Inspection on 04/09/06 for Cherry Tree Lodge

This inspection was carried out on 4th September 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cherry Tree Lodge 19/12/06

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 4th September 2006 10:00 Cherry Tree Lodge DS0000067539.V310491.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.V310491.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.V310491.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.V310491.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 First Inspection Brief Description of the Service: Cherry Tree Lodge was first registered in July 2006, and is registered to provide 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.V310491.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. However, due to delays in registering the home, the first resident only moved in four weeks ago, so it was not possible to assess some of the standards in detail. The fieldwork visit took place over 7 hours. The main method of inspection used was called case tracking which involved tracking the support that the two 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 with the manager. Documents connected with the running of the care home were also inspected. The manager provided information that the fees charged are £2050 per week. What the service does well: What has improved since the last inspection? The home has just opened, and has not been inspected before. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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 DS0000067539.V310491.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.V310491.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are thoroughly assessed prior to admission, to ensure that their health needs are met. They are introduced to the home sensitively, and a range of information about the home is available. EVIDENCE: There is good information available for prospective service users, and their parents and placing authorities. The statement of purpose accurately reflects the service provided, and the service user guide is available in symbols format. However this was not available for a newly admitted service user, due to a fault with a printer. Two service users are currently being introduced to the service, and one was being admitted on the afternoon of the visit. A comprehensive assessment had been conducted, but this was not available for inspection. The acting manager outlined how the service user had visited with her mother and social worker on one occasion, but a second visit had been cancelled due to behavioural difficulties. During the visit, she had chosen her bedroom. Many staff from the home had visited her prior to her admission to introduce themselves, and to gain a knowledge of her support needs. She transferred to the home with care plans from her previous home, and staff offered good support when she became very distressed, going to great lengths to reassure her. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 9 A second service user had visited initially during the homes open day. She then had a one-day visit, an overnight stay, and a two-night visit is planned. A detailed letter is sent to placing authorities following the initial assessment, which outlines how the service users needs will be met, and identifies any issues, such as access to psychology and therapy services. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans contain a good range of information, but do not fully reflect the needs of service users. They are encouraged to make decisions and be involved in the running of the home, whilst risks to them are minimised. EVIDENCE: The care plans of the two service users living at the home contain a good range of information about their support needs. There is good crossreferencing between incident reports, daily records and risk assessments. However, one service user, who has a current ongoing medical problem, did not have a care plan detailing what action was being taken. Because of the service users learning disabilities, it is not possible to involve them fully in the care planning process, so the acting manager explained that he is meeting with parents to discuss the care plan with them. Service users have an ‘All About Me’ booklet, which outlines preferences in daily lives and routines. Person Centred Plans will also be introduced, to consult service users about their future hopes, aspirations and goals. Throughout the visit, staff were observed to be encouraging service users to Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 11 make choices, and one service user confirmed that he is involved in the running of the home. He said, “I do a lot here – I clean my room and the bus, and my washing”. Staff complete a handover report, and a member of staff sat with him, and talked about what he had done this morning, and what had made him happy. She then read out the report to him, and he signed it. Service user meetings have not been set up as yet, but the acting manager confirmed that this is planned, to enable service users to express their views. He is looking at an independent person, not a member of staff chairing this. There are a good range of risk assessments, outlining how residents can develop skills, whilst ensuring that risks are minimised. However, the way that these are printed is confusing, as it is sometimes difficult to identify which particular risk assessment the text refers to. It is recommended that this be reviewed. Residents records are stored in a lockable office, and staff demonstrated a good knowledge about their responsibilities for maintaining service users confidentiality. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activity plans are being developed to ensure that service users have a structured and enjoyable timetable, and educational opportunities are being explored. Catering arrangements reflect individual choices. EVIDENCE: Because the home has only recently opened, it is difficult to fully assess some standards in this section. Activity plans are being developed, as staff get to know service users, and service users express their wishes. The two residents living at the home, both have basic activity timetables covering 7 days per week. These are a mixture of home-based activities, walks and outings. The acting manager explained that person centred plans will identify what activities service users wish to pursue. He is also exploring links with local colleges. One resident said that he enjoys the activities available. He had enjoyed helping to take the minibus to a garage to get it fixed this morning, and had gone for a pub lunch. He said that he had gone swimming in Bourne recently. The home has an activity room, mainly used for art and crafts, and there is also a sensory room, which a service user said she enjoys using, and requested to go Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 13 there on several occasions during the visit. Raised flowerbeds are waiting to be installed in the garden, so that service users can participate in gardening. Families and friends are encouraged to visit, and the home maintains links with the other two home run by the company, with service users attending any social functions that are organised. Staff were observed to respect service users privacy, and one said that staff always knock on his door before entering. Interactions between staff and service users were respectful. Service user have access to all communal areas, and the garden, but because of a potential road safety risk, an alarm has been installed on the front door to alert staff if a resident leaves the house. Catering arrangements are of a domestic nature. With only two service users, it has been possible to accommodate individual choices for each meal, and this was observed during the visit. As occupancy increases, service users will be involved in menu planning. Records of meals provided and food temperature testing were not fully completed, and it is recommended that the advice of the environmental health officer should be sought about the temperature testing of food. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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. 