CARE HOMES FOR OLDER PEOPLE
Cherry Tree House Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU Lead Inspector
Kerry Fell Unannounced Inspection 4th October 2005 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cherry Tree House Address Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU 01252 734417 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Gillian Margaret Nicholls Mrs Gillian Margaret Nicholls Care Home 6 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (4) of places Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Up to 2 (two service users may be in the category: dementia for older persons DE(E). 19th July 2005 Date of last inspection Brief Description of the Service: Cherry Tree House is a privately owned detached house that is situated in a quiet road near the centre of Farnham. The property is the family home of Mr and Mrs Nicholls. The home is managed and staffed solely by Mr and Mrs Nicholls and their family. The home has a domestic feel, and service users are accommodated in attractively decorated single rooms. There is a small parking area at the front of the home, and attractive well-maintained gardens are available for use by the service users. The service is registered to provide personal care for up to six older people, two of whom may have dementia. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second inspection for the inspection year 2005/2006. The inspection was unannounced which means that neither the members of staff nor the service users knew the inspection was going to take place. The inspection commenced at 10.15am. The inspection was undertaken by Mrs Kerry Fell and took one hour to complete. The inspection focused on the key standards that were not inspected at the last inspection, and any requirements that were made at the last inspection. The inspector reviewed the home’s records. Service users were present at the time of the inspection however; they were either resting in their bedrooms or were asleep in their chairs in the lounge, so the inspector did not wake them. All of the service users were spoken to at the last inspection. What the service does well: What has improved since the last inspection? What they could do better:
The inspector observed that some non-prescribed medication was held in an unlocked cupboard. All medication must be stored securely. Medication that is not for use by the service users must be stored separately and safely. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 6 The most up to date copy of Surrey Multi-Agency Protection of Vulnerable Adults Procedures were not available at the home, these must be obtained. The registered persons must also ensure that their protection of vulnerable adults procedure reflects the new multi-agency procedures. It was not evident that all staff employed by the home were completing five days of training each year, therefore the home is required to be mindful about ensuring that this occurs. The CSCI Surrey Local Office appropriately received a notification of an incident that occurred following the inspection. However the inspector was also made aware that another incident had occurred earlier in the year and that this had not been notified to the CSCI Surrey Local Office. The registered person must ensure that all notifications as required under regulation 37 of the Care Homes Regulations 2001 are made to the CSCI Surrey Local Office. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 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 Formal written pre-admission assessments are not available for all service users. EVIDENCE: A requirement was made at the last inspection for the home to ensure that a copy of the care management assessment for the most recently admitted service user be obtained. Previous inspections have evidenced that pre-admission assessments are completed on service users admitted to the home. The inspector was advised that informal assessments were completed on this service user at the time of admission although the home was awaiting the care management assessment documentation. The inspector was advised that the service user, who did not have pre-admission documentation from the local authority, was now selffunding, and therefore a care management assessment would not be sent to the home. Detailed information was held about the service user, however the home must complete their own assessment documentation for this service user.
Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9. All service users have a detailed care plan that is regularly reviewed. Service users medication is stored in a locked cupboard, and is administered from pharmacy labelled containers, however not all medication was stored securely. EVIDENCE: Review record forms had been attached to the front of the service users care plans since the last inspection. These evidenced that the care plans were being regularly reviewed. Care plans observed during the inspection continued to be detailed documents. The home used pro-forma documents that they printed off and completed. The inspector observed that a detailed care plan had been completed, since the last inspection, for the most recently admitted service user. The inspector observed that the home continued to hold prescribed medication in a small lockable safe. The home continues to hold a small amount of medication for service users. All medication is administered directly from the pharmacy labelled package. The inspector observed that some non-prescribed medication was held in an unlocked cupboard. All medication must be stored
Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 10 securely. Medication that is not for use by the service users must be stored separately and safely. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 11 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): 14 Where possible, service users are supported by the home and their relatives to make choices about their lives. EVIDENCE: The inspector observed that service users are able to choose where they wish to spend their time, and are free to move around the home. The home sends out questionnaires to relatives, and there was evidence on the service user’s files that relatives are in regular contact with the home. A document has been developed by the home that lists all of the agencies that may be contacted by relatives or service users, that includes contact details for the CSCI Surrey Local Office, and the Primary Care Trust and Social Services. Service users are able to personalise their bedrooms. No service users manage their own finances. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 12 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 Staff have received training in the Surrey’s Multi-Agency Protection of Vulnerable Procedures, however, an updated copy of these procedures was not available at the home. EVIDENCE: A member of staff spoken to during the inspection confirmed that they had attended training in Surrey’s Multi-Agency Protection of Vulnerable Adults Procedures in September 2004. The registered persons also confirmed that they had received training in these procedures. The home did not hold the most recent copy of Surrey’s Multi-Agency Protection of Vulnerable Adults Procedures, and must obtain a copy. The registered persons must ensure that their protection of vulnerable adult’s procedures reflect these updated Multi-Agency procedures. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 The home is in the process of redecorating communal areas. Laundry is completed in a separate laundry area. EVIDENCE: At the time of the inspection the entrance and main hall were being redecorated at the time of the inspection. The inspector was advised about the forthcoming plans to redecorate the lounge and a service user’s bedroom. The inspector was also advised that the front door was due to be replaced. The home continues to have a laundry area that is separate from the home. The inspector was advised that all laundry is handled safely when being transferred to this laundry area. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The registered persons and their family staff the home. No new staff have been recruited to the home. The registered persons have completed the NVQ Level 4 in care but are having difficulty getting the work assessed. EVIDENCE: The registered persons and their family run the home. Staff rosters are available, and at the time of the inspection the registered individual and their son were available at the home, and the registered manager returned to the home during the inspection having completed the food shopping. The registered persons have completed all modules of the NVQ Level 4 in care, however the company that were due to assess their work have ceased trading. The registered persons have been in close contact with the CSCI Surrey Local Office with regard to the difficulty the have had trying to arrange for their work to be assessed. One member of staff has also completed NVQ Level 3 in care and the registered persons plan to arrange for them to register on the NVQ Level 4. No new members of staff have been recruited to the home. The registered persons have been focusing on completing the NVQ Level 4 course and have therefore not completed any further training. Although no
Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 15 evidence was observed to suggest that mandatory training for the registered persons and their family may have lapsed, the home must be mindful to ensure that mandatory training is kept up-to-date and that all staff complete at least three days training each year, in order to meet this standard. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 16 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, 38 Registered persons with extensive experience manage the home. Fire records are better maintained. EVIDENCE: The registered provider and registered manager have extensive experience in running this home. The home is a family business that has been run for many years. Both registered persons have completed the work for the NVQ Level 4; please also see comments under standard 28. A requirement was made at the last inspection with regard to fire records being updated on a weekly basis. The inspector observed that at the time of the inspection a pro-forma document was being used and that this was well maintained.
Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 17 The CSCI Surrey Local Office appropriately received a notification of an incident that occurred following the inspection. However the inspector was also made aware that another incident had occurred earlier in the year and that this had not been notified to the CSCI Surrey Local Office. The registered person must ensure that all notifications as required under regulation 37 of the Care Homes Regulations 2001 are made to the CSCI Surrey Local Office. Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 18 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 2 Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 19 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 CH3 Regulation 14 Requirement The home would be advised to complete their own assessment documentation for the most recently admitted service user. All medication must be stored securely. Medication that is not for use by the service users must be stored separately and safely. The home must obtain the most recent copy of Surrey’s MultiAgency Protection of Vulnerable Adults Procedures. The registered persons must ensure that their protection of vulnerable adult’s procedures reflect these updated MultiAgency procedures. The home must be mindful to ensure that mandatory training is kept up-to-date and that all staff complete at least three days training each year, in order to meet this standard. Notifications of incidents must be made promptly to the CSCI Surrey Local Office. Timescale for action 04/11/05 2 OP9 13 (2) 04/10/05 3 OP18 13 (6) 04/11/05 4 OP18 13 (6) 04/11/05 5 OP30 18 (1) (c) 04/01/06 6 OP38 37 04/10/05 Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherry Tree House DS0000013597.V253253.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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