CARE HOMES FOR OLDER PEOPLE
Cherry Tree House Collum Avenue Ashby Scunthorpe North Lincolnshire DN16 1TF Lead Inspector
Beverley Hill Unannounced Inspection 24th January 2006 09:30 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 DS0000002879.V281102.R01.S.doc Version 5.1 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 DS0000002879.V281102.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cherry Tree House Address Collum Avenue Ashby Scunthorpe North Lincolnshire DN16 1TF 01724 867879 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) Barton Medical Services Limited Ms Anji Gibson Care Home 34 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (34) of places Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st August 2005 Brief Description of the Service: Cherry Tree House is situated in the Ashby area of Scunthorpe close to local shops and amenities. It is owned by Barton Medical Services, a small private company providing a number of care homes in the area. The home is registered to provide care and accommodation for up to thirty-four older people with a broad range of needs including twenty people who may have needs associated with dementia. In addition they provide a day care service for up to five people per day. District nurses attend to those people who require day to day nursing support. The home has two floors serviced by both stairs and a passenger lift. The home has four lounges, two quiet rooms and two dining rooms. All bedrooms are single occupancy although none have en-suite facilities. The home is divided into four units, each with two toilets and either a bathroom and/or a shower room. The garden has a secured lawned area with seating and a patio is accessible from one of the dining rooms. There is ample car parking facilities for visitors. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager, two care staff and six people who lived in the home. The inspector looked at a range of paperwork in relation to assessments and care plans, the management of medication, adult protection policies and procedures, staff training, quality monitoring, fire drills and alarm checks and equipment servicing records. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to, that their privacy and dignity was respected and that they were able to make choices about their lives. The Inspector completed a tour of the building and checked the cleanliness of the home. What the service does well: What has improved since the last inspection?
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 6 The manager had ensured that all but one of the things the Inspector had asked them to do at the last inspection had been done. Care plans and risk assessments had improved and staff had clear tasks in order to meet people’s needs. The manager had also made sure that assessments of service users completed by care management had been obtained prior to admission and a formal letter was sent to the service user or their representative following initial assessment to state whether the home was able to meet the persons needs. The medication policy and procedure had been reviewed to include how staff will supervise people who are able to self-medicate. All complaints however minor were recorded to show that they had been dealt with satisfactorily. The manager had ensured that two windows had been replaced and other environmental repairs completed. The Commission received notifications of incidents and accidents as required. 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 DS0000002879.V281102.R01.S.doc Version 5.1 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 DS0000002879.V281102.R01.S.doc Version 5.1 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 and 4 The service users had their needs assessed prior to entering the home by the manager and the Care Management Team, when funded by them. The home was able to meet the current needs of service users. EVIDENCE: Service users needs were assessed prior to admission by care management if funded by them or the manager if privately funded. Since the last inspection the manager had ensured that the home received care management assessments and had audited files to address previous shortfalls in assessments completed by them. The manager confirmed that the assessments were used to determine whether the home was able to meet the persons’ needs and there was evidence that service users were formally written to stating the homes capacity to meet the assessed needs. Care plans were formulated from the assessments and addressed identified needs. The home had a staff team that accessed training and were competent in their role. The environment was suitable for its intended purpose and an occupational therapist had assessed the home for any aids and adaptations.
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 9 Specialist equipment was provided via the district nursing services and professional advice through them or GP’s. Service users spoken to felt their needs were met within the home. Staff helped them with personal care tasks and bathing and checked that they were alright during the night. Staff spoken described how they supported service users to settle into the home after admission by showing them around, introducing them to other residents, reading the menus to people and informing them about mealtimes and generally reminding them it was their home. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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): 8, 9 and 10 Service users health and personal care needs were met in a way that respected their privacy and dignity. The lack of any means to weigh those service users unable to weight bear meant that fluctuations in weight could not be monitored. EVIDENCE: Since the last inspection improvements had been made with care plans. They included all assessed needs and had clear tasks for staff. They had been evaluated monthly and changes in need were evident. Service users spoken to described care delivery that respected their privacy and dignity and gave examples of staff knocking on doors prior to entering, sensitive personal care and, ‘left in peace’ when they had visitors. One person described how they used the phone in the quiet room stating, ‘staff will dial the number to see if you are through then go’. Staff, in discussions, were also clear about the need to respect privacy and dignity and stated they always tried to talk to people about tasks they were to support them with, explaining as they went along. The promotion of privacy and dignity was covered in staff induction.
