CARE HOMES FOR OLDER PEOPLE
Cherry Tree Lodge 226/228 Bury Road Rawtenstall Lancashire BB4 6DJ Lead Inspector
Mrs Marie Matthews Unannounced Inspection 13th November 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 Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Lodge Address 226/228 Bury Road Rawtenstall Lancashire BB4 6DJ 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) 01706 224868 Cherry Tree Lodge Limited Care Home 22 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (18) Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Within the overall total of 22 :A maximum of 18 people requiring personal care who fall into the category of OP (Old Age, not falling into any other category over 65 years of age). A maximum of 3 people requiring personal care who fall into the category of DE(E) - (Dementia, over 65 years of age). 1 person requiring personal care who falls into the category of DE(Dementia under 65 years of age) Date of last inspection 10th January 2006 Brief Description of the Service: Cherry Tree Lodge is a care home providing personal care and accommodation for 22 older people. The premises are detached and situated in their own grounds with car parking facilities to the side. There is also an enclosed and well-maintained garden area. The home is located on the main Bury Road close to local shops and is situated on a main bus route that offers transport to all towns in the Rossendale Valley area. Accommodation is provided in 14 single and 4 double rooms situated on two floors, the first floor being accessed by a passenger lift. Communal space is provided in two lounges, a conservatory and a dining area. Smoking is permitted in the upstairs lounge. Information about the services that the home offers is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. The fees from April 2006 range from £360.50 to £375.50. Additional charges are made for hairdressing and personal toiletries if applicable. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key unannounced inspection was conducted at Cherry Tree Lodge on 13th November 2006. The inspection involved looking at records, talking to management and care staff, one visitor and four residents, a tour of the premises and generally looking at what was happening in the home. Information on the home was provided by the registered persons prior to the inspection. Information detailed in comment cards was also provided by two relatives and one professional visitor. This inspection looked at things that should have been done since the last visit and a number of areas that affect resident’s lives. There were twenty-one residents living in the home on the day of the inspection. What the service does well:
The rota showed that staff were provided in sufficient numbers and residents and visitors said there was enough staff to meet needs. Records showed that staff turnover was very low and residents received care from staff that were familiar with their needs. One visitor said all grades of staff ‘have a clear understanding of my dad’s needs’. One resident said ‘there always seems to be a battalion of staff’; another said she always received ‘prompt attention and felt safe night and day’. One relative said staff showed ‘care and compassion’ to residents. All residents who were spoken with stated that staff treated them well and respected their rights to privacy. The records showed all staff had received appropriate training to help them to meet resident’s needs and opportunities were given to staff to update their skills. Residents and a visitor confirmed they were made to feel welcome and could visit in any area of the home. One visitor said ‘there is a friendly, family atmosphere’. The routines and activities of the home were flexible and varied and met resident’s diverse needs, expectations and preferences. One resident told the inspector about all the different activities available and also said ‘I’m allowed to keep my own company if I prefer’.
Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 6 The menus were displayed on the dining tables and showed a choice of meal at each sitting. The records also showed that alternatives to the choice menu had been provided. One resident said she was always given a choice and was on a special diet. Another said ‘ I can always have a choice if I prefer something else and the food is very good and healthy’. From a tour of the home it was clear that the home was clean, safe and well maintained. There were some areas within the home requiring attention but records showed the management was dealing with them to ensure that a safe and comfortable home was provided for the residents. The residents said they were happy with their rooms. Records showed the home was safe and promoted and protected people’s health, safety and welfare. What has improved since the last inspection?