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. Medication administration and storage is not robust enough, and could put service users at risk. EVIDENCE: Service users are funded on a 1-1 basis, and are offered individual support. Staff were observed to ensure that service users privacy and dignity was respected, when offering assistance with personal care. One service user confirmed that he chooses what time to go to bed and to get up. The ‘All About Me’ assessment provides staff with good information about preferred routines. Both service users are registered with the local GP practice, and Health Action Plans are currently being completed. One resident who has recently been assessed has complex heath needs. The offer of a place was dependent on further discussions with the local Consultant Psychiatrist. The letter also pointed out the lack of local therapy services, and psychology services, and suggested three options to ensure that these services were available, including private funding. The company is currently exploring the possibility of buying in Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 15 additional services from a Consultant Psychiatrist for service users coming from out of county. A monitored dosage system is used for medication. Storage facilities are satisfactory, but a large amount of medication for a newly admitted service user was left in the office on a filing cabinet, unlocked and unattended for a lengthy period. This was appropriately stored following a request from the inspector. The administration record for one service users ‘as required’ medication was handwritten, but did not contain the name of the service user for who the medication were prescribed. The directions for the frequency of administration for this medication from the prescribing doctor were not clear, and required further clarification. A medication administration record had been signed at a time when no medication was prescribed, so it was not clear if an additional dose had been administered. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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 good. This judgement has been made using available evidence including a visit to this service. Arrangements for dealing with complaints are satisfactory, and staff have a good knowledge of the adult protection procedures. EVIDENCE: There have been no complaints since the home opened. Each resident has a copy of the complaints procedure in written and symbols format in their care plan, but the manager said that he intends to put a copy of this in each room. There is no method of centrally recording complaints, or their outcomes, and the manager agreed to set up a system. Staff demonstrated a good awareness of the adult protection procedures, and their responsibilities for reporting concerns. New staff said that they had not covered this on induction, and it is recommended that this be included. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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 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: The home has been extensively refurbished prior to registration, and there are a good range of spacious communal areas, enclosed grounds and large ensuite 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. Service users have chosen their own bedrooms, and one said, “I like my room – I’ve got a big bed and lots of records”. One service user confirmed that he assists with cleaning, and the manager said that night staff are responsible for some cleaning tasks. The home was very clean on the day of the visit. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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. Staffing levels allow for individual support to be provided, and staff receive good induction training. However, staff recruitment and selection procedures are not at present robust enough to protect service users. EVIDENCE: Staff are all newly recruited, or have transferred from other care homes run by the company. New staff said that they had attended a two-week induction, and then shadowed experienced staff before working unsupervised. One said, “It’s probably the best induction that I have had”. The company has a training plan, which outlines dates for mandatory and other training, and staff will access this. Five staff files were inspected, and only one contained the documentation necessary for the protection of service users. The company uses an external human resources company, and recruitment records, including references and evidence of criminal record bureau checks are kept by them. New staff interviewed confirmed that their recruitment and selection process had been thorough, and that they had to wait for the relevant checks to be made before commencing employment. Evidence of references and criminal records bureau checks were sent to the commission following the inspection, but this showed Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 19 that one member of staff had been employed before any references had been received. The acting manager stated that he had received verbal confirmation from the human resources company that satisfactory references had been received, so he had allowed the person to start. Staffing is on a 1-1 basis. Staff said that they are “struggling a bit”, with new service users being admitted. The acting manager confirmed that five new staff were due to start, but were awaiting their criminal record bureau checks to come through. Staff rotas only identify staff using their christian names. This is not sufficient for record keeping purposes, and surnames should be used. There was evidence that the acting manager had commenced staff supervision, and staff said that they felt well supported. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The acting manager is enthusiastic about developing the service. Health and safety precautions are satisfactory to ensure that service users are safe. EVIDENCE: Because the home has only recently opened, it is difficult to fully assess some standards in this section. The acting manager has previous experience working with people with an autistic spectrum disorder. He has completed a National Vocational Qualification at level 3, and is waiting to start the registered managers award. He will be applying to become registered manager for the home. The acting manager outlined his ideas for monitoring the quality of the service provided. As previously mentioned, he intends to introduce service user meetings, chaired by an independent person, to enable service users to Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 21 express their views. He is also looking at questionnaires for service users, parents and placing authorities, and a comments and suggestions box. Daily environmental checks, and weekly health and safety checks are conducted. The home is newly registered and maintenance and servicing arrangements were found to be satisfactory at the time of registration. The fire log had only one recorded fire alarm check, and this should be done on a weekly basis. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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 3 3 3 4 3 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 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 3 3 3 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 3 3 1 x 3 x 3 x x 3 x Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 23 N/A 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 Timescale for action 30/10/06 2. YA20 13(2) 3. YA34 17(2) & 19 The registered person must ensure that care plans accurately reflect the identified needs of service users. The registered person must 30/10/06 ensure that medication is stored appropriately and administration records are accurate. The registered person must 04/09/06 ensure that the documents outlined in Schedule 2 are obtained prior to employment, and the documents outlined in Schedule 4(6) are kept in the care home. 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 YA9 Good Practice Recommendations It is recommended that the risk assessment format be reviewed to prevent confusion. Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 Page 24 2. YA17 It is recommended that the advice of the environmental health officer should be sought about the temperature testing of food. It is recommended that adult protection awareness is covered during staff’s initial induction. 3. YA23 Cherry Tree Lodge DS0000067539.V310491.R01.S.doc Version 5.2 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. 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