CARE HOMES FOR OLDER PEOPLE
Cherry Tree Nursing Home Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG Lead Inspector
Sue Smith Unannounced Inspection 21st February 2006 16:30 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 DS0000019193.V284615.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000019193.V284615.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cherry Tree Nursing Home Address Bledlow Road Saunderton Princes Risborough Bucks HP27 9NG 01844 346259 01844 342 698 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) Mr A.S. Dhot Maxine Bennell Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places DS0000019193.V284615.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 50 Physically Frail Elderly Mentally Frail Date of last inspection 12th July 2005 Brief Description of the Service: Cherry Trees Nursing Home is an established care home and is registered to provide nursing care for up to 42 elderly persons; It is privately owned and managed. The home is situated in a rural location close to the market town of Princes Risborough. It is a two-storey building set in well-maintained gardens with a millstream and large millpond, which attracts wild life and birds. Accommodation is in single rooms with comfortable social areas. There are no rooms with ensuite facilities. There is a passenger lift to the first floor. All service users are registered with the local General Practitioner and have full access to local NHS Services through General Practitioner referral. DS0000019193.V284615.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Sue Smith (Regulatory Inspector) on the 21st February 2006. The inspection took place between 4.30pm – 6.30pm. The Manager and Proprietors were available throughout the inspection. During the inspection 14 of the national minimum standards for older people were assessed with 13 fully met and 1 partially met. A variety of documents were sampled which included, pre-admission assessments, Careplans, Medication records and Recruitment documents. A full environmental tour also took place. What the service does well:
Provides pre-admission assessments for all potential Service Users, which ensures the home is able to meet the needs of Service Users on admission. Provides individual plans of care for all Service Users, which are subject to review and reflect the changing needs of Service Users. Provides robust medication procedures, which ensure medication is only administered by suitably qualified staff. Ensures care is delivered in a manner that is both respectful and ensures the dignity of Service Users is maintained. Visitors are welcomed at the home during all reasonable times, with no restrictions in place. The environment is well maintained, providing a homely and welcoming environment for Service Users to enjoy. Single accommodation bedrooms are provided which can be personalised by Service Users with their own furnishings. DS0000019193.V284615.R01.S.doc Version 5.1 Page 6 The home is situated in beautiful, picturesque gardens, which are well maintained, bedrooms overlook a mill lake providing a relaxing and scenic view. Staff recruitment is in line with schedule 2, ensuring all staff employed at the home are subject to relevant security checks before they are employed. The homes manager is suitably qualified and has recently completed her RMA (registered Managers Award) enabling the home to fully meet standard 31. Service Users were complimentary of the service delivered at the home and appreciated the care and support offered by staff. What has improved since the last inspection?
Relevant assessments are now re-written should their be a documented change in needs. Opening dates are now recorded on all bottles and tubes holding prescribed medication. An evident ongoing programme of decoration is in place with doors and frames being painted during the inspection. Careplans are now all reflective of the new Careplan paperwork, with further improvements taking place, which will include a life history page. The home continues to provide a high standard of care. DS0000019193.V284615.R01.S.doc Version 5.1 Page 7 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. DS0000019193.V284615.R01.S.doc Version 5.1 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 DS0000019193.V284615.R01.S.doc Version 5.1 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): 3 All Service Users undertake a pre-admission assessment prior to admission to the home to ensure the home is able to meet all of their needs. EVIDENCE: Pre-admission assessments are found on the Careplan file for each Service User, these are undertaken by a senior member of staff (usually the Manager) using an assessment form. As a high proportion of Service Users are admitted to the home directly from hospital the home gives relatives the opportunity to visit the home and assess whether it would be suitable. All Service Users have a trial period, in this time continued assessment takes place to ensure the home is able to meet the needs of any Service User, should the Service User find the home unsuitable during this time then the home would support the family and Service User until alternative accommodation can be found. DS0000019193.V284615.R01.S.doc Version 5.1 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): 7, 9, 10. An individual plan of care is in place, which ensures the home are able to meet the needs of Service Users. Robust medication procedures are in place, which ensure Service Users are protected from known risks. All care is implemented in a manner that is both respectful and ensures the dignity of Service Users is maintained. EVIDENCE: Careplans have now been transferred to the new paperwork system; this has ensured continuity throughout the home. Further improvements to this system are being made which will further support Nurses and Carers to maintain standards of care. The inspector discussed with the Manager the
DS0000019193.V284615.R01.S.doc Version 5.1 Page 11 necessity for ensuring all staff receive a briefing on how to use the new paper work to ensure Careplans continue to be maintained to a high standard. Careplans include: Pre-Admission Assessments Care needs/History on Admission Photo of Service User TPR & BP Charts Risk assessments such as Waterlow, Manual Handling, falls, Bed Rails. Nursing Careplan Discharge Summaries Property Register Weight Record G.P. Reports Daily Reports. Careplans assessed were found to be maintained to a high standard and were up-to-date. A previous recommendation to ensure all assessments were rewritten should the needs of the Service User change has been implemented. All Careplans were reflective of review. The home is well supported by other specialists such as the Tissue Viability Nurses who offer support and advise to the home. The G.P. for the home visits each Monday and other G.P.’s are called to attend their patients as needed. Medication procedures in the home are robust ensuring that suitably qualified nurses administer all medication. All MAR (medication administration records) sheets were appropriately signed with no gaps evident. Medication is stored in lockable metal cabinets and there was no evidence of out of date medication. A contract has been organised to ensure the safe disposal of returned medication, however this has proved frustrating for the home as the vessel provided was unsuitable. The home is ensuring safe disposal systems take place until such time as this can be resolved. The clinic room is well stocked with controlled medication stored and recorded appropriately. The home has received a repeat requirement due to the usage of one bottle to administer Lactulose and Senna rather than using the bottle prescribed to individuals. The inspector will leave the resolution of this issue to the home, however in the interim a letter from the G.P. and the Pharmacist will be required agreeing to this arrangement until a resolution is found. Service Users spoken with at the time of inspection were happy with the service provided by both the Carers and Nurses. Service Users were complimentary of staff and felt their privacy and dignity were maintained.
