Inspection on 14/08/06 for Cherry Tree House

This inspection was carried out on 14th August 2006.

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.

Other inspections for this house

Cherry Tree House 17/05/05

Cherry Tree House 23/11/04

Cherry Tree House 27/04/04

Cherry Tree House 29/05/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cherry Tree House 49 Dobbins Lane Wendover Aylesbury Bucks HP22 6DH Lead Inspector Gill Wooldridge Unannounced Inspection 14th August 2006 10:00 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 Cherry Tree House DS0000022959.V300808.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. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree House Address 49 Dobbins Lane Wendover Aylesbury Bucks HP22 6DH 01296 623350 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 Peter Hall Mrs Janet Parker Mrs Janet Parker Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Cherry Tree House is a privately owned care home providing accommodation for twenty elderly residents. The home has twenty individual bedrooms with five having en-suite facilities and one of these rooms provides respite care. The accommodation is on two floors with only three residents having bedrooms upstairs which are accessed by stairs. The communal areas are well situated on the ground floor. The home is situated in the village of Wendover, with local shops and facilities close by. The home is in a road of well maintained properties and appears well integrated within the local community with train and bus links to near by towns. The home is supported by the local General Practioners surgery with regular support from the district nursing service. There is an established staff team which welcomes residents relatives and new staff. The fees for the home range from £580.00 to £ 4600.00 for a single room per week. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection which took place on 14th August 2006, from 10.30am until 3.50 pm with the second day of the inspection taking place on 21st August 2006 at 2pm. During the course of the inspection the requirements and recommendations from the previous inspection were discussed and some evidence was found to ensure that these shortfalls had been met. Some of the bedrooms and communal areas were seen during a tour of the building. Three care plans were studied and the care of these residents tracked. Medication Administration Record (MAR) sheets were also studied. Staff practice was observed and staff spoken to during the inspection. Time was spent in discussions with the manager and proprietors. The inspector spoke with residents during the tour of the building and following lunch where staff and residents interactions were observed. What the service does well: Staff give good care and are attentive to residents’ needs. The care of the residents, including their personal care, was noted as good. Residents looked well cared for with attention to detail such as clean fingernails, co-ordinating clothes and wearing their own jewellery. Residents commented favourably on how helpful staff are and how they were happy in the home. Staff attend training to enable them to meet residents’ needs. The managers described a willingness to improve. There was a friendly, homely atmosphere in the home. Staff training was described as regular and meeting residents needs. The home facilitates an advocacy agency who hold regular meetings in the home. Residents described a range of activities. The building is maintained to a high standard. The home provides equipment for staff to provide care to residents. Care plans and risk assessments have been developed and there has been a significant improvement in these documents with an emphasis on independence, the documents when referred to would enable a new member of staff to provide care that meets residents’ needs. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 6 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. Cherry Tree House DS0000022959.V300808.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 Cherry Tree House DS0000022959.V300808.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The needs of prospective residents are satisfactorily assessed in order to ensure that the home can meet the needs of prospective residents. The pre-admission assessment process and staff training programme are designed to ensure that, as far as possible, the home does not admit a person whose needs it cannot meet and that staff have the skills to meet residents needs. EVIDENCE: Assessments seen described the residents needs and reflect the standard. The manager described the process of visiting residents in their home, hospital or residential home. The manager described a clear procedure which reflected good practice. Residents new to the home described the home as welcoming and supportive. The home does not provide intermediate care. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. There is a good standard of care planning which provides staff with the detail to support the care of all residents. There has been some progress in the recording of medication relating to medication procedures and the manager has developed some detailed audit tools to identify and address any inconsistencies, these should protect residents. Residents described the quality of care they received as of a high standard this indicates that residents’ privacy and dignity is respected. EVIDENCE: Care plans studied showed the general overall standard described at the previous inspection. Care plans covered areas such as eating and drinking, mobility, personal hygiene, communication, night care plan and social and recreational needs. Contact details for General Practitioners and next of kin were also on file as was the residents faith or religion. Care plans seen had Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 10 identified needs and goals and indicated that residents had been involved in the document. Weight charts were also completed and Waterlow Assessments were in place and reviewed regularly. The documentation was on the whole signed and dated. The review of the documents was noted however the review detail should be included or added to the care plan or a statement to say ‘refer to the last review’. Three care plans were studied and the care of residents tracked. Staff described clearly their knowledge and practice to meet residents’ needs and this was on the whole supported by the documentation. Daily logs indicated that residents personal care had been attended to. Staff were seen to support residents sensitively when toileting them. Risk assessments are supported by the audit of accidents seen at the previous inspections. The risk assessment process has changed since the previous