CARE HOMES FOR OLDER PEOPLE
Cherry Tree House Collum Avenue Ashby Scunthorpe DN16 1TF Lead Inspector
Bev Hill Unannounced 31 August 2005 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 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 J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cherry Tree House, Address Collum Lane, Ashby, Scunthorpe, DN16 1TF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01724 867879 Barton Medical Services Ltd Anji Gibson CRH 34 20 DE(E) Category(ies) of 34 OP registration, with number of places Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 15.2.05 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 J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 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, one senior carer, two care staff and one cook who were on duty at the time of the inspection. Throughout the day the Inspector spoke to nine people who lived in the home, two people who were having a short break and two people who attended for day care. The Inspector also spoke to two relatives. The inspector looked at a range of paperwork in relation to staff recruitment, rotas, finances, staff supervision, care plans, risk assessments, policies and procedures and complaints. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a tour of the building. What the service does well:
There was a core group of staff that had worked at the home for several years and knew the people who lived there well. The staff tended to remain at the home for a long time, which was good for the people who lived there as they got used to them. People who lived at the home said that nearly all the staff members were caring, patient, kind and they looked after people well, respected their privacy and made their relatives feel welcomed. In a discussion the Inspector had with a few people they mentioned that two staff members could be abrupt. This was mentioned to the manager who will investigate. The Commission for Social Care Inspection received a letter from the relative of a service user who died in the home. They were very pleased with the care the person received during their stay at the home. There were two very frail people living at the home who were nursed in bed a lot of the time but they had not developed any pressure sores and the staff were proud of this record. The home was reassessed for the Local Authority Gold Standard Award for quality monitoring in August 2005 and had been successful. The home write down in care plans all the care that is required and although some improvements are required with these, at the front of everyone’s file is an, ‘at a glance’ pen picture of how staff manage with basic daily tasks. This was really useful to new staff members who could remind themselves quickly of basis information. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 6 There were enough staff members on duty at any one time and people said that they answered call bells reasonably quickly. At one weekend recently there had been a staff shortage and people who lived there said they had to wait longer than usual. See the section, ‘What they could do better’ below. Relatives stated that they were kept informed of important issues, none had any complaints and they were satisfied with the care received. Both relatives spoken to were very involved with the home. The home provided a pleasant environment. It was clean and tidy and had a welcoming, homely feel. There were areas throughout the home where people could sit quietly and plenty of lounges in which to sit. People spoken to stated that the meals were very good. They had two choices at lunchtime and had plenty to eat and drink. People spoken to said that if they didn’t like the choice on offer they could have an alternative. Staff member’s deal with any ‘niggles’ quickly but they needed to write them all down to show that the person who had the ‘niggle’ was satisfied. What has improved since the last inspection?
The manager had seen to it that all but two of the things the Inspector had asked them to do at the last inspection had been done. The information provided to people wanting to look around the home had been updated and included quotes from people who lived at the home. This was important because people needed to have information to help them decide whether Cherry Tree was where they wanted to live. There had been some improvements in care plans although there was still some issues to address. See below. The manager made sure that all medication was stored correctly and this included items that needed to be stored in refrigerators. She had also made sure that when people had been prescribed creams and ointments from the GP, these were properly applied by senior care staff who documented this clearly. When people wanted to remain at the home to die the manager made sure all their needs at this time were written down in a special care plan. This was important to make sure nothing was forgotten and friends and relatives were supported. All toilets and bathrooms now have paper towels and dispensers to make sure there is no cross infection. Policies and procedures that gave guidance for staff were much clearer.
Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 7 The water was really hot in the hairdresser’s room and one of the bathrooms but these have been attended to now to make sure people do not receive scalds and burns. Staff must be supervised with one-to-one discussions with a senior or manager six times a year. The manager made sure that this happened and wrote everything down on supervision forms. Supervision was important to make sure staff were monitored and were able to do their job properly. What they could do better:
When the manager completes an assessment of peoples needs before they are admitted to the home they need to formally write to the person to say the home is able to meet their needs. The home also needs to consistently obtain assessments completed by Social Services. The care provided by staff was written down in care plans, however two of the care plans examined did not contain all the needs that the person had when they were assessed before they went into the home or when their needs had changed. For example, one person’s assessment stated that they had a poor appetite and had a poor memory but these points were not mentioned in the care plan. Similarly one person had started to wander out of the building but there was no plan in place to manage this and the staff had not examined all the risks that this implied. It was really important to write down all the persons needs, update the plans when the person’s needs changed and to examine all the risks of particular activities otherwise people would be at risk of inadequate care. Staff completed monthly reports on whether the care plan is still meeting the person’s needs. Care must be taken with these to make sure they included changes. For example the report for the person who wandered out of the building stated that their risks were low but these had changed and risks were high. The policy and procedure for when people wanted to manage their own medication needed to include information about how staff were to monitor this. This was important as staff needed to be aware of how to monitor selfmedication and people who wanted to self-medicate needed to be aware that staff had a duty to monitor it. Sometimes niggles were reported to staff and although they deal with them they should write them down so there is a record of them. One of the toilet windows wouldn’t open as the frame was damaged and one of the bedroom windows had a rotten window frame with a loose piece of glass. These must be fixed quickly because the toilet needs to be ventilated and the bedroom window needs to be safe. Some of the taps in the toilets dripped and needed adjusting and a leak that was noticed in one of the lounges needed investigating and fixing.
Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 8 The manager needs to have contingency plans for when staff are sick or on holiday as at the moment they have to rely on current staff filling the gaps, which is not always possible and may leave the home short staffed. The home must make sure that when incidents occur that must be reported, for example when a person wanders out of the building for a length of time, then they must fill in a form and let the Commission know. 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 J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 9 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 Standards Statutory Requirements Identified During the Inspection Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 10 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 standard(s) 3 and 5 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 did not always obtain the Care Management assessment, which could mean that vital information is missed and the required care not provided. The home was able to meet the needs of current service users and offered trial visits. EVIDENCE: The manager confirmed that they completed in-house assessments and there was evidence that some assessments completed by Care Management were obtained by the home prior to admission but this was not consistently the case in all care files examined, although local authority care plans were in evidence. The assessments were important as they provided vital information for the care planning stage. The homes assessment documentation covered all the required points highlighted in the standard. The manager visited people in hospital, their own homes or other residential homes to gather information from service users, relatives and carers to complete the assessment. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 11 The manager needed to formally write to service users or their representatives following assessment to state that the home was able to meet their needs. Staff members and people who lived at the home stated that people had the opportunity to visit Cherry Tree House before they decided on permanent residency. The home also offered day care and a respite service, which gave people the opportunity of short stays at the home and introduced them to other service users and staff. The manager confirmed that the first four to six weeks of residency was on a trial basis and this could be extended as required. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 12 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 standard(s) 7, 8 and 11 Service users were at risk of inadequate care as care plans did not include all assessed needs, were not consistently updated as needs changed and risk assessments did not cover all areas. The home provided care, support and access to specialist practitioners for people who chose to die there. EVIDENCE: Three care files were examined in detail. Care plans generally described the care needs identified at assessment, however it was noted that not all assessed needs had been incorporated into the plan. For example one person had a poor appetite and memory loss on the assessment but no plan of care for these. The daily records confirmed fluctuating appetite but there were no tasks for staff in how to manage and monitor it. The inspector was unable to see a weight-monitoring chart for this service user although they were in evidence in other files. Similarly another person had fragile skin mentioned on the assessment and was at risk of skin tears, however no preventative plan was in place.
Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 13 Some risk assessments were in place but again they were not consistent in all files. For example there was no risk assessment for poor appetite, fragile skin and wandering behaviour that posed quite a serious risk of the service user leaving the building. Monthly evaluation of risk took place, however one had not picked up the change in risk for the person who wandered as their risk analysis was documented as low. Care plans were evaluated on a monthly basis and there was evidence that in some cases they had been updated as needs changed. However this was not the case in all the care plans. One person’s change in needs was clearly highlighted in a review but this had not filtered to the care plan itself. Despite some of the care plan issues service users and relatives spoken to stated that health needs were met. There was evidence of GP, community psychiatric nurse, Macmillan nurse and district nurse input and specialist equipment had been provided for pressure relief. Daily personal care sheets were completed for each service user and the home used risk-monitoring tools for nutrition, moving and handling and tissue viability. Monthly weights were recorded in two of the three care files examined. The management of medication is to be assessed in detail at the next inspection, however requirements made at the last inspection about the storage of some medication and eye drops and the recording and application of topical products had been complied with. The home had produced a care plan to use when a person was dying. This included all the care they required when nursed in bed during their final days. It covered personal care, pressure area care, nutrition, oral hygiene, pain control, company, professional input, spiritual needs, and support for the family and friends. Two service users were very frail and elderly and were nursed in bed for the majority of the time with the agreement of relatives. Records showed that they received all the required care and attention and staff members spoken to were proud that the service users had not developed any pressure sores. Monitoring charts were in place for pressure relief and fluid intake. Staff members spoken to were sensitive and aware of the needs of other ill people within the home. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 14 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 standard(s) 12 and 15 Although a small selection of activities was provided the range needed to be expanded to meet the needs of all service users who wished to participate. Service users nutritional needs were met in the home via a well planned and prepared menu. EVIDENCE: Service user spoken to stated that there were no set routines in the home and visitors were welcomed at any time. An activity coordinator was employed for three hours a day, five days a week and provided a selection of activities for people to participate in if they choose. Two of the service users spoken to felt that some of the activities did not match their needs and were aimed at a much younger audience. Similarly two of the service users visiting the home for day care stated that there were not a lot of activities for them to participate in. One person spoken to stated she was not particularly interested in the activities as she was 95 years old and liked to do her own thing, i.e. listen to music, watch TV, read her newspapers and sleep a lot. She stated that staff respected this choice. The activity log showed that activities such as bingo, videos, dominoes, manicures, exercise to music, colouring, scrabble, star bingo, table skittles and entertainers had taken place. The activity coordinator needed to canvass views on the range of activities as part of a quality monitoring/user satisfaction exercise.
Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 15 Thirteen service users were spoken to and all stated the meals were very good. People spoken to stated they had a good range of breakfast meals including cereals, porridge, toast and a full English breakfast of bacon and eggs etc. A three-course meal was served at lunch with two main choices and alternatives were available. Fresh fruit and vegetables were available and there were plenty of hot and cold drinks throughout the day. Menus were written over five weeks and were subjected to seasonal changes or at service users requests. This enabled people to have choices and to influence the menus to incorporate their favourite dishes. A discussion with the cook revealed that the home catered for special diets such as diabetic, soft, high fibre and low fat diets. She was aware of the dietary needs of the permanent service users and those who attended for day care and explained that one service user had been diagnosed with a serious illness and the catering staff were providing them with anything they fancied. The cook described how she always liked to use fresh ingredients and even made her own fish fingers and ensured there was a range of home made cakes and buns for the service users to enjoy. Fresh fruit and vegetables were available along with a small selection of frozen vegetables. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 16 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 standard(s) 16 Most service users felt able to make complaints, however improved documentation would evidence complainant satisfaction for minor complaints/concerns. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. The home had a complaint form, which included aspects of the complaint and what action was taken to resolve the issue. Some service users spoken to felt they didn’t like to make any complaints, although they did say they would go to the manager or their families for what they considered serious matters. Via discussions with some service users, relatives and staff it was evident that not all ‘niggles’ or minor complaints were documented but just dealt with there and then. It was important that all complaints however small were documented with an outcome that meets the complainant’s satisfaction. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 17 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 standard(s) 19, 21,22 and 25 The home was generally safe and well maintained for service users, however the environment would be enhanced by the replacement of two windows, investigation into a leak in one of the lounges and the adjustment of some dripping taps. EVIDENCE: Generally the home was well maintained and the proprietors took note when repairs were required. A maintenance person was employed for day-to-day repairs. A refurbishment plan was in place, however the manager confirmed that a new boiler had taken precedence over the planned refurbishment of some of the bathrooms and toilets. The home was clean and tidy and was suitable for its intended purpose. A recommendation of the last inspection was that toilets had paper towels and dispensers to prevent the spread of infection. These had been installed. The home had two sluice rooms, which were locked when not in use. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 18 The proprietors had organised an assessment of the building by an occupational therapist to advise on aids that were required. Recommendations had been addressed. The home had appropriate moving and handling equipment throughout the home and a lift and stairs serviced the upper floor. Some of the hot water outlets had fluctuating temperatures, however the home had installed a new boiler to address the situation and was working with the installation company to identify ongoing problems. Maintenance personnel completed monthly water temperature records and the manager confirmed that these were to be taken at different times of the day to try to highlight problem areas. Some of the taps in toilets appeared to drip incessantly and were in need of adjustment. Two of the windows were in need of replacement. One of the toilet windows was unable to be opened and therefore the room could not be ventilated. Similarly one of the bedroom windows had rotten woodwork and a loose pane of glass. An immediate requirement notice was issued for the replacement of the two windows. It was noted in minutes of a meeting that relatives had witnessed water leaking near one of the lounge windows. An immediate requirement notice was issued for this to be investigated and addressed. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Service users benefited from the presence of long term staff, however more effective contingency plans for gaps in shifts was required to ensure the homes staffing notice was met. EVIDENCE: The home had a staff rota that reflected who was on duty and in what capacity. Rotas showed that there were four care staff members and one senior on duty throughout the day. Occasionally three staff and a senior were on duty in the afternoons instead of four. There were two waking staff members at night with a senior staff sleeping in the building. The home also employed an activity coordinator for three hours each afternoon Monday to Friday. The manager was supernumerary. There appeared to be sufficient domestic and catering staff. Staff members spoken to stated that the morale was good amongst the staff team. Most people spoken to were very complimentary about the staff team. Service users stated they were very kind and friendly and one of the staff always made them feel happy when she came on duty. One service user stated that the staff team showed her the greatest care when she was bereaved some time ago and she felt she received the best care ever. In a discussion the Inspector had with a few people they mentioned that two staff members could be abrupt. This was mentioned to the manager who will investigate. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 20 Generally call bells were answered quickly but some service users reported that one weekend recently there was a staff shortage and people had to wait longer than they should. The rotas were checked for this weekend and indeed it was found that due to sickness only three staff members were on duty for one of the afternoon shifts. This made the staffing ratio below the required limit and the home must ensure it does not occur again. The manager stated that they did not utilise agency staff but relied on existing staff to cover gaps due to holidays and sickness. The home needed to have a more effective contingency plan to cover gaps in shifts. The manager confirmed that the home currently had one eighteen-hour post for a night care worker vacant. This vacancy was being filled by existing staff. Relatives spoken to knew the names of the key workers, the manager and many of the staff team. The home had recruitment policies and procedures in place. A file of the latest care staff to be employed was examined and it was noted the home had undertaken all the necessary recruitment checks to ensure protection of the service users. It contained an application form, proof of identity, two references and a criminal records bureau check prior to employment. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36 and 37 Service users finances were managed effectively and staff members were appropriately supervised in their role and tasks. EVIDENCE: Families mainly managed service users finances although the home held a small amount of personal allowance for twenty-two people. Individual savings record sheets were maintained with two signatures for each transaction. Receipts were in place for personal shopping, hairdressing and chiropody. A selection of service user records were examined and found to be correct. The manager advised that she was not an appointee for anyone and pensions were paid directly into bank accounts. Service users spoken to were aware that they had small amounts of personal allowance held for them in the safe. Some managed their own finances and had lockable facilities in their bedrooms.
Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 22 The manager supervised senior care staff who in turn supervised care staff. A set agenda was used to prompt the supervisors and this included Health and Safety, policies and procedures, training and development, quality assurance monitoring, caseload/work management and information to be passed on. Dates were organised throughout the year and to date the team were on target to receive six supervision sessions per year. Staff members spoken to felt that they were well supported and participated in supervision sessions. One person stated it enabled them to discuss problems and identify what training courses they needed to attend. Appraisals were held annually. The manager saw supervision and appraisals as important mechanisms for staff development and as a way of monitoring practice in a supportive way. Not all notifications were sent to the Commission as required. For example the Commission were not notified that the missing person procedure was activated for one service user who had wandered out of the building. All incidents that required notification under regulation 37 of the Care Homes Regulations must be forwarded to the Commission. Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 2 x 3 x x x 2 x STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x x x 3 3 2 x Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 24 yes 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. 1. Standard 7 Regulation 15 Requirement The registered person must ensure that care plans cover all assessed needs and that changes in need are reflected in care plans. (previous timescale of 30.6.05 not met) The registered person must ensure that the medication management policy is adjusted to include supervision procedures for service users who self-medicate. (previous timescale of of 31.5.05 not met) The registered person must ensure that the home obtains assessments completed by Care Management The registered person must ensure that the home formally writes to service users following assessemnt detailing their ability to meet needs. The registered person must ensure that all service users are weighed monthly and appropriate action taken as required. The registered person must ensure that risk assessments are completed for all activities Timescale for action 31st Oct 2005 2. 9 13(2) 31st Oct 2005 3. 3 14 4. 3 14(1)(d) 5. 8 12(1)(a) 6. 8 13(4) From date of inspection 31st Aug 2005 From date of inspection 31st Aug 2005 From date of inspection 31st Aug 2005 31st Oct 2005
Page 25 Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 7. 16 12(1)(a) & 17(2) 8. 19 23(2)(b) 9. 10. 11. 25 25 27 23(2)(b) 23 18 12. 37 37 assessed as a risk and these are accurately monitored and reviewed to inform practice. The registerd person must ensure that all complaints however minor are documented and show complainant satisfaction. The registered person must ensure that the leak reported in one of the lounges is investigated and addressed. The registered person must ensure that the two broken windows are replaced. The registered person must ensure that the dripping taps in the toilets are adjusted. The registered person must ensure that the home has contingency arrangements in place to cover staff shortages. The registered person must ensure that allnotifications are forwarded to the CSCI. From date of inspection 31st Aug 2005 immediate immediate 30th Sep 2005 30th Sep 2005 From date of inspection 31st Aug 2005 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 12 Good Practice Recommendations The Activity Coordinator with support from the manager should canvass service users views regarding the quality of the activities provided and adjust as required to meet needs. The manager should continue to work with the heating installation company to address fluctuations in hot water outlets. 2. 25 Cherry Tree House J54 2879 Cherry Tree House V247164 31 August 2005 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 oQF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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