DS0000019193.V284615.R01.S.doc Version 5.1 Page 12 DS0000019193.V284615.R01.S.doc Version 5.1 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 the following standard(s): 13 The home promotes flexible visiting and supports Service Users to maintain contact with friends and family. EVIDENCE: There are no restrictions on visiting times with visitors welcomed at the home during all reasonable hours. Visitors are offered refreshments and supported to spend as much time as they wish with their loved one. DS0000019193.V284615.R01.S.doc Version 5.1 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): x EVIDENCE: DS0000019193.V284615.R01.S.doc Version 5.1 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): 19, 20,21, 22, 23, 24, 25, 26. The Home is maintained to a high standard with a programme of decoration in place, which ensures the Service Users live in a pleasant and homely environment. There are sufficient numbers of toilets and bathrooms to support Service Users Suitable adaptations and equipment are provided to ensure Service Users needs can be met in a safe manner. Suitable single accommodation is provided for Service Users, which enables them to maintain their privacy whilst residing in the home. Standards of cleanliness at the home are good, meaning that Service Users live in an environment that is clean and hygienic, protecting the health, safety and welfare of Service Users. EVIDENCE: DS0000019193.V284615.R01.S.doc Version 5.1 Page 16 The home is a large and pleasant environment that provides Service Users with ample communal areas, which are well equipped and homely. During the inspection there was evidence of painting taking place to all doorways and frames, this is part of an ongoing decoration programme, which ensures the home is well presented and maintains its standards for Service Users. Single accommodation bedrooms, which overlook the pleasant and wellmaintained gardens, are available to all Service Users, these are reflective of Service Users own possessions and are maintained to a high standard. Specialist equipment and adaptations are fitted in bedrooms as required. There are adequate numbers of bathrooms and toilets available, which have suitable adaptations and equipment, provided to meet the needs of service Users. These were found to be clean and tidy with no offensive odours present. A dedicated domestic team ensure the home continues to be cleaned to a high standard and is hygienic for Service Users. Throughout the home there was no evidence of offensive odours. The home is positioned in a well-maintained and picturesque garden, which includes a mill lake providing a safe area for an abundance of wild life for Service Users to enjoy. DS0000019193.V284615.R01.S.doc Version 5.1 Page 17 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 The Home follows a robust recruitment procedure, which ensures that staff are compelled to apply for legislative clearances that render them appropriate for the post applied for. EVIDENCE: Recruitment files assessed during the inspection were found to be reflective of Schedule 2. The files contained: Recruitment checklists. Induction record Training record Application forms X2 written references X2 verbal references Pova list clearance CRB disclosure numbers Copies of passport, birth or marriage cert, bank statement. All files are held in lockable facilities, which can only be accessed, by the Manager or Proprietors. DS0000019193.V284615.R01.S.doc Version 5.1 Page 18 DS0000019193.V284615.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 A suitably qualified and experienced manager is in charge of the home, ensuring it is run in the best interest of Service Users. EVIDENCE: Since the last inspection the Manager has completed her RMA (registered managers award). She has attended several other training courses to ensure she is maintaining her professional practice. The Manager is approachable and transparent in her practice; Service Users were complimentary of the management of the home and the quick response when concerns are raised. DS0000019193.V284615.R01.S.doc Version 5.1 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X DS0000019193.V284615.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes 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 OP9 Regulation 13(2) Requirement All medication (including Senna and Lactulose) is administered from the container prescribed for the individual. Additional storage facilities will need to be provided to support this change in practice. Previously made requirement, which was partly met. Timescale for action 21/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000019193.V284615.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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