CARE HOMES FOR OLDER PEOPLE
Cherry Tree Lodge 100 Wick Lane Southbourne Bournemouth BH6 4LB Lead Inspector
Catherine Churches Announced 26 September 2005 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 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 D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Lodge Address 100 Wick Lane, Southbourne, Bournemouth, Dorset, BH6 4LB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 429326 Mrs Audrey Martha Watts Mr John William Watts Mr Simon John Watts PC Care Home only 20 Category(ies) of OP - 20 registration, with number of places Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21 March 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 mintues 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 D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection undertaken during the morning and afternoon of 26th September 2005. The Registered Persons, Mr and Mrs Watts and Mr Watts were present throughout the inspection. Mr Watts, who takes the role of manager, was present to assist the inspector together with the homes nominated deputy manager and another senior member of staff. The purpose of this inspection was to follow up on issues raised during previous inspections and other visits and to help the home develop an action plan for the future to ensure that compliance with all National Minimum Standards is achieved. Prior to the inspection comment cards were sent to residents, relatives, doctors and other health professionals. Eleven cards were received from relatives/representatives, two from GP’s and five from residents. One card was defaced. All of the residents responded positively about the care, staff, accommodation and food at Cherry Tree Lodge. One person wrote, “ I would like to commend Mrs Watts, her family and carers who have been most attentive and helpful”. During the inspection a number of residents were spoken with and more positive comments such as “it’s a wonderful place” and “I wouldn’t like to be anywhere else” were received. One issue for attention was raised via the relatives/representatives comment cards and a recommendation is made regarding this later in the report. 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 beautifully maintained gardens that residents reported they enjoyed very much. The home provides a detailed and informative Statement of Purpose and Service Users Guide that will provide prospective residents with the information they require. All residents spoken with were positive about the care and attention that they receive. There is a good range of activities both undertaken by care staff from the home and from visiting entertainers. Visitors are encouraged to come to the home whenever possible. The staff group were observed to be respectful, helpful and caring.
Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
A full needs assessment, in accordance with National Minimum Standards, must be undertaken to ensure that the home fully understands the needs of prospective residents prior to admission and that the home has the skills to meet these needs. Letters of confirmation that the home can meet a persons needs should be sent to the resident prior to their admission to Cherry Tree Lodge. Assessment of health, welfare, risks and care planning, once a person is resident at Cherry Tree Lodge must improve in order that the home can demonstrate that they are aware of needs and are meeting these needs or taking steps to ensure that other relevant professionals do so. The home must ensure that all residents, relatives/representatives and other stakeholders are made aware of the complaints procedure and are comfortable in using this should the need arise. Staff must receive training in the identification and prevention of abuse and the actions they should take to protect a resident should they suspect that abuse has occurred. Staff must receive training in Infection Control to help prevent infection in the home or its spread once present. Failure to follow staff recruitment procedures has resulted in the possibility that residents could have been put at risk. Newly recruited staff are not receiving the required induction and foundation training as required by the National Minimum Standards. This means that the home cannot demonstrate staff’s competence to provide care for the residents at Cherry Tree Lodge. A manager must be registered and approved by the Commission; a full staff structure together with clear lines of accountability and responsibility must be developed and implemented. Staff must receive formal supervision at least six times per year.
Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 7 Accidents must be fully recorded in accordance with Health and Safety and Data Protection Legislation. Chemicals must be stored and handled in accordance with COSHH requirements. 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 D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 The homes Statement of Purpose and Service User Guide provide detailed information about the care and services available at Cherry Tree Lodge therefore enabling prospective residents to make an informed decision about the home and its suitability for them. The pre-admission assessment process is insufficient and does not enable the home to thoroughly assess a persons needs or establish whether those needs can be met at Cherry Tree Lodge. EVIDENCE: An amended version of the Statement of Purpose and Service Users Guide was submitted on the day of the inspection. Examination of this confirmed that it now meets the requirements of the National Minimum Standards. Documentation for two recently admitted residents was examined. It was noted from this that one admission was carried out as an emergency despite the homes Statement of Purpose clearly stating that it does not accept emergency admissions. Consequently the proprietors and staff had minimal information about the person’s needs and no way of knowing whether they could provide suitable care. In the case of the second admission there was
Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 10 only basic information recorded and this was not in compliance with the National Minimum Standards, this again meant that the home was unable to demonstrate that it was certain it could meet the person’s needs before they were admitted. There was no evidence available that written confirmation had been given to the prospective resident confirming that an assessment had been undertaken and the home could meet their needs. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 There is a care planning system in place but this is not used appropriately and therefore does not provide staff with the information they need to satisfactorily meet resident’s needs. Systems for resident consultation and participation in the assessment and care planning process are inconsistent. This means that there is little evidence that resident’s views are actively sought or acted upon. There are satisfactory arrangements in place to meet resident’s healthcare needs. EVIDENCE: Care plans and related documentation were examined for 3 residents. It was found from these records that there is a care planning structure in place but that it does not cover all of the recommended areas as set out in the National Minimum Standards. Through discussion with staff and observation of/discussions with the residents whose care plans were examined, it became evident that the gaps in care planning structure meant that some areas of care requirements were not properly assessed and reviewed. Care plans that were in place were being reviewed monthly.
Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 12 Resident’s health needs are met through visits to/by doctors and other health professionals as required. Resident’s weights were not being recorded as required. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Cherry Tree Lodge provides a homely, relaxed environment. There is a range of in house activities and entertainment in accordance with resident’s expectations and abilities. Visitors are welcome in the home and residents benefit from such contact with relatives and friends. A nutritious and varied diet is provided for residents. 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 CD’s 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. Residents are encouraged to maintain contact with family and friends and there was a steady stream of people coming and going from the home during the inspection. Two visitors were spoken with and were 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 D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 had not received training in Adult Protection and the home is therefore 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. 50 of relatives/representatives responding to the pre-inspection questionnaires said that they were not aware of the home’s complaints procedure. Policies and procedures were available regarding the protection of vulnerable adults from abuse. However, staff had not received training in the detection and protection of abuse. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is well presented: it is nicely decorated and furnished and has a homely atmosphere. The grounds are also well maintained, providing lots of colour and interest as well as a variety of places to sit and relax. The home maintains a good standard of hygiene and all areas seen were clean and free from offensive odours. EVIDENCE: A tour of the premises confirmed that the home is well decorated, furnished and equipped. Dorset Fire and Rescue Service has visited the home and confirmed that it complies with their requirements. The home employs 2 cleaners. It was noted that protective clothing is available to assist with infection control but that staff have not yet received training in this important area. (See standard 38) Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30 The standard of vetting of staff and recruitment practices is poor. Appropriate checks are not being carried out and this potentially leaves residents at risk. The arrangements for the induction and foundation training of staff do not comply with minimum requirements. This means that staff may not have basic competencies in the areas required of them. Some other training has been provided for some staff but there is no planned analysis of training needs to ensure that all staff have the appropriate skills required of them. EVIDENCE: Staff records were examined for 1 newly appointed staff member and an existing member of staff. The latter was satisfactory but the file for the new staff member raised serious concerns. The person concerned had commenced their duties without a POVA (Protection of Vulnerable Adults) or CRB (Criminal Records Bureau) check, no references had been taken up and there was no evidence that identities have been verified. Staff discussions and examination of records confirmed that various in house training courses continue to take place. There was little analysis of the training needs of staff that would then enable a training plan to be developed. It was also evident from discussions and examination of staff files that Induction and foundation training, compliant with the National Training Organisation requirements, was not being provided. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36 and 38 The home does not currently have a registered manager. The current management arrangements can mean that there is no clear line of leadership and delegation and staff are unsure with regard to their roles and responsibilities. Formal staff supervision is not being undertaken resulting in staff being unclear of their roles and responsibilities. Fire Precautions and fire training for staff were satisfactory and therefore promote resident safety. Management practices with regard to the Control of Substances Hazardous to Health (COSHH), do not promote the health, safety and welfare of residents. Staff have not been trained in infection control and this may put residents at some risk if it is not addressed. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 18 EVIDENCE: At present Mrs Watts and her son are in day-to-day charge of the home. Although both have considerable experience in the running of care homes, neither have the requisite qualifications in care and management as set out in the National Minimum Standards. Mr Watts has already identified this as a problem area. One member of staff is currently undertaking the NVQ level 4 training and Mr Watts is also considering undertaking this. However, without a registered manager, the home is operating outside of the remit of the Care Standards Act 2000 and this matter must be addressed as a priority. This inspection highlighted the fact that there are currently no properly defined roles and this is causing confusion and frustration for all. Staff are keen to accept responsibility and also to develop professionally but are unsure of their remit within the home and therefore defer to Mrs Watts and Mr Watts. Mr Watts confirmed that he is aware of the need to undertake formal supervision with all staff but has not yet implemented this. Fire records; staff training records and risk assessments were examined and found to be up to date and detailed. Also observed during the inspection were a number of laundry chemicals that were not being kept securely. It was also noted that staff have not received training in infection control procedures. Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 1 x x x x 1 x 1 Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 20 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 OP3 Regulation 14 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. 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 resdients needs in respect of his/her health and welfare. All service users must have a plan of care that sets out in detail the action which nees to be taken by care staff to ensure that all aspects of health, personal and social care needs of the service user are met. The plan must be reviewed at least once a month and updated to reflect changing needs. The plan must be drawn up with the invovement of the service user and recorded in a style accessible serviceuser; agreed Timescale for action Immediate - prior to admission of all further new residents Immediate - prior to admission of all further new residents 31/12/05 2. OP3 14 3. OP7 14 and 15 Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 21 4. OP8 12 and 13 5. OP18 13 6. OP29 19 7. OP30 12 and 18 8. OP31 9 9. OP36 18 and 19 10. OP38 and signed by the serice user wheneever capable and/or representative (if any). Risk assessments, nutritional and psychological assessments must be undertaken and kept up-to-date. 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 sufferring 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 emplyees 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. The management structure of the home must be clarified and an application for a registered manager must be made to CSCI 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. The registered person must ensure that safe workin practices are operated in the home. Coshh regualtions must be complied with and staff should 31/12/05 31/1/06 31/12/05 30/3/06 31/12/05 30/3/06 30/3/06 Cherry Tree Lodge D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 22 receive training in infection control. 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 D55 S3929 Cherry Tree Lodge V236436 260905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 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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