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 11 There was evidence that generally health care needs were met, however the home was unable to weigh those service users who were unable to weight bear. This was about seven to eight people and in a discussion with the manager it was clear that there was no alternative monitoring system in place for this, no recording of any visual check completed. This potentially meant that service users could lose large amounts of weight before it was noticed via clothing and addressed. The manager did state that loss of appetite would be recorded and steps taken to monitor this. Medication was well managed within the home. One staff member had designated responsibility for ordering and stock control. All medication was stored correctly, signed on admission to the home and on administration and policies and procedures reflected the way the home worked. There was a photograph for each service user and information about the medication they took and any allergies they had. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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): 13 and 14 The home promoted community links and encouraged contact with family and friends. Service users were able to make decisions and have choices about aspects of their lives. EVIDENCE: Service users and staff spoken to confirmed that relatives and friends could visit the home at any time and were made to feel welcome. The home had maintained some links with the local community to help improve the quality of life for people. Clergy visited the home for services and one person maintained contact with their own church in the community. The library visited four times a year to exchange books and the home regularly had visiting entertainers. Four service users have maintained contact with various clubs and a carers support group meets once a week at the home although the manager confirmed this had tailed off lately. The home received information about a local cinema showing, ‘Golden Oldies’ and although this was initially well received there had been no takers of late. The manager confirmed that service users seemed more active in accessing external facilities in the spring and summer months when the weather improved. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 13 Staff spoken to felt that service users were able to make choices about everything in the home. As examples they cited clothes, meals, rising, retiring, activities, visitors, trips out, drinks and bathing. Service users spoken to confirmed they were able to make choices about aspects of their lives. They stated that there were no set routines about rising and retiring, they could choose to join in activities or not, sit in any of the lounges, bring in items for their bedroom and have their own telephone. They were happy with the care they received within the home and stated they were well cared for. One service user has chosen to adopt the house cat and chooses to feed it and care for it. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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): 18 The home had policies and procedures and staff training in order to protect service users from abuse, however new staff members had not received training. EVIDENCE: Since the last inspection the manager had ensured that all minor complaints or niggles as well as more formal complaints were documented to enable a check on the outcome for the complainant. The home had a protection of vulnerable adults policy and procedure that linked to the multi agency policy and procedure. Staff spoken to were aware of what constituted abuse and what to do to report any incidents. All staff apart from two new staff members had received training in the protection of vulnerable adults from abuse. The manager was aware of referral procedures to social services as the lead agency for investigation. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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): 26 The home provided a clean and tidy environment for service users. EVIDENCE: Since the last inspection the manager had ensured that two broken windows had been replaced, a leak in one of the lounges had been identified and addressed and some dripping taps had their washers replaced. The home was clean, tidy and free from any unpleasant odours. It was clear that the domestic staff worked hard to maintain standards. The housekeeper checked the cleanliness of the home daily and ensured that scheduled tasks were completed. Service users spoken to were happy with the cleanliness of their bedrooms and the home in general. One service user was very pleased and described how staff came around every morning dusting and tidying and completed a full deep clean of their bedroom last week, removing all the furniture to clean behind it.
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 16 Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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): 28 and 30 On the whole competent staff supported service users but not all had completed relevant training. EVIDENCE: The home had a central training log in place that covered mandatory and some service specific training. The central training log stated that most staff had completed basic food hygiene, health and safety, infection control, first aid, dementia awareness, adult protection, fire and moving and handling. Individual training records were maintained. One staff file examined in detail did evidence a range of training both mandatory and service specific. Two files of new staff were examined and the inspector could not find evidence of their participation in training although the central log stated they had completed certain training. The individual training files need to match to the central training log with regards to evidence of participation in training. All seniors had completed accredited medication training and all staff including ancillary staff had completed or were progressing through a distance learning pack on dementia awareness. A training plan was incorporated in the homes annual Business Plan. The manager confirmed that the current induction was allied to TOPPS specification and new staff members worked through an induction booklet with support from senior staff. However the company had been proactive in
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 18 currently reviewing the induction booklets and they were to include new information and standards from Skills for Care. Six staff had completed NVQ level 2 in care and one had completed Level 3. A further staff member was progressing through Level 3. When completed the home will have 42 of staff trained in NVQ. Staff members spoken to were keen to participate in training and felt the company supported and encouraged them to do this. Completed NVQ training figures had been affected recently by two trained staff that had moved on to further their careers in caring. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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, 37 and 38 The manager provided leadership and guidance to staff and ensured the quality of the service was monitored and the environment was a safe place to live and work. EVIDENCE: The manager had been in post since 1999 and completed the Registered Managers Award and NVQ Level 4 in Care in 2005. They had completed a recent two-day first aid update and was a trainer in moving and handling and health and safety. The manager had also completed an accredited medication course and, in the past, a course to enable them to facilitate adult education. Service users spoken to knew the manager and staff members felt supported and had access to the Directors who visited the home. The home had a system to monitor the quality of care provided and this consisted of a range of environmental audits and questionnaires to service
Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 20 users, relatives and visiting professionals. Results were collated and action plans made to address any shortfalls. Results were formulated into graphs and made available to service users and the Commission. The home had been awarded the Gold Standard by the local authority in their Quality Development Scheme. Service users spoken to were positive about the care they received. The home ensured that information and documentation covered by data protection legislation was held securely. Care plans were held within cabinets in the seniors’ office and the administrator held financial information. The manager secured staff information and any other considered to be of a sensitive nature. Computers accessed by the manager and staff were maintained in secure offices. Equipment was serviced appropriately and the environment was regularly checked as part of the homes quality monitoring system. Fire drills were carried out monthly and fire equipment checked weekly. The manager and staff were aware of health and safety issues and training and adherence to policies and procedures ensured the home was a safe place to live and work. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 x x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x 3 3 Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 Standard OP8 Regulation 12(1)(a) Requirement The registered person must ensure that all service users are weighed monthly or an effective monitoring system is developed that will establish any weight loss sufficiently for staff to take remedial action (previous timescale of 31/08/05 not met) The registered person must ensure that new staff complete training in the protection of vulnerable adults from abuse. The registered person must ensure that new staff complete mandatory training and update their individual training logs to provide evidence of their participation Timescale for action 28/02/06 2 OP18 13(6) 31/03/06 3 OP30 18 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 23 No. 1. Refer to Standard OP28 Good Practice Recommendations The home should continue to work towards 50 of staff trained towards NVQ Level 2. Cherry Tree House DS0000002879.V281102.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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