Residents were provided with appropriate written information about what services the home offered and had received assurances their needs could be met by the home before they were admitted. The cook maintained clear records of meals served to residents, including details of special diets served. The complaints procedure had been reviewed and supplied to residents to ensure people were aware of how to make a complaint. The vulnerable adults procedure had also been amended and gave clear guidance for staff in the event of any allegation or suspicion of abuse. The way in which the home recruited new staff had improved and this ensured residents were safe and protected. Care staff confirmed they received regular supervision and support to ensure they had the skills and expertise to meet resident’s needs. Residents and their representatives were involved in decisions about the home and consulted about whether the home was meeting their needs and expectations. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 7 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 Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 8 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 Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Detailed information was obtained before residents were admitted and this ensured the home was able to meet their needs. Residents were provided with appropriate written information about what services the home offered and had received assurances their needs could be met by the home. EVIDENCE: Information about the services offered by the home was available in resident’s rooms; one resident said they had read ‘parts of it’. Detailed assessments had been completed and residents and their relatives were assured the home would be able to meet their needs before they were admitted to the home. A number of staff had received specialised training to help them to meet the needs of all of the residents living in the home. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The care plans needed to include in detail the action to be taken by staff to meet resident’s needs and need to show that residents or their representatives had been involved in the care planning process. Care practice took full account of the residents’ rights to privacy and dignity. Medication policies and procedures needed review to provide safe guidance for staff and reflect current practice to ensure residents were safe. EVIDENCE: Two resident’s care plans were looked at. Both care plans contained information from the initial assessment and generally indicated what action was to be taken by staff to meet resident’s needs. There was no evidence that residents had been involved in decisions about their care although the care plans showed that staff had reviewed and updated the care plans regularly. Two relatives said they were kept informed of important matters and were consulted about their care. One visitor said all grades of staff ‘have a clear understanding of my dad’s needs’
Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 11 Risk assessments were included in one of the care plans but these needed developing. Staff needed to ensure that when a risk had been identified the action to be taken to reduce or prevent that risk must be recorded and be kept under review. The residents’ files seen showed that their health was monitored and promoted and they had access to all necessary health care facilities. The medication policies and procedures needed review to ensure staff had clear and safe guidance for the management of resident’s medication. One resident was self-medicating but there was no procedure to guide staff or risk assessments to support this was safe practice. Records were generally accurate although directions for PRN (as required) medications were unclear, handwritten charts needed to be verified by a second person and the directions on the medication charts and labels needed to include clear instructions. Medication storage areas were secure although the trolley was not safely secured to the wall when not in use and room temperatures, to ensure medications were stored at the right temperature, had not been regularly recorded. Staff had received medication training from a member of the management team but assessments of competency were not in place to show that staff had the appropriate skills and knowledge to manage medication safely. Care staff had not had appropriate training and had not been assessed as competent to perform blood glucose testing. Residents’ rights to privacy and dignity were respected. Staff were seen being respectful, friendly and kind to residents. All residents who were spoken with stated that staff treated them well and respected their right to privacy. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. The judgement has been made using available evidence including a visit to this service. The routines of daily living and activities provided were flexible and varied and met residents diverse needs, expectations and preferences. The meals were varied and nutritious and to the liking of the residents. EVIDENCE: Residents said they were able to exercise their preferences and choices and that the daily routines of the home were flexible. An activity co-ordinator provided a range of suitable activities and entertainments that met the diverse needs and expectations of the residents. One resident told the inspector about all the different activities available and also said ‘I’m allowed to keep my own company if I prefer’. Residents and a visitor confirmed they were made to feel welcome and could visit in any area of the home. One visitor said ‘there is a friendly, family atmosphere’. The menus were displayed on the dining tables and showed a choice of meal at each sitting. The records also showed that alternatives to the choice menu had
Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 13 been provided. Special diets were catered for and the cook had collected information to help her to provide a varied diet for all residents. The menu had been reviewed taking into account suggestions made by the residents at the committee meetings. One resident said she was always given a choice and was on a special diet. Another said ‘ I can always have a choice if I prefer something else and the food is very good and healthy’. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. People knew how to complain and were confident they would be listened to and action would be taken to resolve their concerns. Staff were aware of how to respond appropriately to any suspicion of abuse and this ensured that residents were protected from harm. EVIDENCE: The complaints procedure had been reviewed and a copy had been sent to all residents or their representative. Three visitors were aware of how to complain and one felt the home would respond appropriately. Two residents said they would talk to staff and one said they would ‘sort it out for me’. The adult protection procedure had been reviewed and reflected relevant contact numbers and staff were aware of how to respond to any suspicion of abuse to protect the residents. All staff were due to attend update training planned for this year. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The residents were provided with a clean, comfortable and well- maintained environment, which was furnished and decorated to a good standard. EVIDENCE: From a tour of the home it was clear that the home was clean, safe and well maintained. The residents said they were happy with their rooms. There were a number of areas within the home requiring attention including but records showed the management was dealing with them to ensure that a safe and comfortable home was provided for the residents. Residents had been provided with aids and adaptations to assist them to maintain their independence. There was a call facility in every room. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 16 The driveway needed some attention, as the tarmac had been worn away leaving an unsafe, uneven surface for vehicles and pedestrians. The management was aware of this. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of new staff had improved and would ensure protection for the people living in the home although a number of existing staff files needed to be audited to ensure all checks were in place. Staff had the skills and knowledge to meet the needs of the residents in their care. EVIDENCE: The rota showed that staff were provided in sufficient numbers and residents and visitors said there was enough staff to meet needs. Records showed that staff turnover was very low and residents received care from staff that were familiar with their needs. One resident said ‘there always seems to be a battalion of staff’; another said she always received ‘prompt attention and felt safe night and day’. One visitor said there was ‘always staff around’. One resident said that the staff were ‘great girls’ and another said ‘they are just like my own family’. The records showed all staff had received appropriate training to help them to meet resident’s needs and opportunities were given to staff to update their skills. It was recommended that actual dates of training were recorded in the training book. The home had improved the way it recruited new staff and had followed a robust recruitment procedure; this ensured that residents were protected from
Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 18 being cared for by unsuitable people. However it was recommended that existing staff files were audited to ensure all required checks were in place. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Residents and their representatives were involved in decisions about the home and consulted about whether the home was meeting their needs and expectations. Staff were supervised to ensure they had the skills and expertise to meet resident’s needs. Records showed the home was safe and promoted and protected people’s health, safety and welfare. EVIDENCE: From the information available and comments received it was clear that the home was managed in the best interest of the residents. A ‘staff manager’ and ‘business manager’ were responsible for day to day running of the home although neither was registered with the Commission for Social Care Inspection to manage the home; an application must be forwarded to rectify this and this was discussed during the inspection.
Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 20 The home did not have an annual development plan but records showed that funds to maintain and improve the home were allocated on a monthly basis. Residents were involved in a committee that had been established for some years; residents met each month and were given the opportunity to be more involved in the running of the home. Residents and visitors to the home had been consulted about whether the home was meeting their needs and expectations in October 2006. The home no longer managed any residents personal allowances, however clear records were maintained of fees paid to ensure residents financial interest were safe guarded. . Staff were supervised to ensure they had the skills and expertise to meet resident’s needs. Two staff confirmed they had received supervision and felt management supported them. Records showed that systems in the home were safe and that people’s health, safety and welfare were protected. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 OP8 Regulation 15 13 Requirement The care plan must be drawn up in consultation with the service user or their representative. Individual risks must be assessed (including falls and pressure risk assessments) and interventions recorded in the care plan. Risk assessments must be kept under review. There must be a procedure and risk assessments in place to support self-medication. All staff designated to administer medication must receive documented accredited training. There must be written evidence to support that carers have had training, given by an appropriate practitioner, and have been assessed as competent to perform blood glucose tests. Review dates must be included. The registered person must forward an application to register a manager with the Commission for Social Care Inspection. Timescale for action 08/01/07 08/01/07 3. 4. 5. OP9 OP9 OP9 13 13 13 08/01/07 08/01/07 08/01/07 6. OP31 9 08/01/07 Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 23 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. 2. 3. 4. 5. 6. 7. 8. 9. Refer to Standard OP9 OP9 OP9 OP9 OP9 OP19 OP29 OP30 OP31 Good Practice Recommendations Medication procedures should be developed to include ordering, leave/visits, PRN medication and self-medication. Handwritten directions on medication charts should be witnessed. The criteria for PRN administration should be clearly defined. The temperatures of medication storage areas should be monitored regularly. The medication trolley should be secured when not in use. The driveway should receive attention to reduce the risk of hazard to service users, staff and visitors to the home. All staff files should be subject to an audit to ensure they contain all documentation and meet Regulation. Training dates should be clearly recorded in the training book. The registered person should complete an NVQ 4 in both management and care. Cherry Tree Lodge DS0000009644.V312954.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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