Inspection on 18/09/06 for Cherry Tree House

This inspection was carried out on 18th September 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 22/09/08

Cherry Tree House 31/10/07

Cherry Tree House 09/05/07

Cherry Tree House 04/10/05

Cherry Tree House 19/07/05

Cherry Tree House 02/09/04

Cherry Tree House 29/04/04

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

CARE HOMES FOR OLDER PEOPLE Cherry Tree House Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU Lead Inspector Kerry Fell Unannounced Inspection 18th September 2006 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 Cherry Tree House DS0000013597.V302235.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 DS0000013597.V302235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree House Address Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU 01252 734417 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 Gillian Margaret Nicholls Mrs Gillian Margaret Nicholls Care Home 6 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (4) of places Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 2 (two service users may be in the category: dementia for older persons DE(E). 4th October 2005 Date of last inspection Brief Description of the Service: Cherry Tree House is a privately owned detached house that is situated in a quiet road near the centre of Farnham. The property is the family home of Mr and Mrs Nicholls. The home is managed and staffed solely by Mr and Mrs Nicholls and their family. The home has a domestic feel, and service users are accommodated in attractively decorated single rooms. There is a small parking area at the front of the home, and attractive well-maintained gardens are available for use by the service users. The service is registered to provide personal care for up to six older people, two of whom may have dementia. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the key inspection for the inspection year 2006/2007. The inspection was unannounced which means that neither the staff nor the residents, as they prefer to be known, knew that the inspection was going to take place. Mr Graham Cheney and Mrs Kerry Fell undertook the inspection, and it took two hours and forty-five minutes to complete. The inspectors met with all of the service users during the inspection, reviewed residents’ records, health and safety checks, policies and procedures, and other records held by the home. The inspectors also took a tour of the home. What the service does well: What has improved since the last inspection? What they could do better: The home had been advised by the environmental health officer that they did not need to keep records of meals given; however it was recommended that the home continue to keep these records in order to demonstrate compliance with National Minimum Standard 15, which states that residents ‘receive a wholesome appealing balanced diet.’ Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 6 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 DS0000013597.V302235.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 DS0000013597.V302235.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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Information was available for prospective residents, and pre admission assessments are completed and used to develop residents’ care plans. EVIDENCE: The home forwarded a copy of the updated statement of purpose to the CSCI Surrey Local Office shortly following the inspection. The inspector observed that this had been updated in line with the changes to the Care Homes Regulations 2001 that came into force on 1st September 2006. The statement of purpose continued to be written in a friendly style, that gave clear and succinct information about the home and the services provided by the home. Residents’ files contained pre-admission assessments. The most recently admitted residents were admitted with care management assessments. The inspectors observed that these assessments were being used as the basis for the residents’ care plans. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 9 Cherry Tree House DS0000013597.V302235.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 at least once during a 12 month period. 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 the service. Residents’ health, personal and social care needs are identified and met by the home. Medication administration procedures, records and storage were managed well. Residents were happy living in the home and felt in control of their lives. EVIDENCE: The registered persons had access to a computer package that provided proforma documents for residents’ records. The registered persons had chosen records from this package and adjusted others to develop a record that covered all elements required under standard 7 of the National Minimum Standards for Older People. These care plans included information about the resident’s health and medical needs, daily routines and brief life histories. A form was available on each file to demonstrate that these were being reviewed on a monthly basis. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 11 The GP and community nurses continued to visit the residents as required, and evidence of appointments with health professionals were held on residents’ files. Medication that was not for use by the residents had been removed from the medication cupboard. At the time of the inspection, little medication was being held, as the monthly prescriptions were due to be delivered. Medication records were observed to be well maintained, and orderly. The registered persons were able to describe sound procedures with regard to the administration of medication, and no concerns were identified at the last inspection with regard to the administration of medication policies and procedures. The inspectors were also shown records of monitoring the home’s management of medication by the local pharmacist, which would now be overseen by the Primary Care Trust. The residents met during the inspection stated that they were settled in the home, and that where they wished to were able to maintain a good degree of independence. All of the residents were able to move around the home unaided and their care needs were stable. Residents stated that they were happy living in the home and felt in control of their lives, although some explained that they were not able to do many of the things the had previously enjoyed due to reduced abilities, for example, poor eyesight. All of the residents were able to choose how and where they spent their time. One resident enjoyed staying in bed in the morning, and the home supported them to do this, by taking breakfast and drinks to their bedroom, and assisting them to dress and bath once they user rose and asked for assistance. Residents confirmed that they were able to bring personal items into the home, and stated that they could have visitors at any time. The registered persons advised the inspectors that a cordless telephone was available for use by the residents, and therefore they could make telephone calls in the privacy of their bedrooms if they so wished. Cherry Tree House DS0000013597.V302235.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are supported to take part in social, cultural and recreational activities as they wish. Contact with friends, relatives and the local community are promoted. Meals are freshly prepared and to a good quality. EVIDENCE: The home is operated on a family basis with residents treated as a part of the provider’s extended family, the day before the inspection all of the residents had been involved with a party at the home. The relationship between the staff and residents was observed to be good. Residents’ interests were recorded on their files, and residents advised the inspectors that they kept as busy as they wished to. Residents were able to make choices about what they wished to do and the meals that they wished to take each day. The home maintains community links for residents, i.e. linking with local churches and visits by the Rainbows. