Inspection on 19/12/06 for Cherry Tree Lodge

This inspection was carried out on 19th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Tree Lodge 04/09/06

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cherry Tree Lodge 34 Station Road Ruskington Sleaford Lincolnshire NG34 9DA Lead Inspector Mick Walklin Key Unannounced Inspection 19th December 2006 12:30 Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 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 DS0000067539.V322351.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 Adults 18-65. 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 DS0000067539.V322351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree Lodge Address 34 Station Road Ruskington Sleaford Lincolnshire NG34 9DA 01749 676724 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) Home From Home Care Ltd Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered to provide accommodation for service users aged 18-65 years of age of both sexes whose primary needs fall within the following category:Learning disability (LD) - 6 The maximum number of service users to be accommodated is 6. 2. Date of last inspection 4th September 2006 Brief Description of the Service: Cherry Tree Lodge was first registered in July 2006, and provides care for 6 people with a learning disability. It is situated close to the centre of Ruskington, which has a range of amenities and shops. The home is a detached property situated in a residential street, and has been totally refurbished to a high standard. Accommodation is spacious, and comprises a lounge, kitchen diner, conservatory, quiet lounge, sensory room and activity room. All bedrooms are en-suite, and are situated both on the ground floor and first floor, which is accessed by two lifts. The front of the property has lawns and a gravel driveway and parking area. The rear of the property is enclosed, and laid to lawns and flowerbeds, with a large patio area. The home is owned by Home from Home Care, who operate two other care home in the area, and are planning further developments. The Company’s stated philosophy is ‘Recognising and celebrating the uniqueness of every individual’. The home specifically caters for people with autistic spectrum disorder, and staffing is on a 1-1 basis. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of Cherry Tree Lodge, and through undertaking a visit to the home. The fieldwork visit took place over 7 hours. The acting manager was not present during the fieldwork visit, and therefore some confidential documents were not accessible. These documents were inspected the following day. The main method of inspection used was called case tracking which involved tracking the support that three service users living at the home receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the communal areas was undertaken. Documents connected with the running of the care home were also inspected. Information provided at the previous inspection was that the fees charged are £2050 per week. What the service does well: What has improved since the last inspection? What they could do better: The home could be made safer by staff making sure that medicines and dangerous liquids are always locked away. There should be better information about service users in their care plans, so that staff have clear guidelines about the support they should be providing. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 6 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 DS0000067539.V322351.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are thoroughly assessed prior to admission, to ensure that their needs can be met. EVIDENCE: Two service users have been admitted since the last inspection. Both had been assessed at their previous home or school by staff from Cherry Tree Lodge. The assessments were detailed, and provided good information about support needs and lifestyle. Both had individual introduction packages, which involved staff from the home visiting them to get to know them, and the service user visiting Cherry Tree Lodge to meet the people that live there. Another service user is due to be admitted in a few months time, when she is 18 years of age. Staff will be visiting her every other week, and she will be visiting Cherry Tree Lodge every month. Staff are also providing photographic information to help her to become familiar with the home. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans have improved since the last inspection, but some important information is still not recorded. Service users are encouraged to make decisions and choices, and risks are minimised. EVIDENCE: Care plans and risk assessments contain a good range of information, but do not always match, or reflect other assessment information. For example, one service user who has epilepsy has a risk assessment for bathing, which highlights the need for supervision, but the care plan does not make any reference to this. Another service users care plan identified a risk of him putting objects in his mouth, but there was no risk assessment. Care plans are not signed by staff or service users (or their representatives), so it is not clear who has written then, or whether the service user has been involved. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 10 An incident had occurred in November, where a service user had left the home at night, and had been returned by the police. A risk assessment was now in place for this service user, which gives staff clear guidelines about monitoring during the night. Daily records are kept, with a separate sheet for morning and afternoons. Whilst day-to-day routines are well recorded, some important information is not recorded. One service user had attended a hospital Accident and Emergency Department, but the daily record covering the visit was missing. Another service user had been prescribed antibiotics, but there was no record as to why. Staff described how they are in the process of helping service users with Person Centred Plans, to identify longer-term goals and aspirations. Service users have an ‘All About Me’ booklet, which outlines preferences in daily lives and routines. During the inspection, staff offered and respected choices made by service users. For example, a service user chose to sit out in the garden on a cold day, but would not wear a coat. Staff discussed the issues around her exercising choice against their concerns about her getting cold. Initially tried to encourage her to wear a coat, which she refused to do, so she went out for a short while, before staff encouraged her back in again. Service users were offered choices relating to meals and activities, and staff stressed the importance of knowing service users well, in order to recognise how they communicate. A member of staff outlined how they help service users with non-verbal communication to make choices, by using pictures, photographs and signing. They said, “It can be quite subtle things like expression, or major things such as throwing chairs”. An example of this was a service user who came into the office and sat down. She was not able to indicate what she wanted, but staff thought that she might wish to speak to her parents on the phone. Following the call, she indicated that she was very happy. The new manager said that she was keen to expand the use of communication aides. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service user have a good range of activities to participate in, and access to college courses is being explored. They have good contact with their families, and menus reflect personal taste. EVIDENCE: Each resident now has an individual timetable, which provides a combination of educational, vocational and leisure activities. There are a good range of home and community based activities. Service users have good links with the other two homes run by the company, and share social activities. One service user said, “I like going to The Hawthorns to see my friends – they give me coffee”. On the afternoon of the inspection, none of the service users were following their activity timetables, and staff explained that there was a certain amount of flexibility in these. One of the team leaders explained that she was exploring opportunities for service users at local further education colleges. The home Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 12 has a people carrier, and one service user said that “going out on the bus” was his favourite activity. Staff said that there is very good contact with families. Two service users are going home for Christmas, and all service users have regular contact. One service user said that his parents visit every week, and phone him regularly. Another service user has a touch screen computer in her bedroom, which she can access pictures of her family on. Menus are on a three weekly rota, but staff explained that these are flexible. Service users are asked for suggestions, so that they can choose their favourite meals. Staff are collecting pictures of meals to laminate, so that service users have better information to help them choose meals. One service user does not eat meat, so a vegetarian option is provided. Service users assist in preparing meals according to their abilities. One enjoys baking, and another was helping prepare buffet snacks for an outing that afternoon. A record of food temperatures and meals served is kept. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are offered individual support, and there are satisfactory arrangements with local health care providers to ensure that service users health needs are met. There have been improvements to medication administration, but storage is still not robust enough to safeguard service users. EVIDENCE: Staffing levels allow a high level of support to be provided for service users. All service users are funded for 1-1 support or higher. Staff were observed to ensure that service users privacy and dignity was respected, when offering assistance with personal care. The ‘All About Me’ assessment provides staff with good information about preferred routines. Service user are registered with a local doctors surgery and other services such as psychology and psychiatry are available by referral. Two Consultant Psychiatrists are currently seeing service users from the home. Some service Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 14 users have a health action plan, which clearly outlines any health needs that they have. A person in the company has been given responsibility for coordinating health action plans, to ensure that all service users have one. A monitored dosage system is used for medication. Senior staff and team leaders administer medication after received training. Medication administration records were properly completed. The previous inspection identified that although there were satisfactory storage facilities for medication, the medication for a newly admitted service user had not been appropriately stored. During this inspection, a bottle of liquid medication and a box of tablets were left temporarily unlocked in the office. This medication had been taken on an outing with a service user. Staff arranged for it to be appropriately stored, when they realised the error. Discussions with the operations manager and the acting manager were held, and they proposed actions to prevent this from happening again. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge of the adult protection procedures. Arrangements for dealing with complaints are satisfactory, but service users would benefit from ‘easy read’ versions of the procedure. EVIDENCE: There is now a record of any complaints and compliments received. There has been one complaint and two compliments since the last inspection. The complaint related to how a visitor to the home was received by staff. At the time of the last inspection, the complaints procedure in written and symbols format was included in each service users care plan. However, these documents could not be found on this occasion, and it is recommended that the complaints procedure is available in accessible formats for service users. New staff confirmed that they had covered adult protection during their induction, and showed a good knowledge of their responsibilities for reporting and incidents or suspicions. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable well-decorated and maintained environment of a very high standard for residents to enjoy. EVIDENCE: There are a good range of spacious communal areas, enclosed grounds and large en-suite bedrooms. Communal space comprises a lounge, kitchen diner, conservatory, quiet lounge, sensory room and activity room. Furniture and fittings are of a very good quality, and the home is well maintained. Service users have chosen their own bedrooms, and one said, “I like it here”. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff receive good induction and training. Staffing levels are good and recruitment and selection procedures are robust enough to protect service users. EVIDENCE: The home is currently relying on agency staff to maintain agreed staffing levels, with 37 shifts being covered by agency staff during the week of the inspection. On the morning of the inspection, staff on duty included a team leader who usually works in another home, two new staff who had just completed induction, and four agency staff. There were three agency staff on duty in the afternoon. Two of the agency staff were working in excess of 80 hours that week, and another was working in excess of 65 hours. The agency staff interviewed had a good knowledge of the support needs of service users, and said that they had been working regularly at the home for a few months. Five new staff have just completed induction, and it is hoped to have phased out the use of agency staff by March. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 18 One of the newly appointed staff said that he had received a good induction. He had completed “a lot” of training, and had been shadowing more experienced staff. He said that other staff had been very helpful and supportive. All new staff attend a two-week induction, where they receive both a basic induction, and mandatory training. The company has appointed a training co-ordinator, who will be responsible for arranging training events, and ensuring that staff have received the necessary updates. The staff files of the five newly appointed staff were inspected. All contained evidence of a satisfactory recruitment and selection process. Four of the staff have been recruited from overseas via an agency. Although references had been translated, the origin of some of them some were not clear, and the text was confusing. The agency obtains police checks from the home country, but these were not available for inspection. Senior staff at the home had misunderstood the guidance relating to the supervision of new staff who had received a Protection of Vulnerable Adults First (POVA) check, but were still waiting for a full Criminal Records Bureau (CRB) check. Arrangements are now in place to ensure that the new staff are fully supervised until the CRB check is received. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements are becoming more stable. Some health and safety issues were identified, which could potentially put service users at risk. EVIDENCE: There have been temporary management arrangements at the home, following the previous acting manager leaving. A temporary manager has been covering since the middle of November, and a new acting manager started three weeks ago. She has completed a National Vocational Qualification at level 3, and has nearly completed the Registered Managers Award. Two team leaders are currently on sick leave, which is having an impact on management arrangements, but staff said that the home is well managed. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 20 Regular health and safety checks are carried out, and generally the environment was safe. However, the following health and safety issues were identified: • Two containers of hazardous substances were found stored unlocked in the en-suite of a spare bedroom. The en-suite was being repaired by workmen, and staff arranged for this room to be locked. At the time of the last inspection, the home had only recently opened, and there had only been one recorded fire alarm test. A letter from the fire officer had given details of the frequency of checks expected, but these had not been occurring. Planned weekly fire alarm test had only been conducted once since the last inspection, and monthly emergency lighting checks had not occurred since July. Staff explained that a service activates the fire alarm regularly during behavioural incidents, but these had not been recorded in the fire log. • Cherry Tree Lodge DS0000067539.V322351.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 Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x x x x 2 x Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 22 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 YA6 Regulation 15 Requirement The registered person must ensure that care plans accurately reflect the identified needs of service users. (This requirement is outstanding from the previous inspection. Timescale of 31/10/06 not met). The registered person must ensure that medication is stored appropriately. (This requirement is outstanding from the previous inspection. Timescale of 31/10/06 not met). The acting manager must submit an application to become registered with CSCI. The registered person must attend to the health and safety issues identified. Timescale for action 31/03/07 2. YA20 13(2) 31/12/06 3. 4. YA37 8 13(4) 31/03/07 31/12/06 YA42 Cherry Tree Lodge DS0000067539.V322351.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. Refer to Standard YA22 Good Practice Recommendations It is recommended that the complaints procedure be available in easy read format. Cherry Tree Lodge DS0000067539.V322351.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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