CARE HOMES FOR OLDER PEOPLE
Cherry Tree Manor 8 Great Road Adeyfield Hemel Hempstead Hertfordshire HP2 5LB Lead Inspector
Mrs Sheila Knopp Unannounced Inspection 10:40 22 September 2005
nd 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 Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Manor Address 8 Great Road Adeyfield Hemel Hempstead Hertfordshire HP2 5LB 01442 217621 01442 262955 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) Oak.care@virgin.net Oak Care Limited Care Home 47 Category(ies) of Dementia - over 65 years of age (47), Old age, registration, with number not falling within any other category (47), of places Physical disability over 65 years of age (47) Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Cherry Tree Manor is a care home which provides personal care and accommodation for 47 older people. The home is in Adeyfield, a residential area of Hemel Hempstead, close to a shopping and local community facilities. There is a good sized car park and access to local bus routes. This purpose built home opened in 1996. Resident accommodation is on floors reached by stairs or lifts. There is a choice of lounges and a dining room on each floor with additional kitchenettes for providing snacks and drinks. All of the bedrooms are single rooms with an en suite toilet and wash hand basin. There are additional assisted toilets and bathrooms on each floor. Residents have access to an enclosed garden area and conservatory. The home aims to meet the needs of older people who may also have physical disabilities or dementia. It does not provide a service to people who are assessed as requiring nursing care; it will however continue to provide a service for people with changing needs as long as they can be met in the home with input from the primary health care team. Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two inspections planned for this home for the year April 2005 – March 2006. Details of standards not inspected during this visit can be found in the inspection report dated 26 April 2005. This report reflects what was observed in the home during this unannounced inspection which took place between 10.40 am and 4.20 pm. The inspector met individually with residents, relatives and staff in the home to gather their opinions on how the service is managed and whether their needs are being met. Overall this was appositive inspection with a high level of satisfaction being expressed. As well as carrying out this inspection the Commission also wrote to local to General Practitioners, Community Nurses and Social Workers to ask for their views on the care and support being provided at Cherry Tree Manor. Positive responses have been received from 5 General Practitioners with patients in the home, a Community Nurse and Social Worker. Their comments have been added to this report. CSCI comment cards were completed by 11 residents supported by staff. All 11 people said they felt safe and knew who to go to if they were unhappy with their care. Nine people stated their privacy was respected. A new manager has been appointed since the last inspection. Mrs Swendell’s application to become the Registered Manager under the Care Standards Act was agreed by the Commission following this inspection. No complaints or concerns have been received by the Commission about this service between inspections Ten hours of inspector time has been allocated to this inspection. What the service does well:
Since the last inspection dementia care services provided at Cherry Tree Manor has been accredited by Hertfordshire County Council. This accreditation is subject to annual review. As well as seeing documents in the home this was confirmed by a social worker who completed a CSCI comment card stating ‘this home recently met standards and has subsequently achieved dementia care accreditation, this home works very well with the local team’. The home has good links with the Community Nursing Service which means residents who have health or medical problems are well supported. A Community Nurse stated ‘staff have always been friendly and helpful.’
Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 6 A General Practitioner stated they were ‘Impressed with the friendliness of staff and the genuine care they show towards the patients. I have never experienced any problems in relation to their management or attitude and would happily recommend this home to my patients’. There is a high level of day-to-day involvement with residents from friends and family, which makes the home, feel part of the local community. What has improved since the last inspection? What they could do better:
To ensure the safety of residents and to make sure there are clear guidelines for staff the risk assessments in relation to the use of specialist seating and bed rails need to be reviewed. This area was a requirement following the last inspection and has only been partially met. The manager and Registered Provider have agreed to review the systems for recording this information. Guidance form the Commission has also been sent to the manager. The new manager has identified some gaps in training updates for some long standing members of staff, which she is addressing through an action plan presented to the Registered Provider. The Manager and Registered Provider need to continue to promote the National Vocational Qualification (NVQ) programme for staff to achieve the 50 of care staff with a qualification in care practices detailed in the National Minimum Standards for Older people which was to have been achieved by 2005. The manager has been asked to look at ways of providing a more interesting outlook for a resident whose only view from their bedroom window is a wooden fence. The manager needs to discuss the storage of a particular liquid medication with the dispensing pharmacist to ensure the treatment room temperature is
Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 7 suitable for this product which requires a lower temperature than other medicines. 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 Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 the following standard(s): Not inspected. EVIDENCE: Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 10 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): These standards were not fully inspected. However following a review of requirements made at the last inspection the following action has been required. Under standard 7 the manager needs to review the system for recording risk assessments for the safe use of furniture and fixtures such as bed-rails so there are clear indications as to the reason for their use and instructions for staff. Under standard 9 staff have been advised to contact the dispensing pharmacist to confirm the temperature of the storage area required for a specific liquid medication (Lactulose). EVIDENCE: Some work had been carried out to provide more details on the care plans where items of furniture or equipment are in use which may restrict residents but it was felt that this needed to be detailed in one place in the form of a risk assessment to provide a clear rationale for it’s use, discussions and agreement with health & social care professionals and clear instructions for staff on it’s use.
Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 11 Staff are now recording the temperature of the medication storage areas to ensure medication is stored as required below 25 degree centigrade. An air conditioning unit has been provided for the ground floor room. However a commonly used liquid medication (Lactulose) requires a lower storage temperature and the manager has been advised to discuss this with the dispensing pharmacist so alternative arrangements can be made if required. Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 12 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): 12, 13, 14 & 15 Residents at Cherry Tree Manor have the opportunity to take part in a varied social programme and make choices about how they wish to spend their time. The open friendly atmosphere at Cherry Tree Manor together with the links many of the residents have with the local community enables contact with friends and family to be maintained. A feature of this home is the high level of day to day involvement that friends and family have with residents. There are opportunities for residents and their relatives to contribute their views to how the home is being run. Residents are provided with a plentiful and varied diet. EVIDENCE: Nine out of 11 residents who completed comment cards said suitable activities were provided. Two people said sometimes. The activity programme is reviewed with the residents informally and as part of resident’s meetings. Details of individual interests and life events are discussed with residents and their relatives and recorded as part of the care plan. Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 13 Two activity organisers are employed and a varied daily programme of group activities and events is arranged. One resident said ‘they’re always showing me new things, the staff are very good’. A relative said ‘there are always things to do’. The programme includes things to stimulate the mind, exercises and entertainment. One to one sessions her held with residents who choose to stay in their room. Current magazines are provided for residents to pick up and there is a hairdressing salon which was in full swing on the day of the inspection. As part of the on-going development of social care within the home the activity staff are attending a course looking at the specific needs of people with dementia. There has recently been a change of cook and the impression the inspector got from talking with residents was that they were very positive about the meals that they have. However only four out of 11 residents who completed comment cards responded with a ‘yes’ to the question ‘Do you like the food?’ Two people said no and 5 said sometimes. One person said they would like more variety and gave the example of fresh fruit another person commented that ‘recently the meat had not been edible’. There are regular reviews of the menu with the residents and a new autumn menu is due to be introduced. Residents were overheard remarking that lunch had been very nice. Staff also asked if people had had enough. The monthly reports provided to the Commission by the Registered Provider indicate this is an area that is kept under review. The views of relatives are obtained through quality questionnaires sent out by the company and opportunities for regular meetings with senior staff are provided as well as day to day contact. Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 the following standard(s): Not inspected. EVIDENCE: Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 the following standard(s): 26 All areas of the home were found to be fresh and clean on the day of inspection. Residents are provided with a good laundry service. There are systems in place to reduce the risk of infection. However, following new guidance from the Hertfordshire Infection Control nurses the provider is considering changing the style of soap dispenser in use. EVIDENCE: The house keeping team were observed interacting positively with the residents and ensuring their personal items and ornaments were well cared for when they cleaned their room. The domestic hours have been extended to cover time in the evening to maintain good standards. Residents were wearing smartly laundered clothing.
Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 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): 29 & 30 To protect residents the company recruitment system ensures staff are checked for their suitability to work with older people before they start work in the home. There are systems in place to ensure new staff receive an induction into the care of older people and safe working practices and existing staff receive annual updates. However the new manager has identified some gaps in training updates for long standing staff which she is addressing. EVIDENCE: The personnel records of two new members of staff were checked to confirm that the required checks and records were available. Staff training records were checked. The manager will need to review the NVQ training programme if the home is to achieve 50 of care staff achieving level 2. Currently 1 member of staff is reported to have an NVQ with 6 others starting the programme. Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 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): Not inspected EVIDENCE: Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 x 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x x x x Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 13(4)(c)& (7) 17(1)(a) Requirement That a further review of the risk assessments in relation to furnishings and equipment which restrict movement such as reclined/inclined chairs and bed rails is carried out. Clear details of the rationale for use, multidisciplinary assessment / agreement and instructions for staff must be recorded. Provide CSCI with an updated risk assessment form. Partially met requirement from last inspection. Timescale for action 30/11/05 Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 20 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 2 3 Refer to Standard OP9 OP25 OP26 Good Practice Recommendations Confirm guidance given by dispensing pharmacist in relation to the storage temperature for Lactulose. Review fencing outside the identified bedroom to provide the resident with a more interesting view. The Hertfordshire Infection Control Nurses have recommended that refillable liquid soap dispensers be replaced by cassettes to reduce the risk of contamination and infection. Provide the Commission with an action plan to achieve 50 of care staff with qualifications at NVQ level 2 or equivalent. 4 OP28 Cherry Tree Manor DS0000019313.V250386.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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