Inspection on 20/04/06 for Cherry Tree Lodge

This inspection was carried out on 20th April 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Tree Lodge 18/04/07

Cherry Tree Lodge 08/11/05

Cherry Tree Lodge 27/06/05

Cherry Tree Lodge 30/03/05

Cherry Tree Lodge 17/08/04

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 133 Macaulay Drive Lincoln Lincs LN2 4ET Lead Inspector Mick Walklin Unannounced Inspection 20th April 2006 09:30 Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 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 DS0000002605.V288980.R01.S.doc Version 5.1 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 DS0000002605.V288980.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cherry Tree Lodge Address 133 Macaulay Drive Lincoln Lincs LN2 4ET 01522 545580 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) Prime Life Limited Care Home 19 Category(ies) of Learning disability (18), Learning disability over registration, with number 65 years of age (1) of places Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of Registration To admit one LD(E) service user on a named basis only 8th November 2005 Date of last inspection Brief Description of the Service: Cherry Tree Lodge is situated on a residential housing estate approximately one and a half miles north of the city centre of Lincoln. It is close to local facilities and has public transport links to the city centre. The home is registered to accommodate 19 people with a learning disability. Accommodation is provided within a large two-storey house. The first floor is accessible by lift. There are 15 single bedrooms, and 2 double rooms, none of which have en-suite, but they have wash hand basins. There are two lounges, an activity room and a dining room. The grounds are enclosed and private. They are laid to lawns at the front and side of the property, with car parking to the rear. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 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 8 hours. The main method of inspection used was called case tracking which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted with the deputy manager. Other documents connected with the running of the care home were also inspected. What the service does well: What has improved since the last inspection? What they could do better: Arrangements for the storage and administration of medication should be improved to ensure that it is stored and administered safely. Staff recruitment procedures should be more thorough to protect residents. Residents must be assessed thoroughly prior to admission to ensure that their needs can be met, and that the home is registered to accommodate them. Care plans should be fully completed to ensure that residents care needs are fully documented. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 6 Problems with the downstairs bathroom floor and the hot water delivery in one of the bedrooms have not been rectified since the last inspection. 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 DS0000002605.V288980.R01.S.doc Version 5.1 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 DS0000002605.V288980.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A range of information about the home is available for prospective residents. One residents was not assessed thoroughly prior to admission to ensure that their needs can be met, and that the home is registered to accommodate them. EVIDENCE: The home has a Statement of Purpose and Service User Guide, which gives residents and prospective residents information about the home, and the services provided. However, this will require updating to reflect changes in management arrangements. There have been two new admissions to the home since the last inspection. Both have been admitted from other Prime Life homes, because of their need for nursing care. They were admitted with accompanying information from their previous homes, and although the admission record for one resident was incomplete, there was concise information from the previous home. One resident had been admitted outside the registration category of the home. The home is registered to provide care for people with a learning disability aged between 18 and 65. Documentation relating to this individual, who is Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 9 over 65 years of age, contained no reference to him having a learning disability, but contained a diagnosis of dementia. An immediate requirement was made, and the registered person must provide evidence that this individual has a learning disability, and submit an application for a variation to the homes registration to accommodate this individual. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. 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 are comprehensive, but one did not contain sufficient information to enable staff to fully meet her needs. Staff communicate effectively with residents to enable their wishes and choices to be respected. EVIDENCE: Care plans contain a good range of information, and assessments cover all aspects of daily living, and generate a care plan and risk assessment if issues are identified. The deputy manager said that more detailed care plans are in the process of being introduced, but these were not inspected on this occasion. One resident admitted in early March only had a partially completed care plan, with some sections blank. The deputy manager explained that this would be completed shortly. Most are unable to agree or contribute to their plan of care, so a letter was sent to all relatives, asking them if they wish to contribute to the plan. Risk assessments on file enable residents to live as independently as possible, whilst ensuring that risks are minimised. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 11 All residents have a severe learning disability, with associated communication difficulties. Observations of interactions between care staff and residents demonstrated that staff used a variety of communication methods to ascertain residents choices and wishes. There is a very relaxed atmosphere within the home, with good relationships between staff and residents. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An adequate range of activities are provided to ensure that residents are stimulated. There are good arrangements for accommodating visiting relatives. Catering arrangements reflect dietary needs and individual preferences of residents. EVIDENCE: There has been a reduction in the day service provision provided by Social Services, so a majority of residents now have home based activities. The deputy manager explained that there were plans for Outreach workers to do sessions in the home, but this has not commenced as yet. Some residents attend the Mencap ‘Forget me not Club’, two or three days per week, and one resident attends a day centre two days per week, which he said that he enjoys. Activities in the home are relatively unstructured, but staff were seen to be undertaking a range of activities, including arts and crafts, sing-a-longs and games. Some residents went out shopping with staff, and a bus with a tail lift Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 13 is available for outings every two weeks. The last outing was to the West Midlands Safari Park. There has been positive feedback from relatives during previous inspections about how they are made to feel welcome when visiting. A relative visiting at the time of the inspection said that he visits every day to see his son, and is very satisfied with the visiting arrangements and the standards of care provided. Residents said or indicated that they enjoy the food served. The cook has a good knowledge of the dietary requirements of each resident and their likes and dislikes. The previous inspection highlighted the high level of encouragement and support offered by staff to two residents who were reluctant to eat, including offering food alternatives. This was again seen, with successful strategies being used for one person who was reluctant to eat or drink. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is good provision to meet residents healthcare needs, but medication storage and administration requires improvement to ensure that residents are not at risk. EVIDENCE: There was widespread evidence of referrals to health care services to meet residents needs. All residents are registered with local GP surgeries, and letters relating to outpatient appointments, and referrals to specialists were on file. There are satisfactory arrangements for optical and dental provision. Staff were seen to be offering flexible personal support, and maintaining privacy and dignity whilst providing personal care. The home uses a pre-dispensed system for medication administration. Medication storage has now moved from the office to a clinical room. The following issues require attention. • The temperature in the clinic room was measured at 29°C. Medication not requiring cool storage must be stored at a maximum temperature of DS0000002605.V288980.R01.S.doc Version 5.1 Page 15 Cherry Tree Lodge • • 25°C. The deputy manager explained that she had been unable to adjust the temperature in the room, possibly due to a fault radiator. Temperature records for the medication refrigerator showed that it had been operating at 0.2°C for some time. The minimum temperature for medication requiring cool storage is 2°C, but staff had not realised that there was a problem. The deputy manager attempted to adjust the fridge temperature, but it was not clear if it was the refrigerator or the thermometer that was faulty. The medication administration records for three medication rounds on one day had not been signed, and it was not clear if any medication had actually been administered. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. 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. Arrangements for dealing with complaints and adult protection allegations ensure that residents are safe. EVIDENCE: There have been no recorded complaints since the last inspection. There is a good accessible complaints policy available in written and symbols format. These are displayed in areas of the house. The policy is also contained in the staff policy handbook, and staff were able to describe the procedure, should they receive a complaint. A notice is also displayed in the dining room, describing how residents and others can offer their views, by talking to key workers, senior managers or the Commission. At the time of the last inspection, some staff were unclear on the procedure for reporting suspicions of adult abuse. Staff interviewed on this occasion were clear about their responsibilities, including reporting to the Commission and Social Services. They confirmed that they receive training as part of the Learning Disabilities Awards Framework. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been continued improvements to the environment, which provides a comfortable and homely place to live. EVIDENCE: The home is well maintained, brightly decorated and clean. Since the last inspection, one of the downstairs rooms has been converted into a clinic room, and a fish tank has been installed in one of the lounges, to provide visual stimulation for residents. The floor in the downstairs bathroom, which was identified as requiring replacement at the time of the last inspection, has not been fixed. Residents said or indicated that they are satisfied with their bedrooms, and the overall standard of the accommodation. The lift broke down in December, and an additional visit was made. Emergency arrangements to ensure that this did not inconvenience residents were found to be satisfactory. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” There are adequate staff to meet the needs of residents, and they are well supported and trained. However, recruitment and selection procedures are not robust enough to protect residents. EVIDENCE: The core staff group has remained stable, and they know the needs of the residents well, and are fully aware of their roles and responsibilities. Three new staff are due to commence employment shortly. The home maintains staffing levels of four carers, a cook and a cleaner, which staff and residents confirmed was sufficient. One member of staff had been recruited with a Criminal Records Bureau (CRB) disclosure from their previous employment, with no POVA First check or written references having been received prior to her commencing employment at the home. A telephone conversation between the deputy manager and the personnel department confirmed that the personnel department were confused about the portability of CRB disclosures, and had given incorrect advice. An Immediate Requirement was made. Staff said that training opportunities are good with the company, with staff undertaking the Learning Disabilities Awards Framework prior to commencing Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 19 NVQ level 2. A newly recruited member of staff confirmed that she had been well supported, and that her induction had been thorough and helpful. Staff said that they are well supported and receive regular supervision. A supervision timetable is displayed in the office, and staff have individual supervision contracts. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements require further clarification, but staff morale has improved, ensuring a relaxed atmosphere in the home. Documentation is well organised, ensuring a safe environment, but there are problems with hot water temperatures in some areas of the building, which could pose a risk to residents. EVIDENCE: The registered manager resigned recently, and the present acting manager is a registered manager from another Prime Life home. Management arrangements, including the clinical leadership for the registered nurses still need to be clarified with the Commission. Staff said that the recent management changes had been a difficult period for them, but the atmosphere was now more settled, and morale had improved. One member of staff said, “we all get on and have the same attitude to work – we work well as a team and help each other out”. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 21 Regular Regulation 26 visits are conducted, and copies of reports were available for inspection. The homes Certificate of Registration was removed by the previous manager, and the Commission is arranging for a replacement to be issued. In December, the Commission was notified that some residents money had gone missing. This money has now been replaced, but an additional visit to the home was made on 13th February 2006, following an anonymous complaint that no residents money was available for staff to buy clothing and toiletries. Although this was found to be correct, the acting manager had commenced at the home on that day, and had undertaken to rectify the problem immediately. The minutes of the following staff meeting confirmed that staff were now satisfied with the situation. New procedures are now in place to ensure that residents monies are safely stored and robustly accounted for. The previous inspection identified that the water being delivered to the washbasins in three of the bedrooms was too hot. Recent maintenance records showed that all rooms had water temperatures within an acceptable range. However, the hot water temperature in bedroom 5 was measured at 57°C at the time of the inspection. Although all windows are fitted with window restrictors, these can be disabled to allow the windows to open fully. It is recommended that a review and risk assessment be undertaken on all windows. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 22 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 3 2 2 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 3 36 3 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 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 2 x 3 3 3 x 3 2 x Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 23 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 YA2 Regulation 14 Requirement The registered person must provide evidence to the Commission that the service user identified falls within the registration category of the home, or apply for a variation in registration. The registered person must ensure that all service users have a comprehensive plan of care. The registered person must ensure that medication is stored and administered safely. The registered person must arrange for the floor in the downstairs bathroom to be replaced. (Original timescale of 31/12/05 not met). The registered person must ensure that the documentation outlined in Schedule 2 is obtained prior to staff being employed. The registered person must ensure that the hot water temperature is regulated in bedroom 5. (Original timescale of 31/12/05 not met). DS0000002605.V288980.R01.S.doc Timescale for action 20/05/06 2. YA6 15 31/07/06 3. 4. YA19 YA24 13(2) 13(4) 31/05/06 31/07/06 5. YA34 19 20/04/06 6. YA42 13(4) 31/05/06 Cherry Tree Lodge Version 5.1 Page 24 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 YA42 Good Practice Recommendations It is recommended that a review and risk assessment be undertaken on all windows to ensure that the type of restrictors fitted are satisfactory. Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Cherry Tree Lodge DS0000002605.V288980.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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