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 13 The inspectors were also advised that the local priest and vicar had visited the home, and that one resident has attended church. Residents stated that they were visited regularly by their families and enjoyed life in the home. Their bedrooms were personalised and they were able to bring items of furniture with them. The provider stated that they spent time with residents discussing current affairs, i.e. football and antiques in the same way as a family would have such discussions. All of the residents made very positive comments about the quality of the food. The registered persons confirmed that meals were freshly prepared, and that although there was a planned menu, residents were asked on a daily basis what they wished to eat. The registered persons stated that they would be happy to prepare whatever the resident wished to eat. The inspectors observe lunch being prepared, which was a home cooked meal of salmon, mashed potato and vegetables, followed by dessert. All residents stated that the meal was “lovely”, but some stated that the meals were sometimes the too large. Drinks and snacks were available throughout the day. The home had been advised by the environmental health officer that they did not need to keep records of meals given; however it was recommended that the home continue to keep these records in order to demonstrate compliance with National Minimum Standard 15, which states that residents ‘receive a wholesome appealing balanced diet.’ Cherry Tree House DS0000013597.V302235.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents feel safeguarded and know how to raise concerns. EVIDENCE: Residents spoken to during the inspection confirmed that they had not had reason to complain to the registered persons, but that they knew who to complain to in the event that they did. Residents were also confident that their concerns would be acted upon. No complaints had been logged since the last inspection. The home had accessible, easy to use complaints procedure available. The registered persons had updated their copy of Surrey’s Multi-Agency Protection of Vulnerable Adults procedures since the last inspection. Cherry Tree House DS0000013597.V302235.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is well maintained. Laundry is completed in an area separate from the home. EVIDENCE: The home was well maintained and in good decorative order. The residents were all happy with their accommodation and one was pleased to show the inspector their room. Residents were encouraged to make their room as homely as they wished, although larger items of furniture could not be accepted. Inspectors observed that radiators in areas accessible to residents were not of a low surface temperature or covered. The registered persons must undertake a risk assessment and high-risk radiators or hot water pipes must be covered as a matter of priority. The home completed a risk assessment on all of the residents accommodated at the home and a copy was forwarded to the CSCI Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 16 Surrey Local Office shortly after the inspection. The risk assessment identified that all of the radiators were thermostatically controlled and that rooms were arranged so that residents could not fall against them and burn themselves. Although a risk assessment had been completed as required during the inspection, the home would be strongly advised to expand this risk assessment to include more specific information about the risks on a room-by-room basis and prioritise actions to comply with Standard 25.5, which states that ‘pipe work and radiators are guarded or have guaranteed low temperature surfaces’. The laundry area continued to be sited in a separate from the home. Washing machines continued to have the programmes required. Cherry Tree House DS0000013597.V302235.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The registered persons and their family staff the home. No new staff had been recruited to the home. The registered persons have completed the NVQ Level 4 in care. EVIDENCE: The registered persons and their family run the home. Staff rosters were available. The inspectors were advised that staffing levels had been reduced earlier in the year to reflect the numbers of needs of the service users resident at the home. The registered persons were now in the processing of increasing staffing levels again now that the home had 5 residents. At the time of the inspection, sufficient staffing levels were available, and the residents confirmed that they received the support that they required. The registered persons had completed all modules of the NVQ Level 4 in care, and following closure of the company that they had trained with were awaiting the final assessment from the awarding body. The registered persons still plan to complete the Registered Managers Award, once this had been completed. No new members of staff had been recruited to the home. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 18 Cherry Tree House DS0000013597.V302235.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Registered persons with extensive experience manage the home. Residents are consulted about the service provided. The health, safety and welfare of the residents are promoted. EVIDENCE: The registered provider and registered manager have extensive experience in running this home. The home is a family business that has been run for many years. Both registered persons have completed the work for the NVQ Level 4; please also see comments under standard 28. Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 20 The home asks residents and their relatives to complete annual questionnaires about the service that they receive. The registered persons planned to complete this in the autumn, shortly following the inspection. In most cases service their relatives or solicitors manage user’s finances. Where any finances were managed at the home, the inspectors observed that records of all transactions were held, and receipts of transactions were available. The inspector observed from records available that the home continued to complete the relevant health and safety checks. The home had not received the receipt for the annual Portable Appliance Test, and a copy of this was forwarded to the CSCI Surrey Local Office shortly following the inspection. The environmental health officer had inspected the home since the last inspection. Recommendations made during that inspection had been acted upon by the home. Cherry Tree House DS0000013597.V302235.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 3 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 X X X X X 2 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 Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? 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. Refer to Standard OP19 Good Practice Recommendations The home would be strongly advised to expand the risk assessment of hot water pipes and radiators to include more specific information about the potential risks on a room-by-room basis. It was recommended that the home continue to keep these records of meals provided in order to demonstrate compliance with National Minimum Standard 15, which states that residents ‘receive a wholesome appealing balanced diet.’ 2 OP15 Cherry Tree House DS0000013597.V302235.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 DS0000013597.V302235.R01.S.doc Version 5.2 Page 24 - 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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