CARE HOME ADULTS 18-65
Cherry Tree cottage 6 Kinoulton Lane Kinoulton Nottinghamshire NG12 3EQ Lead Inspector
Stephen Benson Key Unannounced Inspection 11th October 2006 9:30 Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 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 Cherry Tree cottage DS0000067869.V315970.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 Adults 18-65. 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. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cherry Tree cottage Address 6 Kinoulton Lane Kinoulton Nottinghamshire NG12 3EQ 0115 981 9080 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) Mr John William Nunn Mr Noel Allcock Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No one falling within the category LD to be admitted into Cherry Tree Cottage when there are 5 persons of this category already accommodated The maximum number of persons to be accommodated within Cherry Tree Cottage is 5 N/A Date of last inspection Brief Description of the Service: Cherry Tree Cottage is a care home providing long-term personal care and accommodation for up to five younger adults who have a learning disability. The home is one of several owned by Mr John Nunn and is run as a small business. The home is located in a rural area on the outskirts of a small village. The home is intended for those who prefer to live in the countryside. The home was opened in July 2006 is a former domestic dwelling. All of the home’s bedrooms are single, and none have en-suite facilities. Four bedrooms are located on the first floor and one on the ground floor. The home has an enclosed garden with further land beyond where horses are kept. There is car parking available. The manager said on 12/10/06 that the fees for the service range from £1262 - £1300 per week depending on dependency needs. Additional charges are also made for additional individual time with staff. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since registering in July 2006. The inspection looked at key standards for younger adults. The site visit lasted for 3 hours and the main method of inspection used was called case tracking which involved selecting 1 resident and tracking the care they receive through the checking of their records and discussing this with them. A discussion was had with the manager, staff on duty and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the service does well:
There was a full assessment and background information seen on the one resident at the home and the manager said that the admission process requires prospective residents to be assessed. The evidence shows that new residents are assessed before they come to live at the home. There were well written and detailed care plans which clearly explained residents needs and how these are to be met. Plans included prompts for staff to use if required. Residents discuss their care at monthly meetings, called circle meetings. The evidence shows that residents know their assessed needs and personal goals are reflected in their individual plan. Residents are offered choices of what they would like to do and are able to make their own arrangements. The evidence shows that residents’ make decisions about their lives with assistance as needed. Residents are able to follow interests such as horse riding and cycling subject to being risk assessed. The evidence shows that residents are supported to take risks as part of an independent lifestyle. A college place has been found for a resident to start after Christmas, which she is looking forward to. Staff are looking for a youth club and trips take place to the local pub. The evidence shows that residents are able to take part in age, peer and culturally appropriate activities and are part of the local community. Families are able to remain actively involved in supporting residents and have attended circle meetings. A resident spoke of going to visit her family. The evidence shows that residents have appropriate personal and family relationships. There is not a set routine within the home and residents can influence when and how things are done. The evidence shows that residents’ rights are respected and responsibilities recognised in their daily lives Residents are involved in food shopping and can choose what they have to eat. A record is made in the daily log of what food is had. There were good supply
Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 6 of food including fresh fruit and vegetables. The evidence shows that residents are offered a healthy diet and enjoy their meals and mealtimes. Staff spoke of providing support and encouragement and a resident said she can care for herself apart from washing her hair. The evidence shows that residents receive personal support in the way they prefer and require. A record is made of all healthcare appointments. Staff and families are able to share the responsibility of ensuring healthcare needs are met. There was information about how to make appointments less stressful. The evidence shows that residents physical and emotional health needs are met. 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. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents are assessed before they come to live at the home. EVIDENCE: There have been several referrals made to the home, but so far only one resident has been admitted. The resident’s care file included background information about the resident, and there was a community care assessment. There information was detailed enabled the home to decide if they were able to meet the residents needs. The resident said, “I came to visit before moving into the home. The manager said that part of the admission process requires an assessment and these include details of any specialist assistance a resident requires. The manager said that anyone is welcome to apply for a place providing they fall within the registration category for the home. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know their assessed needs and personal goals are reflected in their individual plan. Residents’ make decisions about their lives with assistance as needed. Residents are supported to take risks as part of an independent lifestyle. EVIDENCE: The care plan seen was extremely informative about the resident and explained their needs and abilities. There was also information about the resident’s likes, dislikes, fears, things that are important and things that the resident must not do. The plan included triggers which can result in bad behaviour and prompts for staff to manage situations, for example what to say if the resident wanted a fizzy drink, which had been identified as affecting her behaviour. Care plans include details of resident’s gender, ethnic origin, religious beliefs and any disability. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 10 Staff and the resident explained about circle meetings, which are held every month, and involve the resident, their family and staff. These meetings are to look at the placement and set a list of goals and aims about what the resident would like to do and wants over the coming months. This included attending church on Christmas Eve, getting a pet rabbit, having a new bike and finding a college placement. Staff said that the resident is able to make decisions about many aspects of her life, from where they go shopping, what she does each day and what domestic chores she will do. Staff were seen offering a choice of washing or drying the dishes after breakfast. The resident was asked if she is able to make decisions and said, “Yes”. The care plan at the home recorded the resident making choices and staff said that the resident had arranged with her grandmother to go and visit her yesterday, which she had done. There was information in the care plan about potential risks such as road safety. The resident is interested in animals and is able to help and ride the horses living in the paddock at the end of the garden. Staff said there was a risk assessment for this but this could not be located. The resident said that she will be getting a bike for Christmas and will have a safety helmet. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents have appropriate personal, family and sexual relationships. Residents rights are respected and responsibilities recognised in their daily lives. Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: Finding a college placement was identified as one of the aims of the placement in the care plan. Arrangements have been made for the resident to attend a college when the new term starts after Christmas. Staff said that this will be for 3 or 4 days a week. In the meantime the resident decides what she would like to do each day but also helps with the shopping, cooking, cleaning and
Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 12 other domestic duties. The resident said, “I am going to college after Christmas, I am looking forward to it”. Staff said they are looking for a youth club where the resident can mix with others and play games such as pool and table tennis. The resident said, “I like to go for walks and go to the pub and have a beer”. The care plan included the role of the family and staff said that they have a lot of input into what is happening. The resident has visited another home owned by the same provider, Broadoaks, and met some residents from there and it is planned they will go swimming together. The resident spoke of her family visiting and going to see them. Staff said that the resident has her own daily routine, which she has chosen. This includes getting up early and having a bath each evening. The resident said yes to questions asked about choosing when to get up and go to bed. Staff said that the resident is able to choose what she has to eat and there were plenty of food supplies. A record is made in the daily record of what the resident has had to eat. The resident spoke of preparing a buffet for everyone who came to her recent circle meeting. The manager said that any special diet for personal choice, religious or health reasons would be accommodated. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in the way they prefer and require. Residents physical and emotional health needs are met. Residents can retain, administer and control their own medication where appropriate, but are not being fully protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Staff said that the resident is prompted and encouraged to look after their own personal care, which works well, although assistance is given in washing hair. The resident said, “I have help with my hair and do the rest myself”. The resident went out several times and was dressed appropriately for the wet weather. Staff said that the family are involved in the resident’s healthcare and routine healthcare appointments are made. Staff said that they will be looking to going to a well woman’s clinic in the near future. The resident said, “I tell staff if I feel poorly”. The care plan had information about the resident’s healthcare needs and a record is made of any healthcare provided. There was a very Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 14 useful care plan describing how to have a good hospital appointment that avoided known difficulties and caused the least stress to the resident. The manager said there is a system to assess whether any resident is able to self medicate. Medicine Administration Records were fully completed and the resident said, “Staff give me my tablets”. There was not a locking cupboard to store medicines in and one is required. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel their views are listened to and acted on. Systems are not in place to protect residents from abuse, neglect and self harm. EVIDENCE: The home has a complaints procedure and staff were aware of this and said they would make a record of any complaint made. The resident said that she would tell someone if she was not happy. There was information in the residents care plan about making her feel safe and the resident said that she did. There was not a copy of the Adult Protection Procedures in the home and the manager said that he would arrange for one to be provided. The manager said there have not been any reported incidents of abuse and that any form of abuse or discrimination would not be accepted and would be dealt with by following the Adult Protection Procedures and if involving staff disciplinary action would be taken. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment. The home is clean, pleasant and hygienic.. EVIDENCE: The home is suitably laid out and provides a homely environment. As the home has not been operating for long there are still things to be done to get some rooms ready for use. There are no window restrictors and a risk assessment should be undertaken to see if these are needed. There are no locks on bedroom doors or lockable facilities. One bedroom, although not in current use, houses the hot water tank and this was extremely warm. The radiator was also on in this room but it should be established that the room is an acceptable temperature before use. Staff said that the building has worked well so far giving plenty of space. The resident said “I like my room”. The manager said that with some small alterations the home could accommodate one wheelchair user on the ground floor. The staff and resident share in keeping the home clean and do this together at some point in the day. A photograph was seen of the resident doing her ironing and staff said the resident had put her bedding in the washing machine that morning.
Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff. Residents are supported and protected by the home’s recruitment policy and practices. Residents individual and joint needs are met by appropriately trained staff. EVIDENCE: At present there is one member of staff on duty at all times, although this will be increased to two as soon as there is another resident admitted. Staff said that they have access to support if needed through Broadoaks, another home owned by the provider. The activities coordinator from Broadoaks also spends time at the home most days. The staff employed were transferred from Broadoaks and no new staff have been recruited to work at the home yet, although an advert is currently out. Staff files are held at head office at present until the office is fully furnished. The manager said he was aware of the correct recruitment practices and would ensure that these are followed. Staff have received training prior to moving to the home and a training programme has not yet been established at the home, but in the meantime staff can access training through Broadoaks. It is planned to set up links with a local college to assess staff taking National Vocational Qualifications.
Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are suitable temporary management arrangements. Residents are confident their views underpin all self monitoring, review and development by the home. The health, safety and welfare of residents are not being promoted and protected. EVIDENCE: The registered manager is also the registered manager of another home owned by the provider, Broadoaks. This is a temporary arrangement to enable the home to get up and running when a separate registered manager will be recruited. The resident is able to express any views at the circle meeting. The manager said that it is intended to implement the quality assurance programme, The
Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 19 Quality Tree, provided by Nottinghamshire County and Nottingham City Councils. The manager said the water system does not need testing for Legionella. The fire log had not been completed and staff said they have not been carrying out the required checks. Cleaning materials are stored in the laundry and not in a locked cupboard as required. The resident said, “I went outside when the fire alarm went off”. Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X X 3 3 X X 2 X Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 2 Standard YA20 YA23 Regulation 13 12 Requirement The registered person must ensure that thee are suitable facilities for storing medication The registered person must ensure that residents are protected from abuse and self harm The registered person must ensure the health and safety of residents is protected and promoted Timescale for action 01/11/06 01/12/06 3 YA42 12 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Cherry Tree cottage DS0000067869.V315970.R01.S.doc Version 5.2 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
