CARE HOMES FOR OLDER PEOPLE
Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB Lead Inspector
Catherine Churches Unannounced Inspection 16th February 2007 10:00 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 DS0000003929.V330795.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 DS0000003929.V330795.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Lodge Address 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB 01202 429326 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 Audrey Martha Watts Mr John William Watts, Mr Simon John Watts Mr Simon John Watts Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th June 2006 Brief Description of the Service: Cherry Tree Lodge is registered as a care home, providing accommodation for up to twenty older persons. The home is situated in a quiet residential area of Wick; approximately 10 minutes walk from the shops and facilities of Tuckton. The home is registered in the name of Mr and Mrs Watts and their son, Mr S Watts. Mr S Watts is in day-to-day charge of the home. Accommodation at Cherry Tree Lodge is arranged over two floors. On the ground floor there are nine single bedrooms all with en-suite WC and wash hand basins. There is also a communal bathroom with WC and two further communal lavatories. On the first floor there is one double and nine single bedrooms all with en-suite WC and wash hand basin and two also have baths in the en-suite facilities. All bedrooms have been personalised by their occupants and reflect individual taste. The communal space on the ground floor comprises a lounge with adjoining dining room. Both rooms are attractively furnished and have a welcoming, relaxed atmosphere. A stair lift is available to assist residents between floors, leaving just one step to negotiate to access the first floor. The home has level, well-maintained gardens surrounding it and limited off road parking. There is also ample parking on the roads surrounding the home. The home has a number of pets including a cat, dogs and a parrot. Fees range from £431 to £450 per week. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 16th February 2007. In total four and a half hours were spent in the home undertaking the inspection. Mr Watts, the registered manager was unavailable but Mr and Mrs Watts, the registered owners and the deputy manager were present throughout the inspection. The inspection took place as part of the regular, programmed inspection schedule for the home. The last inspection took place in June 2006. The purpose of this visit was to monitor the home’s compliance with National Minimum Standards and with requirements and recommendations made during the previous inspection. Also, to check that the home is run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents, visitors and staff. This report refers throughout to “residents” meaning to include persons accommodated in the residential home, and the overall term “service users”, which is the preferred term of the Commission. What the service does well:
Cherry Tree Lodge provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is well presented and has attractive gardens. Residents were able to confirm that the life they are able to lead is as they expected. They stated that they receive the assistance they require and that staff are always willing and helpful. Care planning, healthcare and medication administration is well organised and responsive to residents’ needs. The home is continuously looking to improve its services and facilities: there is a good range of activities and the environment is currently being upgraded. Bedrooms vary in size but all were nicely decorated and many people had taken the opportunity to personalise their rooms with their own items of furniture, furnishings, pictures and plants etc. Residents are supported in maintaining contact with family and friends and appropriate assistance is given to enable them to retain their rights to exercise
Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 6 choice and control over their lives wherever possible. Visitors are encouraged to come to the home whenever possible. The staff group is stable and were observed to be respectful, helpful and caring. The staffing level is good and provides opportunities for staff to take residents on one to one trips and spend time chatting in the lounge etc. What has improved since the last inspection? What they could do better:
Action must be taken to ensure that safe recruitment practices operate in the home: staff must not commence duties in the home without at least a satisfactory Protection of Vulnerable Adults list check and not be confirmed in post until receipt of a satisfactory Criminal Records Bureau check. It is of concern that this is the third time such a requirement has had to be made of the home. Further failure to meet the requirement will result in enforcement action being taken. All fire doors must be maintained to ensure that, in the case of an outbreak of fire, systems are in place to help prevent its spread. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 7 Care plans need to be formally reviewed at least once a month and this should be recorded. Policies for the Protection of Vulnerable Adults need minor amendments to make them more usable. The programme of training a minimum of 50 of care staff must be continued to help ensure that staff have the necessary skills and competencies. All accidents must be recorded and, if necessary, reported to the relevant Regulatory Authority. 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. The summary of this inspection report can be made available in other formats on request. Cherry Tree Lodge DS0000003929.V330795.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 DS0000003929.V330795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of prospective residents’ needs have improved since the last inspection. This means that residents can now be more certain that the home is aware of their requirements prior to admission to the home and that the staff will therefore be able and prepared to meet these needs. EVIDENCE: Documentation for three residents was examined as part of the case tracking procedure used during this inspection. Two of these residents had been newly admitted to the home since the last inspection. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 10 The pre-admission assessments were viewed. They contained good information about each person’s needs and a letter was also available on file to confirm, that having carried out the assessment, the home could meet the person’s needs. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Plans for residents who live at Cherry Tree Lodge have improved in the level of detail and information. This means that staff have better information to provide a good level of care and the home can also demonstrate the care that has been provided. The home ensures that residents’ healthcare needs are met through seeking appropriate input from GPs and other healthcare professionals. Medication in the home is well managed, promoting good health. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled at the home and their privacy is respected. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 12 EVIDENCE: Care Plans and related documentation regarding care for three residents were examined. Files were well laid out and risk assessments had been undertaken. Reviews were being undertaken but not always on a monthly basis or more frequently if changes dictated this. Evidence was available on file and through discussion with staff that GPs, district nurses, specialist nurses and other health professionals are called upon whenever the need arises. Medication systems were examined. Appropriate recording systems are in place and all staff responsible for administering medication have received up dated training. Medication was stored and secured appropriately. During conversations with a number of residents, they confirmed (where they were able to) that they were happy with the care they received. They also confirmed that they feel respected by staff and are able to maintain their privacy when receiving personal care or visits from professionals such as GPs and solicitors, family and friends. It was observed that staff knock on doors before entering and that a resident’s preferred form of address is recorded and used. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Cherry Tree Lodge provides a caring, homely and relaxed environment. Open visiting arrangements are in place enabling residents to retain contact with families and friends. Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food available that meets residents’ tastes and needs. EVIDENCE: Cherry Tree Lodge provides occasional organised activities such as concerts from visiting musicians and various games such as bingo and “Play your cards right”. In addition the home has a wide selection of CDs and videos and staff confirmed that they have the time to spend with residents, either singing, playing games or chatting in the lounge or perhaps taking people out for occasional walks.
Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 14 Residents are encouraged to maintain contact with family and friends and there were people coming and going from the home during the inspection. One visitor was spoken with and was very positive about the welcome they receive and the care provided for their loved ones at Cherry Tree Lodge. Food records and discussions with residents confirmed that a suitable and varied diet is provided in the home. Food stocks were satisfactory and plenty of fresh provisions were available. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Cherry Tree Lodge has a satisfactory policy and procedure for the making of complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be listened to and matters of concern will be acted upon. Arrangements for protecting service users from abuse were satisfactory. This means that Cherry Tree Lodge is a safe environment that will protect residents from abuse. EVIDENCE: The complaints procedure is included in the Service Users Guide/Terms and conditions of residence that is given to all residents/representatives and also available in the main entrance area of the home. No complaints have been made to CSCI or to the home since the last inspection. Policies and procedures for adult protection and whistle blowing were checked. Work had been undertaken since the last inspection but this had resulted in the creation of two separate policies neither of which were complete but read together were. This is dangerous as staff may not realise that to obtain all the information they need to read both documents.
Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 16 Since the last inspection staff have had training in the recognition and prevention of abuse. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is nicely presented. Residents live in a well-maintained environment, which is clean, hygienic and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is nicely decorated and furnished. Dorset Fire and Rescue Service have visited the home and confirmed that it complies with their requirements. Cherry Tree Lodge is very well maintained with good access to communal areas. It is light and airy and furnished and decorated to a good standard. The atmosphere is homely and relaxed. There is an ongoing programme of refurbishment: since the last inspection the bathrooms on both the ground and first floors have been redecorated and upgraded and a number of bedrooms have been decorated. Ensuite facilities have been added to two bedrooms.
Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 18 All of the areas seen during this inspection were clean and no offensive odours were detected. Infection control policy and procedures were reviewed and found to be satisfactory. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met through the provision of a mix of experienced, qualified and unqualified staff. Good progress is being made in ensuring that staff obtain minimum level qualifications. This means that residents are more likely to receive consistent care. Vetting practices for the appointment of new staff have improved but still have some weaknesses. The home has therefore potentially put residents at risk by employing staff without undertaking suitable checks. The arrangements for the induction training of staff has improved and is now being done within the required timescales. This means that staff have the necessary skills to enable them to undertake all aspects of their role competently. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 20 EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number staff to meet the needs of residents. Staff and residents spoken with confirmed that they were satisfied with staffing levels. One of the thirteen care staff has achieved the minimum NVQ level 2 qualification in care or higher. Two people are currently studying NVQ level 2. Staff records were examined for two newly appointed members of staff. Records demonstrated serious omissions as both staff had commenced their duties without POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) checks. The new Skills for Care induction programme has been implemented in the home and evidence that new staff were undertaking this was available. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mr Watts is undertaking the required training and has the relevant experience. He is a competent, committed and approachable manager and both residents and staff confirmed this. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents, staff and relatives. Residents’ finances are safeguarded with clear policies, procedures and management guidance. The health, safety and welfare of residents and staff is, in general, protected by the systems that the home has in place for staff training, maintenance and risk assessment.
Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the last inspection Mr S Watts has become the registered manager of the home and is undertaking the required NVQ level 4 management training. Mr Watts has considerable experience of working in and managing Cherry Tree Lodge and this is now on a more formal basis with the undertaking of training to support this. The home has detailed policies and procedures for the promotion of quality assurance in the home. The deputy manager confirmed that annual surveys and analysis had been undertaken in August 2006. Records of this were examined as well as a detailed response and action plan which had been drawn up in response to the analysis. The deputy manager confirmed that residents are encouraged to retain control of their own finances for as long as possible. Where they state that they no longer wish to or they lack the capacity to do so then the home ensures that either family or other representatives such as solicitors take on this role. No cash is held by the home for any residents. Fire records, staff training records and accident books were examined. It was noted that one accident sustained by a resident had not been recorded in the accident book. It was also noted that the laundry door, a high risk area, was not closing to latch. Since the last inspection a hoist has been purchased and training for staff in its use was planned for the week following the inspection. Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 24 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. Standard OP29 Regulation 19 Requirement The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. A Criminal Records Bureau and POVA check must be obtained prior to an employee commencing duties or being confirmed in post. 16/2/07 This is the third time this requirement has been made. Failure to comply may result in enforcement action being taken. The Registered person must ensure that adequate precautions against the risk of fire are taken. All fire doors must close fully to help prevent he spread of fire. Timescale for action 30/04/07 2. OP38 23(4) 30/04/07 Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 25 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 OP7 Good Practice Recommendations It is recommended that care plans are reviewed by care staff at least once a month, updated to reflect changing needs and current objectives for health and personal care as well as demonstrating that these changes are actioned. It is recommended that policies for the Protection of Vulnerable Adults should be reviewed and amalgamated into one user-friendly document. A programme should be created detailing how the required minimum of 50 staff trained at NVQ2 will be met and the timescale in which this will be achieved. All accidents in the home must be recorded and, if necessary, reported to the relevant Authority. 2. 3. 4. OP18 OP28 OP38 Cherry Tree Lodge DS0000003929.V330795.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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