CARE HOMES FOR OLDER PEOPLE
Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth Dorset BH6 4LB Lead Inspector
Catherine Churches Unannounced Inspection 10:45 23 January 2006
rd 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.V279180.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 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.V279180.R01.S.doc Version 5.1 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 Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th September 2005 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 Watts and his mother are 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. The proprietors will always consider requests from prospective residents who may wish to bring pets with them. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning of 23rd January 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. This report should be read in conjunction with that from the inspection in September 2005 as all key inspection standards are reported on in these two reports. The purpose of this visit was to check that requirements and recommendations made during the last inspection have been acted upon, 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 and staff. Mr S Watts was available throughout the inspection. What the service does well: What has improved since the last inspection?
10 requirements and 1 recommendation were made at the last inspection. For 3 of these requirements the timescale for action had not expired by the time of this inspection. Progress has been made with all of the requirements but as yet full compliance has not been achieved. In summary, documentation and planning regarding pre-admission procedures, care planning, staff training and quality assurance systems have been improved and once fully implemented will improve staff skills and care of residents. Recording and reporting of accidents has improved as has COSHH compliance thereby making the environment safer for residents.
Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 6 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 DS0000003929.V279180.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Work has been undertaken to improve the admissions process. This has not yet been used but appears to be satisfactory and should therefore provide a thorough assessment to ensure that the home is able to meet a prospective residents needs. EVIDENCE: A requirement was made at the last inspection that residents may only be admitted to the home after a full needs assessment has been undertaken and written confirmation given to the resident that the home can meet their needs. No new residents have been admitted to Cherry Tree Lodge since the last inspection. Mr Watts was able to provide copies of template documents that he has developed in response to this requirement and confirmed that these will be used for all future admissions. Requirements regarding this standard have been repeated in this report as the standard is not demonstrably met. It should be noted that progress and improvements in this area have been made.
Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents receive prescribed medicines at the correct times and in the correct amounts; those wishing to do so can manage their own medicines. Some recording procedures could be improved to provide an even higher level of risk management. The ethos in the home is one of respect for the residents living there. This means that the residents feel settled and at home and their privacy is respected. EVIDENCE: Care plans for three residents were examined. The structure and content of these plans has improved since the last inspection: monthly reviews are being undertaken, residents are involved where possible, risk assessments and nutritional assessments have been introduced and the detail of general recording has improved. Psychological assessments were not being undertaken and it was noted that in cases where problems/health issues were identified in residents, there was little information available about the actions taken by the home to address this. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 10 The medication cupboard, management of medication and records relating to this were examined. Storage of medication is well organised and records were found to be clear and up to date. It was noted that quantities received from the chemist are not checked. This must be introduced and quantities received should be recorded to enable checking that correct doses are given and missing medication can be identified. Mr Watts confirmed that resident’s privacy is promoted when receiving personal visits from professionals such as GP’s and solicitors, family and friends. It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. EVIDENCE: It was noted from documentation and observation of rooms that residents are encouraged to bring their own personal items of furniture and to personalise rooms etc. Choices are also promoted with encouragement to make decisions regarding food, clothing, social activities etc. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory system for making 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 taken seriously and that matters of concern will be acted upon. The procedure is not widely known and this should be rectified. Staff have not yet received training in Adult Protection although a training package has been sourced. Until all staff re fully trained the home is putting residents at potential risk as a lack of knowledge may mean that an abuse is not noted. EVIDENCE: The complaints procedure was displayed in the main hallway of the home and included in the Service Users Guide that is given to all residents. At the last inspection it was identified that few people were aware of this procedure. Mr Watts advised that he will be re-issuing the procedure with a covering letter to all relatives and other stakeholders and also placing a copy in each bedroom. Policies and procedures were available regarding the protection of vulnerable adults from abuse. However, at the last inspection staff had not received training in the detection and protection of abuse. Mr Watts confirmed that he has now found a suitable training provider and staff will be receiving the required training shortly. Requirements regarding these standards have been repeated in this report, as the standards are not yet fully met. It should be noted that progress and improvements in these areas have been made.
Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Neither of the key standards were assessed on this occasion as both were assessed at the last inspection and found to be met. EVIDENCE: Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The deployment and number of available staff is sufficient to meet the needs of residents. Residents are in safe hands, however not all staff have yet been trained to the required standard. Training plans are being developed. Two people have been employed since the last inspection. Appropriate checks had not been completed therefore potentially putting residents at risk. Improvements to the way staff receive induction training are being made which will lead to an increased competency amongst the staff. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number of staff to meet the needs of residents. The home employs 14 care staff, 2 of whom hold the minimum qualifications. Mr Watts confirmed that he was aware that the home is currently failing to meet this standard and is seeking to address this through recruitment of qualified staff and training of existing staff. Staff records were examined for the two newly appointed members of staff. These demonstrated some serious omissions as the persons concerned had commenced their duties without a POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check. Since the introduction of POVA checks
Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 15 staff may only commence duties once a satisfactory POVA check has been received. An induction package has been purchased in order to meet the standard. No new care staff have been employed and so the package has not yet been used. (the 2 staff employed since the last inspection were employed as domestic assistants). Requirements regarding these standards have been repeated in this report, as the standards are not yet fully met. It should be noted that progress and improvements in these areas have been made. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Mr Watts acts as the homes’ manager although not yet registered as such. Lines of communication and leadership have improved since the last inspection therefore improving continuity for residents. Quality monitoring systems need to be better defined and implemented in order to evidence that the home is run in the best interests of the residents. Sound practices and procedures are in place regarding resident’s finances. Residents, staff and visitors to the home are potentially being put at risk due to poor practice in relation to some areas of fire prevention. EVIDENCE: At the last inspection it was noted that staff, residents and relatives were unsure of management roles and responsibilities. Mr Watts has now taken over the major management role and is reviewing the staff structure as it has been recognised that in a home of this size he needs a deputy manager and senior carers to help share the management of the home and ensure that all
Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 17 tasks are dealt with efficiently. Mr Watts has considerable experience of managing a care home but does not yet have the required qualification. A quality assurance system is in the process of being developed by the home but as yet no proactive action has been taken in the home to identify its strengths and weaknesses and take any necessary action. Mrs Watts 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. She also confirmed that the home does not hold cash or valuables for any resident. Chemicals in the laundry area are now being stored securely. Accidents are recorded appropriately in the accident book and reported as required. Fire records were checked and found to be satisfactory with the exception of twice yearly fire drills, which had not been undertaken since May 2005. Staff were observed to using inappropriate moving and handling techniques to assist residents into the lounge at lunchtime. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 1 Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement The registered person must ensure that new residents are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective resident, his/her representatives (if any) and relevant professionals have been party. 23/1/06 Improvements have been made to the systems to be used for pre-admission. However no new residents have been admitted since the last inspection so the improvements cannot be measured. This requirement is therefore carried over for the next inspection. The registered person must confirm in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of his/her health and welfare. 23/1/06 Improvements have been made to the systems to be used for pre-admission. However no new residents have been admitted since the last inspection so the improvements
DS0000003929.V279180.R01.S.doc Timescale for action 1. OP3 14 31/03/06 2. OP3 14 31/03/06 Cherry Tree Lodge Version 5.1 Page 20 3. OP7 14 & 15 4. OP8 12 & 13 5. OP18 13 6. OP29 19 7. OP30 12 & 18 8. OP31 9 cannot be measured. This requirement is therefore carried over for the next inspection. All service users must have a plan of care that sets out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and social care needs of the service user are met. Care must be taken to ensure that issues identified in daily recording are acted upon and recorded. Psychological assessments must be undertaken and kept up-todate. Any identified issues must be addressed via a care plan. The registered person must make arrangements by training of staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse The registered person must operate a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Evidence of a new employee’s identification must be held on file, 2 written references and a Criminal Records Bureau/POVA check must be obtained prior to an employee commencing duties or being confirmed in post. All staff must receive induction and foundation training to NTO specification within 6 weeks of appointment to their posts. 23/1/06 Induction packs have been developed but no new staff have been recruited. This requirement is therefore carried over for the next inspection. The management structure of the home must be clarified and
DS0000003929.V279180.R01.S.doc 31/01/06 31/01/06 31/03/06 31/01/06 30/03/06 31/03/06
Page 21 Cherry Tree Lodge Version 5.1 9. OP36 18 & 19 10. OP38 23 11 OP28 18 an application for a registered manager must be made to CSCI. 23/1/06 Improvements to the management structure have been made but not formalised. Care staff must receive formal supervision which covers all aspects of practice, philosophy of care in the home and career development needs, at least six times a year. 23/1/06 Not assessed on this occasion. This requirement is therefore carried over for the next inspection. The registered person must ensure that safe working practices are operated in the home. Fire Drills must be undertaken at least twice a year and must involve residents. Staff must receive up dated training in safe moving and handling procedures. A programme should be submitted detailing how the required minimum of 50 staff trained at NVQ2 will be met and the timescale in which this will be achieved. 30/03/06 30/03/06 31/01/06 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 OP16 Good Practice Recommendations It is recommended that steps are taken to ensure that all residents, relatives and representatives are aware of the homes complaints procedure. Cherry Tree Lodge DS0000003929.V279180.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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