications. The manager said that no one was on controlled drugs, so that the controlled drugs book was not examined. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’ s lifestyle in the home met their expectations and satisfied their needs. People who used the services were able to make choices about their life style, and were supported to develop their life skills. Social, educational, cultural and recreational activities met individual’s expectations. People enjoyed an appealing, varied diet in pleasant surroundings, at a time that suited them, with support from staff. EVIDENCE: People said that they had a choice in how they spent their time and if they wished to join in activities in the home. One person said that they preferred to stay in their room and they did not feel isolated as staff popped in and they had regular visits from outside of the home. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 13 Assessment and care plan information did include basic information about how people wished to spend their time. Staff, were aware of peoples past hobbies and interests and how they may wish to spend their time either in the home or with their family. The manager said that the development of an activities programme that built on peoples’ strengths was being developed and was looking forward to working on this. The homes service users guide gave examples of the kind of activities available to people living at the home. For example going on outings, going to church on Sunday, going shopping and being independent. More description and detail, in care plans and the service users guide, of the kind of activities that people are enjoying, would help to reassure people that the home supports leisure, social and religious activities. Surveys from relatives and carers said that they were welcomed into the home and that the home helped people to “keep in touch”. Staff, were observed in the homes kitchen preparing individualised meals for each person. Staff, were clearly aware of peoples choices and preferences. For example using smaller plates for those people with a small appetite and cooking a separate meal for someone who did not want what was on the planned menu. People said that the meals in the home were “tasty” and that they could choose to eat in the homes dining room or in their own rooms. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who used the service were able to express their concerns, and complaints and suggestions from those using the service, relatives or other visitors to the home were treated seriously. People were protected from abuse, and had their rights protected. EVIDENCE: The homes service users guide and statement of purpose included details of how people could raise concerns and complaints. The information provided included the Commissions details so that people were informed about how they could make complaints. Staff said that they had received training on adult protection / safeguarding issues and were aware of who to contact if they had any concerns. People said that they felt able to raise concerns with “anyone in the home” the manager and their family. The manager had continued to record complaints and how they were resolved, in a complaints booked purchased and introduced at the previous inspection Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 15 visit. The manager said that she monitored complaints and tried to address any concerns not matter how big or small quickly. Surveys from relatives and carers said that the service usually responded appropriately, if concerns were raised or that “we have no reason to complain”. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home presented as a clean, tidy home, decorated, furnished and maintained to a good standard. EVIDENCE: The premises, was toured with the homes manager and time was also spent in the kitchen with staff and in peoples private rooms. The home presented as clean, tidy and private rooms had been personalised to each person’s tastes and preferences. The manager, owner and staff group had implemented a range of health and safety audit checks to ensure the safety of the building. This included a risk Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 17 assessment for every room, equipment testing, records for fire safety checks and checking equipment such as wheelchairs. Other safety measure for the premises included the guarding of radiators, restricting water temperatures and restricting window openings. These measures help to ensure that the home was a safe environment for people to live in. Since the last inspection the manager and owner had acted upon a recommendation made at the previous inspection and had extended risk assessments to the garden and grounds. They had also secured part of the garden to limit the risk of people falling. The kitchen was clean and tidy and records had been kept of cleaning schedules and temperature monitoring of equipment and foods. Demonstrating good food health and hygiene practices. The manager said that the kitchen is in need of refurbishment as the units are old, worn and dated. The manager had plans to refurbish this area in the future. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people using the service, were supported by Staff, who were trained, skilled and competent. Staff had been subject to rigours recruitment checks. EVIDENCE: People said that there was “always someone around” and that staff responded, “quickly, when they need to”. Surveys from relatives and carers said that staff had the “skills and knowledge to care for people properly”. The manager said that training for staff continued to be planned for the future, building on training that had already been completed. Training included a detailed, induction training pack for staff newly employed in the home. The manager and owner had also completed a range of training so that, knowledge and skills could be passed on to staff. Staff said that they had the opportunity to attend training. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 19 Staff files held clear details of staff roles and responsibilities in job descriptions and procedure documents. The home had a good recruitment process that included interview checklists and questions, references and police checks, identity checks and photographs of staff. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a well managed home, with the management, administration and staff team, working together to provide a safe environment that respected and protected peoples’ rights. EVIDENCE: The service was run and managed by Mr and Mrs Ivavoo, who lived on the premises. Mrs Ivayoo acted as the manager for the home. They were supported in providing care, by other members of the family and a small staff team that been recruited locally and from abroad. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 21 Mr and Mrs Ivayoo had a range of experience, skills and training in care and both had completed the registered managers award in care. A range of policies, procedures and systems were in place to ensure that the home was well managed and well maintained. For example the improved care planning and risk assessments for peoples care and documents for the safe maintenance of the building. A quality assurance system had been developed and was being newly introduced into the home, to assist in monitoring and improving services. People were asked about the service provided and how it could be improved. The manager said that the service did not manage peoples’ finances and that finances were dealt with through outside advocates, such as family members or solicitors. The service has received several inspection visits over the year and had continued to make steady progress in addressing any shortfalls in meeting the standards. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 22 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 3 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 3 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 x x 3 Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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. 2 3 4 Refer to Standard OP12 OP12 OP19 OP33 Good Practice Recommendations Introduce as planned the development of an activities programme that builds on peoples strengths Introduce more description and detail, in care plans and the service users guide, of the kind of activities that people are enjoying. As planned refurbish the kitchen Continue as planned to implement a quality assurance system ensure that residents remain satisfied with all aspects of the home. Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tree Tops Residential Care Home DS0000066167.V353953.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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