inspection. This needs to be developed further to ensure all risks have a control measure in place, it is recommended that the manager attends training in risk assessments. It is recommended that all aspects of the care plan interrelate with each other. For example, where residents have diabetes, staff identify what the normal range of blood sugars and are that they record these. It is acknowledged that care plans are supported by health protocols. This is noted as good practice. Care plan documentation confirmed that residents have access to regular health professionals and the manager has secured the support of a clinical specialist nurse from a local surgery to support the health care needs of residents this ensures a speedy service. Residents were able to describe the care they received and praised staff for their support and attitude. Privacy and dignity were observed to be respected during the time of the inspection. Sensitive practice was noted. Staff were seen to knock on residents doors and wait for a response before entering. Medication Administration Records (MAR) sheets were studied, overall there has been a marked improvement in staff recording. There were a few inconsistencies in practice noted however, the manager has developed further the audit system and continue to address any shortfalls and anomalies with staff through checking staff competencies on an ad hoc basis. Staff are reminded to have the signature of two staff if any hand written entry is made and when an entry is changed following the instruction of the GP. The process is supported by the clinical nurse specialist who supports the home by reviewing residents medication. Staff support is to continue through training and the manager must continue to address shortfalls formally. The staff and manager described training for staff who administer medication. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 11 Since the previous inspections the manager has developed risk assessment for residents wishing to self medicate. Cherry Tree House DS0000022959.V300808.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. Regular visitors to the home and positive comments received from comment cards from family members indicate that residents are encouraged to maintain contact with friends and family. This was confirmed by residents. The regular advocacy meetings should ensure that residents have a forum which encourages choice and can influence the running of the home. Residents described a range of activities which seem to meet their needs. EVIDENCE: Residents described a range of activities including quizzes, bingo, gentle exercises, trips to the garden centre and regular entertainers. A number of activities were also advertised in the home, which included the regular visit from an advocacy agency and a selection of entertainers visiting the home at regular times. Minutes of the resident and advocates meeting where seen and covered topics such as outings, meals and staff support all of which were favourably described. Residents have access to an individual advocate if they choose. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 13 Staff did not appear phased by the inspection process, which added to the relaxed feel in the home. Care plans indicated that residents had been involved in the process which should ensure that their choices are respected. The visitors’ book indicated that the home has frequent visitors and residents confirmed that their families visited frequently and kept in contact by phone as well. Residents described the food as great and fresh fruit and drinks were readily available throughout the home. The meal at lunchtime looked appetising and was enjoyed by all. One regular visitor joins the residents for lunch daily. Residents described celebrations of birthdays where they choose the menu of the day and enjoy a present and a ‘glass of something.’ The menus have been recently re- vamped and residents choices are held in a book by the chef and detailed in care plans. Cherry Tree House DS0000022959.V300808.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. Consultation with residents and relatives in open forums indicates that complaints and concerns would be appropriately actioned which should ensure that residents and relatives views are both listened and responded to. Staff and the manager appear aware of how abuse may manifest itself and are supported by the organisation’s policies and procedures. These measures should ensure residents are protected from abuse. EVIDENCE: Since the last inspection the managers have developed a system for recording verbal concerns. The home encourages an open door policy inviting comments and listening and acting on any small concerns. Residents described staff and the managers as approachable. Staff clearly described how abuse may manifest itself and who they would report any potential or actual abuse to. Care Line and action on elder Abuse were advertised on the home’s notice board. It is recommended that the manager discuss adult protection in staff meetings. Residents and relatives are invited to a regular coffee morning where there is an exchange of views, this is noted as good practice. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The home is warm, well furnished and well maintained and provides a comfortable environment for residents. EVIDENCE: The home is a pleasant, large detached house a few hundred yards from Wendover town centre. Access is easy by car and the area is served by a bus and train service. There is space for drop off or collection and parking to the front and a pleasant medium sized garden to the rear. The house is warm, well furnished, clean and tidy, and well maintained. Communal space consists of a lounge and conservatory which has seating and is used as a dining area. The conservatory looks on to the garden. The garden has a small patio area which is used in warm weather and there is a pond. The lighting is domestic in character and furnishings are of good quality and suitable for purpose. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 16 A tour of the home indicated that the environment is generally well maintained with the proprietors continually upgrading the home. Recent water damage is in the process of being addressed to enhance the homely feel. Residents praised the home and its comfortable surroundings and they stated that they enjoyed the opportunity to sit and watch birds in the garden from the lounges. The cleaning of the conservatory roof was discussed with the manager and she has agreed to explore options to cover the area. Residents bedrooms viewed showed that residents are encouraged to bring in to the home items of furniture which create a homely feel. Residents new to the home described how, they bought small items of furniture into their bedrooms which helped them settle into the home. Housekeeping staff are to be commended for their hard work in maintaining the cleanliness of the building. one bedroom had a slight odour this needs to be eliminated. The manager described ways in which this could be done. