Inspection on 22/09/08 for Cherry Tree House

This inspection was carried out on 22nd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Tree House 31/10/07

Cherry Tree House 09/05/07

Cherry Tree House 18/09/06

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 05/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cherry Tree House Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 2 2 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cherry Tree House 29 St Johns Road Cherry Tree House Farnham Surrey GU9 8NU 01252734417 Telephone number: Fax number: Email address: Provider web address: cherry-tree-house@hotmail.com Name of registered provider(s): Name of registered manager (if applicable) Mrs Gillian Margaret Nicholls Type of registration: Number of places registered: Mrs Gillian Margaret Nicholls care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Up to 2 (two service users may be in the category: dementia for older persons DE(E). Date of last inspection Brief description of the care home 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 a large, level garden is 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. The fees at this service range from #327.00 per week to #400.00 per week. Care Homes for Older People Page 4 of 27 Over 65 2 4 0 0 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The Commission for Social Care Inspection (CSCI) undertook an unannounced site visit on the 22nd September 2008 using the Inspecting for Better Lives (IBL) process. Regulation Inspectors Mr Kenneth Dunn undertook the site visit. The registered provider was present throughout. People living at the home prefer to be known as residents, therefore this term of reference is used throughout his report. The inspection process included a tour of the premises, direct observation of practise and sampling of residents care plans and risk assessments. Other documents sampled Care Homes for Older People Page 6 of 27 included the menu, records of medication and health an safety records. The inspectors had discussions with the manager and staff. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the care home has been used as a source of evidence in this report. The weekly fees for the home range from 327.00 pounds to 400.00 pounds. The inspector would like to thank the manager, staff and residents for their cooperation during this site visit. Feedback was provided on both days of the site visits. The date of the last key inspection was the 31st October 2007. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents will only be admitted to the home following an assessment of their needs. The home does not provide intermediate care. Evidence: The home had a statement of purpose and service user guide which was informative and contained sufficient information about the home. The information should to allow prospective residents to make a decision about the home and it suitability to met their needs. However the statement of purpose contained the contact details for additional professional agencies this was found not to be current and should be updated and reviewed on a regular basis. There has been no new residents admitted into the home since the last inspection by the Commission for Social Care Inspection (31/10/2007). The registered provider stated prospective residents would be now only be admitted to the home following a Care Homes for Older People Page 10 of 27 Evidence: full assessment of their needs. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have care plans and risk assessments in place to ensure their health care needs are met. People are protected by the homes storage of medication and administration procedures. The dignity of residents is being appropriately promoted. Evidence: The care plans for both residents were sampled during the site visit. Care plans were maintained and included information in regard to physical and health care needs. Care plans had been signed and had been reviewed on a monthly basis. Daily notes were maintained. Risk assessments were in place and had been reviewed regularly. Dietary assessments are undertaken monthly including the monitoring of weights. The care plans viewed include a medication plan that is also included in the medicine records. Social activities had been included in the care plans. The registered provider stated that the residents Care Homes for Older People Page 12 of 27 Evidence: prefer to enjoy a peaceful lifestyle interacting with the staff and their family. There is evidence of care plans receiving regular reviews. Fluid intake was also monitored on a daily basis, this was in line with a requirement that was made in the previous inspection report. Records of all health care professional appointments are maintained that include the GP, district nurse, diabetic nurse, the community psychiatric nurse, and chiropodist and physiotherapy appointments. Medication records sampled were good and no gaps were identified in the Medicine Administration Record sheets (MARs). During discussions staff told us that they respect residents privacy and dignity through knocking on bedroom doors, attending to personal care needs in the privacy of bedrooms and calling residents by their preferred names. The AQAA informs that the home uses robust medication policies and procedures are in place. Care Homes for Older People Page 13 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have the opportunity to further their lifestyle choices, and are encouraged to maintain contact with their family. Meals are varied and choices are offered ensuring that residents have a balanced diet. Evidence: The ethos of the home is to ensure that the residents live in a environment which is homely and meets their individual needs. The registered provider stated that the service does have an activities plan neither of the current residents partake in events, preferring to interact with each other and the provider and his family. The registered provider stated that the home provide activities in a more spontaneous fashion and can organises outings and events that the residents can access and join. There are no restrictions to visiting times and staff support and encourage the residents to maintain family links and friendships both inside and outside the home. Menus were varied and well-balanced. The lunchtime meal was being prepared and served during the visit and the food was presented in an appetising manner. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to a robust complaints system that enables them to raise concerns. Staff have all received training in the Protection of Vulnerable Adults to ensure residents are fully protected from abuse. Evidence: The service has a robust complaints policy. The registered provider stated that the service has not received any complaints in the last twelve months. The AQAA informed that the home has not logged any complaints since the previous Commission for Social Care Inspection site visit (31/10/2007). Commission for Social Care Inspection has not received any complaints in regard to the care home during the last twelve months. No safeguarding referrals have been made since the last inspection. We were told that the registered providers had undertaken training in the Local Authority Safeguarding Adults Procedures however this should be updated to ensure that the residents are fully safeguarded. All staff working at the home have undertaken Adult Abuse Training the certificates confirmed that these are current. During discussions, staff were able to demonstrate that they were aware of the different types of abuse. They were able to demonstrate an understanding of Safeguarding Adult issues and the importance of reporting to the manager. The home has policies and procedures in place to protect residents from financial abuse. Residents and/or their relatives are responsible for their finances. The home Care Homes for Older People Page 16 of 27 Evidence: holds small amounts of monies for residents that is kept secure. The registered provider stated that all transactions are full documented and a audit of these records did not highlight any discrepancies. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and lay out of the home are suitable the homes stated purpose. The people living at the service live in a safe and well-maintained environment. Evidence: The residents accommodation is situated on the ground floor of the property. There is a ramp to access the front of the property and handrail at the back of the building enabling access to the garden. All the residents bedrooms were seen during the site visit. They were clean, warm and comfortably furnished. The bedroom windows however had not been fitted with window restricters and could be fully opened. This was discussed during the visit and the registered provider stated that suitable remedial works would be completed to fit and secure the window locks. The sitting/dining room is homely and suited the needs of the residents. The registered provider stated that the sitting room was a pleasant room and the residents enjoy the relaxed atmosphere especially when the open fire is lit. During a discussion it was agreed that the open fire and the fire guard must be risk assessed to ensure that the residents a safeguarded. The service has had a new bath hoist fitted since the previous Commission for Social Care Inspection site visit (31/10/2007). The hoist was fitted by the registered provider, who stated that he was trying to identify and engage a suitable service engineer to maintain the hoist. Care Homes for Older People Page 18 of 27 Evidence: The service had two dead bolts fitted to the door frames. It was stated that the bolts had been fitted to safeguard a former resident. When the inappropriateness of the locks was raised with the registered provider both locks were removed immediately. The home was clean and hygienic, with good infection control measures in place. Paper towels are now provided in the communal toilet and bathroom. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing are satisfactory. People who use the service require to be protected by the homes recruitment policy and procedures. The staff hours and cover are sufficient to met the needs of the numbers resident at the time of this site visit. Evidence: The registered providers and their immediate family provide personal care and carry out all other roles, including shopping, cooking, laundry and house keeping. A staffing rota has been developed and is being maintained. The registered manager provided evidence that he undertaken all the required checks on the people who work in the home for example CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults). There was some confusion regarding the information required by there service in respect to application forms and employment histories of the staff. It was felt that because of the very family orientated service application forms for family members would not be appropriate and an alternative form of records could be sourced. During discussions with staff it was agreed that they would supply copies of their full CVs, which must include full details of training they have undertaken. The registered manager stated that the service would retain this information as the basis for the staffs personnel files. Care Homes for Older People Page 20 of 27 Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for management and administration ensure the home is run in the best interests of residents, and their health and safety is promoted and safeguarded. Evidence: The home is managed jointly by the registered providers, and they have run the home for several years undertaking all duties on a day to day basis. Both registered providers have undertaken and completed an NVQ 4 (National Vocational Qualification) in care. The registered provider stated that the residents and/or their families are responsible for their finances. The home holds a small amount of money for basic day-to-day purchases. The staff record all transactions undertaken for the residents and receipts are maintained in conjunction with their individual cash books. A full audit of the residents daily financial records was undertaken as part of this site and they were found to be in very good order. Care Homes for Older People Page 22 of 27 Evidence: The health and safety of the people who use the service is produced by the policies and procedures in place at the service. The registered provider had a new bath hoist fitted on the 12th September 2008, they have however not purchased a maintenance contract fro the hoist. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The registered provider must ensure that window restricters are fitted to all windows. To ensure the continual safe keeping of the residents 25/10/2008 2 19 16 The registered provider must complete a risk assessment on the open fire and the fire screen. To protect the resident from potential harm. 25/10/2008 3 19 16 The registered provider must ensure that an appropriate service contract is arranged for the future maintance of the bath hoist. To ensure that the residents a safe and secure. 25/10/2008 4 29 19 The registered provider must ensure that a CV is obtained from all staff ensuring that it contains a copy of all training undertaken by the staff 10/11/2008 Care Homes for Older People Page 25 of 27 member. The registered provider must provide copies of the CVs and training information to the CSCI within the prescribed timescale. The people who use the service must be protected by the services recruitment procedures. 5 38 23 The registered provider 07/11/2008 must ensure that a regular maintenance contract is developed for the regular up keep of the bath hoist. The health, safety and welfare of the people who use the service is promoted and protected Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered provider should ensure that the statement of purpose is updated on a regular basis to ensure that the information is accurate and relevant. It is recommended that the registered provider and the registered manager undertake a refresher course with Surrey County Council regarding Protection of Vulnerable Adults. 2 18 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!