CARE HOMES FOR OLDER PEOPLE
Cherry Tree Manor 8 Great North Road Adeyfield Hemel Hempstead HP2 5LB Lead Inspector
Sheila Knopp Unannounced 26 April 2005 09:15 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 Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Manor Address 8 Great North Road Adeyfield Hemel Hempstead HP2 5LB 01442 217621 01442 262955 oak.care@virgin.net Oak Care Limited 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) Mrs Susan Slade Care Home 47 Category(ies) of OP Old Age 47 registration, with number PD(E) Physical Disability over 65 47 of places DE(E) Dementia over 65 47 Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 14 December 2004 Brief Description of the Service: Cherry Tree Manor is a care home providing personal care and accommodation home for 47 older people. The home is in Adeyfield a residential part of Hemel Hempstead close to a shopping centre and local community facilities. There is a good-sized car park and acess to local bus routes. The home which was purpose built opened in 1996. Resident accomodation is on two 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 hand basin. There are additional assisted toilets and bathrooms on each floor. There is an enclosed garden and conservatory. The home aims to meet the needs of older people and for service users who have 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 for as long as their needs can be met in the home with input from the multi-agency team. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors who were in the home from 9.15 am to 3.45 pm. Before the visit the records of CSCI contact with Cherry Tree Manor since the last inspection were checked. These included notifications of accidents, incidents and deaths. Fourteen hours of inspector time has been allocated to this inspection. Both inspectors spent the morning talking to residents and observing the interaction between residents and staff as staff assisted residents to get up and have their lunch later in the day. Discussions and contact was made with 14 residents, 3 relatives and 7 staff as well as the deputy manager. Mrs Reekhaye, Director of Oak Care Ltd, was present when the inspectors presented their assessment of the inspection. Care and administrative records were checked. The residents, staff and deputy manager were very helpful and open in their contact with the inspectors. What the service does well:
There was calm relaxed atmosphere in the home. Residents were bright and alert. Good interaction between staff and residents was observed with staff providing sensitive and dignified support and encouragement when required. This included recognising and responding appropriately to residents who were becoming anxious. The domestic staff also involved themselves with the residents and appreciative comments were received. The home is bright with lots of things for residents to look at. There are small seating areas as well as the lounges for residents to sit. Having windows on to the dining and lounge areas enables residents with dementia to understand the purpose of each room and find their way about. Relatives had been encouraged to personalise individual rooms and staff were using familiar items to provide comfort to residents. There were nice touches that showed consideration to the residents like the availability of a selection of magazines. The following comments from residents indicated that they were relaxed in the home and got on well with staff. ‘It’s lovely here they’re very good’, ‘It’s very nice here I am very happy, ‘I’m thankful to be here’. One person with dementia was able to say ‘This is a good old house, she’s really good, I like it’.
Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 6 This was felt to indicate this person sense of well being living at Cherry Tree Manor. Another person said people were ‘ very friendly and we get along alright’. One resident said ‘it’s a wonderful place, no worries or trials’, a ‘lovely care free life’. Another resident pointed out a member of staff and said ‘she’s very nice’. One person said ‘the staff are very good’. A resident was also concerned to ask after a member of staff indicating a positive relationship. One person said they felt safe, they had not felt like this when they were in their own home. The home has an activities organiser and is currently recruiting a second person. The programme of activities and events included VE celebrations and regular tea dances. When asked if staff had time one person said ’ some staff have time some are in a hurry to get off’. Overall the comments were very positive. One person said there ‘was not much to do’. Another person said ‘ I don’t feel isolated, I have my phone and paper and can enjoy the entertainment’. What has improved since the last inspection? What they could do better:
Staff demonstrated that they were able to respond and communicate appropriately to service users with dementia and relatives had completed personal life histories. However, information of how to provide individual support to promote the feeling of well-being and build on the strengths of service users with dementia was not brought together as a plan of care. The home’s Statement of Purpose, which is a document that provides information to residents, relatives and commissioning authorities about the philosophy of care does not specifically mention the approach taken in relation to research based dementia care. Some issues regarding the use of chairs that have the potential to restrict individual residents from moving about the home were raised. Medication storage temperatures must be checked to demonstrate that medicines are being stored at a safe temperature. Some excess equipment needed to be removed from an area near a fire exit to make sure this area remained clear. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 7 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 I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 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 Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 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) 2 & 3 Residents are issued with contracts and made aware of the terms and conditions of the home. To see if the home can provide a suitable service the manager meets with the service user before admission to carry out an assessment. Information is also obtained from other health and social care workers involved with the individual. EVIDENCE: The assessment and care records of a newly admitted resident were checked and found to contain the required information. A contract had been issued providing details of the home’s terms and conditions. Following admission a care plan is put in place and the records checked had been discussed with representatives of the resident. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, & 10 Residents were being well supported to achieve high standards of personal care by staff who were familiar with their individual needs. Care plans are in place to direct staff how to meet the personal care and health needs of the residents. However, the care planning approach for residents with dementia should be reviewed so that a more person centred approach is taken which reflects how that individual wishes to be cared for. This approach would enable staff to identify activities and stimulation. This, in turn, should have a positive effect on the person’s sense of well-being. Good access to support from Community Nurses, General Practitioners and other health and social care staff supports the health needs of the residents. Overall the medicine systems were found to support the safe administration of medicines but staff need to record the temperature of the treatment rooms. EVIDENCE: Each service user has a care plan describing their personal care needs. These are in the form of pre-printed care pathways which staff fill in to reflect individual needs. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 11 They give a clear description of physical care needs but do not reflect the person centred planning approach associated with providing a specialist dementia care service. Care needs are described in terms of what action needs to be taken by staff rather than how each individual wishes to be cared for. Good interaction between residents and staff was observed with staff responding as the as the needs and emotional state of individual residents changed during the day. Examples of staff providing one to support for residents beginning to show signs of anxiety were observed. Mobile residents were able to walk feely about as they wished and nobody was observed to be ill at ease. All residents appeared to be comfortable and had received a high standard of personal care with attention to their hair, nail and mouth care. The records showed that residents were weighed regularly. Drinks and snacks were available throughout the day and a soft or pureed diet was provided for those who needed it. Staff sat with residents who needed help with their meals and this was sensitively organised. Comments made by residents demonstrated they felt supported by staff and staff were kind and gentle. Details of arrangements for visiting doctors, dentists, chiropodists and opticians were recorded in the care plans reviewed. A dentist was visiting a resident during the inspection following a referral from staff. They said he was ‘ever such a nice man’. Staff and residents confirmed that community nurses are in regular contact with the home and have provided equipment for the prevention of pressure sores. At the time of the inspection one person was reported to be receiving treatment for a pressure sore that had developed in hospital. The resident appeared to be comfortable in bed and a pressure relieving mattresses was in place. This person’s care plan stated that pain relief was to be regularly reviewed but there was no indication from the daily record that this had been considered. A number of frailer resident’s no longer able to walk were sitting in reclined ‘bucket’ style chairs, which restrict movement. All the residents appeared to be comfortable and relaxed. However, the care plans did not detail the reason for the use of these chairs or include a multi-disciplinary risk assessment agreed by health or social care professionals. Further guidance has been provided to the home. To support the dignity of residents staff need to ensure that net undergarments are labelled for the use of individual residents as the system previously in place seems to have lapsed. The home’s quality assurance system includes asking for feedback from other health care professionals.
Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 12 Overall the systems for managing the medicines required by residents were found to be in order but a requirement has been made that staff record the temperature of the ground and first floor treatment rooms to demonstrate medicines are being stored at the correct temperatures. It was reported that an extractor fan is to be fitted in the ground floor room. Medication not stored at the correct temperature may become less effective or even unsafe for use. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 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) Not inspected. EVIDENCE: Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 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, 17 & 18 Good communication between residents, relatives, staff and the management of the home enable issues to be raised and dealt with as they arise. Residents have been provided with the opportunity to vote. Staff are aware of the need to protect residents from abuse and report any concerns. EVIDENCE: The home’s quality assurance system includes feedback from service users and their relatives. The director is currently reviewing the responses to a recent survey and will provide feedback to service users and their relatives. One issue raised by a relative during this inspection in relation to missing laundry has also been picked up by the home’s questionnaire. The home’s complaints procedure includes details of the response time expected if a complaint is made and contact details for CSCI. No written complaints had been received by the home or CSCI since the last inspection on 14 December 2004. That inspection was carried out early in the morning in response to information received by CSCI regarding night staffing levels. An immediate requirement was made to increase the number of staff on night duty. This inspection confirmed by checking rotas and talking with staff that the required action has been taken. Residents confirmed they were able to go to bed and get up when they wished. No concerns have been brought to the attention of CSCI by other health or social care workers between inspections. A resident confirmed arrangements had been made for them to have a postal vote and that they were very pleased to be able to take part in the election.
Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 15 A wide range of information on advocacy, legal and financial services is available in the front hall. The home’s policies and procedures do not allow staff involvement with the financial affairs of residents. It was reported that no money is held in the home on behalf of residents. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 16 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 Cherry Tree Manor was found to be well maintained and decorated providing a comfortable place to live. EVIDENCE: A redecoration and refurbishment programme has recently been completed. The maintenance and service records indicated that there are good systems in place and services were up to date. The hot water temperatures are thermostatically controlled and regularly tested to make sure they do not become too hot. The hot water tested as part of the inspection was within the required temperature. Residents are able to open their windows but those above ground level are restricted to prevent accidents. Residents have been able to create a homely feel to their rooms and examples of support from relatives in providing photographs and familiar items were seen. Residents were positive about their rooms and the support provided by the domestic staff. All areas of the home visited by the inspectors were found to be fresh and clean.
Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 17 It was observed that the bed linen on the bed of a service user and in the linen cupboard was beginning to look very worn. One person asked that some bedside shelves be replaced. On the day of inspection the director agreed to remove some obsolete drug trolleys, which had been stored beside a fire exit. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 18 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) 27, 28 The number of care and support staff provided is set at a level to support the needs of the residents. To protect residents the required recruitment checks are carried out before staff start work in the home. Staff receive training appropriate to their job and to support the needs of the residents. EVIDENCE: At the time of the inspection the deputy manager, 7 care staff, 2 domestics, laundry and catering staff were supporting 47 residents. Staff were well organised and aware of their responsibilities towards individual residents during the morning. Agency staff are not currently used. No concerns were raised by residents, relatives or staff in relation to staffing levels. The personnel records for 2 new members of staff were checked to confirm that a police check and two references had been completed before they started work. The training records indicated that recent training since January had included, moving and handling, risk and challenging behaviour, dementia care, continence, medication training for senior carers, first aid and protection of vulnerable adult training Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 19 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) 33,35, 36 & 38 Cherry Tree Manor was found to be well managed with informal and formal systems in place to respond to the views of residents and relatives. The homes policies safeguard the financial interests of residents. Staff are supervised in their day-to-day work by senior staff and also have planned formal appraisal and supervision sessions. There are well organised systems in place for protecting and promoting the safety of residents and staff. EVIDENCE: The home has a quality monitoring system in place, which takes account of the views of residents, relatives and visiting professionals. Feed back on questionnaires is made available to residents and relatives. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 20 It was suggested that providing residents/ relatives with a summary of the outcome of the annual audit and further action planned is considered for future development. It was positive to note that an issue raised by a relative had already been identified from a recent questionnaire and arrangements were being made to deal with the matter. Mrs Reekhaye, director is available to residents and relatives during her daily visits to the home. Details of the contractual arrangements were available for each service user including a person new to the home. A relative confirmed they had no concerns about the contract or payment arrangements. The public liability insurance certificate was on display. The home’s procedures do not allow staff to be involved in the financial matters of residents. Information on financial and legal matters is available in the entrance hall to residents and relatives. The safety, servicing and accident records in the home were found to be well organised and up to date. No concerns were identified from the records see. Regular fire safety checks, including fire drills are carried out. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 21 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 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 3 x 3 3 x 3 Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 22 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 7 Regulation 13(4)(c) 13(7) 17(1)(a) Schedule 3 (q) Requirement The use of furnishings and equipment which restrict movement such as reclined/inclined chairs and bed rails must be subject to a multidisciplinary agreement and the reason for use and safety guidelines recorded as part of a risk asessment in the care plan. Keep a daily record of the temperature of the medicine storage areas. Confirm excess equipment has been removed from the vicinity of the identified ground floor fire exit. Timescale for action 30.6.05 2. 3. 9 19 13(2) 23(4)(c) (iii) 30.6.05 31.5.05 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 7 Good Practice Recommendations Review the homes Statement of Purpose and care planning to reflect the research based approach taken in relation to residents admitted under the dementia care category. Reinstate system for identifying net undergarments for
I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 23 2. 10 Cherry Tree Manor 3. 4. 19 24 individual use. Replace ornametal glass shelves in room 44. Replace worn bed linen. Cherry Tree Manor I52 s19313 cherry tree manor v223389 260405 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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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