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit. Staff were able to clearly describe good communication as the key to team work and an acknowledgement of individual staff members skills which should support the care of residents. Staffing levels observed during the inspection indicate that residents needs are met. Recruitment procedures need to be developed and improved to ensure the safety of residents. EVIDENCE: Following a group discussion with various staff it is apparent that staff are skilled to support the care of residents, they were thoughtful in their answers and described clearly their actions in given scenarios. Staff discussed the approach and support they offered to residents and this was observed as thoughtful and sensitive. Residents spoken to confirmed that staff work as a team and there are lots of smiles. Staff were able to clearly describe good communication as the key to team work and an acknowledgement of individual staff members skills. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 18 Rotas viewed indicate that there is still a member of staff appointed to do a sleep in. Staffing levels observed during the inspection indicate that residents needs are met. This was supported by the rotas seen at the inspection. The manager stated that she continues to assess residents needs regularly and she is reminded to increase staffing levels dependent on the level of need of residents. The home has an ongoing programme of training to meet the needs of residents. Staff confirmed that they had undertaken lots of training. NVQ is promoted in the home with at least two staff working towards their NVQ in care Level 3 award. The inspector viewed three staff files the most recent members of staff file was not available on the first day of the inspection, but at the managers own home, this practice needs to be supported by a protocol and detailed records kept in the home of where staff files are. On the second day of the inspection this protocol was in place as was the staff file. The manager confirmed that one member of staff had a PoVA First check but she had not received their CRB, she stated that this member of staff was providing personal care unsupervised. This is not appropriate and the manager must ensure that this employee is supervised until her CRB is received. A formal risk assessment should support the process. On the second day of the inspection the manager had improved the checklist, relating to the recruitment process, to ensure this oversight did not happen again. The manager should ensure that she records that she has checked the authenticity of any reference and maintain records. It is acknowledged that the manager confirmed that authenticity had been checked although no records were seen. Staff described a clear induction ,ongoing training and supervision to support the care of residents. There is an ongoing programme of training submitted to the Commission as part of the pre inspection questionnaire. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The manager demonstrates her commitment to the care of the residents and is fully aware of her responsibilities to the residents. Residents finances are protected by generally sound systems It is evident from the residents comments that they are positive about living at Cherry Tree House. However, the home needs to consider the development of further quality audit systems to ensure residents views are sought in all areas that could potentially effect their lives. It is acknowledge that the home has some quality assurance systems in place. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager is open and receptive to new ideas and is continually looking to improve the service. She clearly understands her responsibilities and accountability. The manager has not completed the registered manager s award this is in part due to a period of sickness which the manager has now recovered from. The home keeps small amounts of residents money safely. Residents actual money did tally with the record of the amount recorded. The manager is strongly recommended to develop the homes finance policy as discussed at the inspection. Quality assurance was discussed at length and it is acknowledged that the home has a number of audit systems in place. Some further developments in the systems may be prudent and thus will continue to ensure residents receive a quality service. The manager needs to take the next step in developing these systems. Health and safety records viewed were generally satisfactory and reflective of the information sent to the Commission in the pre inspection questionnaire. The emergency lighting was last checked on the 31/7/06 and the manager described having this in hand. It is advised that if the manager is not available these checks must be given to a responsible person. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 21 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 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 22 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 OP7 OP7 OP8 OP9 Good Practice Recommendations It is strongly recommended that the manager develop the risk assessment process to include all control measures and so minimise the risk to residents. It is strongly recommended that all aspects of the care plan interrelate with each other. It is strongly recommended that where residents who have diabetes that a record of their normal range of blood sugars are recorded. It is strongly recommended that staff are reminded to have the signature of two staff if any hand written entry is made and when an entry is changed following the instruction of the GP. It is strongly recommended that the manager supports the recruitment process by having a risk assessment in place until the CRB has arrived. It is strongly recommended that the manager should ensure that she records that she has checked the DS0000022959.V300808.R01.S.doc Version 5.2 Page 23 5 6 OP29 OP29 Cherry Tree House 7 OP35 authenticity of any reference. It is strongly recommended that some further quality audit systems be developed as discussed during the inspection. Cherry Tree House DS0000022959.V300808.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 House DS0000022959.V300808.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. 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. 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