Inspection on 01/08/07 for Cherry Trees

This inspection was carried out on 1st August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cherry Trees 07/10/09

Cherry Trees 04/09/06

Cherry Trees 27/02/06

Cherry Trees 05/07/05

Cherry Trees 09/11/04

Cherry Trees 25/05/04

Similar services:

Coton Hill House

Doddington Lodge

Far Croft

Churchill House Nursing and Residential Home

Field Farm House

Church Terrace Nursing & Residential Home

Fountain Court

The Forbury

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cherry Trees 242 Dunchurch Road Rugby Warwickshire CV22 6HS Lead Inspector Michelle McCarthy Key Unannounced Inspection 1st August 2007 10:40 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 Trees DS0000004217.V342317.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 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 Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Trees Address 242 Dunchurch Road Rugby Warwickshire CV22 6HS 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) 01788 816940 0871 9940284 cherrytrees@pinnaclecare.co.uk Pinnacle Care Ltd Miss Sharon Evans Care Home 14 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (14) of places Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may also provide care to the person named in the application for variation of registration dated 21 June 2004. 4th September 2006 Date of last inspection Brief Description of the Service: Cherry Trees care home is situated approximately 1 mile from Rugby town centre along the Dunchurch Road. The home is set back off a busy road. Local buses pass close by. Cherry Trees is a large detached domestic type dwelling converted into a care home, that can accommodate up to 14 older persons over the age of 65 years who have dementia. The home is owned by Pinnacle Care. There is one double room and twelve single rooms. Rooms have wash basins, but no en suite facilities. The home provides residential, not nursing care. Residents needing nursing care receive this from the visiting community nurses. The current weekly charge for a person living in the home is £508. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection visit which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for people living in the home. This report uses information and evidence gathered during the key inspection process which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. The visit to the home was made on 1st August 2007 between 10.40am and 4.45pm. 14 people were living in the home on the day of the visit, one person was in hospital. It was the assessment of the home manager that the majority of people living in the home had medium dependency needs. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. A tour of the building and several bedrooms was made. The systems for the management of medication were also examined. The inspector had the opportunity to meet most of the residents by visiting them in their rooms, spending time in the communal lounges and talking to several of them about their experience of the home. There was an opportunity to chat socially when the inspector joined residents for their midday meal. General conversation was held with others, along with observation of working practices and staff interaction with the people living in the home. The home manager was present throughout the day. The inspector also spoke to several care staff. The care of three people living in the home was identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. The manager completed and returned an Annual Quality Assurance Audit before the inspection visit. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improvements to the environment made in the last 12 months were included in the home’s AQAA and have included new carpets in corridor, the redecoration of the small lounge, new carpets in some bedrooms and a ‘revamp’ of the steps to the garden from the conservatory. Staff training in infection control was implemented and most staff have received the training. Medicine administration records are accrately maintained and arrangements Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 7 have been implemented to ensure medicines are stored at recommended temperatures. Cracked tiles in the upstairs bathroom have been replaced to promote safety and reduce the risk of infection. Further staff recruitment has taken place so that the home almost has a full complement of staff. One Team Leader care assistant post remains vacant. 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. The summary of this inspection report can be made available in other formats on request. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 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 Trees DS0000004217.V342317.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were assessed. Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of three people identified for case tracking were examined to assess the pre-admission assessment process. The manager said that it was usual practice for a senior member of staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities. Each of the files examined contained information about all of the person’s needs and abilities and confirms that the home can meet their needs. Files also Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 10 contained pre-admission information provided by professional health and social care agencies. Information gathered about the needs and abilities of people living in the home is used to develop care plans to meet these needs. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. Quality in this outcome area is adequate. People living in the home are treated respectfully. They each have a plan of care, access to other health professionals and medicines are administered accurately. However, care plans do not consistently describe what staff have to do to meet the identified needs of people living in the home which puts them at risk of not having their needs met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from observation that the personal care needs of people living in the home are met residents are provided with a good quality of life. The majority of people living in the home at this inspection visit looked well and happy and are supported to maintain their abilities. Residents looked well cared for and were clean, their hair had been combed or ‘dressed’ and nails were trimmed and clean. They were well presented and Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 12 wore clothes that were suited to the time of year. It is evident that people living in the home are supported to retain their individuality in how they are presented; one lady enjoyed putting on her make up and several wore jewellery they had chosen themselves ‘to match the outfit’. Three people were identified for case tracking. Each person had a care plan, daily records and monitoring records. Care plans were generally based on information secured during the initial care needs assessment. The ethos of the home is to build on the strengths and abilities of each individual. Each case file contained details of the strengths and abilities of the person and identified needs. However, care plans do not consistently describe the actions staff need to take to meet each individual need. Examples of good practice in care planning include: • A care plan was developed for one person with impaired verbal communication skills; staff had recognised some non-verbal communication used and recorded it in the care plan. For example, it was recorded that the resident ‘touches her face when she wants a drink’ and ‘fiddles with her clothes when she wants to use the toilet’. The care plan for another person with impaired hearing includes instructions to ‘keep sentences short and simple focusing on one topic at a time and allow plenty of time for him to take in what you’re saying’. • Examples of shortfalls in care planning include: • One resident had been seen by the speech and language therapist because of a difficulty swallowing. The speech and language therapist advised a normal diet and fluids but ‘difficult textures such as lettuce leaves and food with a chewy consistency’ should be avoided. This information was recorded in the Health Professionals Visits section of the care plan but it had not been transferred to a care plan. This means staff do not have easy access to the information which may result in the person having an inappropriate diet. Staff had identified and recorded one person’s difficulty with going to the toilet in inappropriate places but had not recorded the actions that needed to be taken to prompt the person to use the commode or lavatory. • Care plans are reviewed every three months. A system should be developed and implemented to review care plans at least once a month to reflect changing needs and current objectives for health and personal care. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 13 Access to other healthcare professionals such as the district nurse, GP, dentist and optician are recorded in the case files of people living in the home. Residents’ weight is monitored monthly but weight records were recorded in both Kilograms and stones/pounds. This means a weight loss or gain cannot be immediately identified. Potential risks to the health or well being of people living in the home are not consistently assessed. For example, there was evidence of a risk assessment for nutrition in one person’s case file but none for the risk of falls or the risk of developing pressure sores. This means staff are not aware of those people who have increased risks and could lead to an oversight of care. The systems for the safe management of residents’ medication were examined. Medicines are stored in locked cupboards in the conservatory area. Daily temperature records indicated the temperature of the cupboards was within recommended limits for the storage of medicines. However, temperature recordings have not been made since May 2007 and there was no thermometer available in the cupboard on the day of this inspection visit. Medicines that require refrigeration are stored in a separate box in the fridge in the kitchen. Arrangements should be made for secure storage of medicines requiring refrigeration to protect people living in the home from potential harm. The keys for the medicine cupboard are kept in a drawer in the manager’s office. Arrangements should be made to keep the keys on the person responsible for administration of medicines to make sure access to medicines is only available to authorised people. The facility for storing controlled drugs is inadequate. Arrangements must be made to make sure the storage of controlled drugs is secure and complies with legislation to protect people living in the home from potential harm. The home retains photocopies of prescriptions dispensed. This is good practice but could be further improved by keeping the copies of the prescriptions with the MAR sheets so that staff can easily refer to them. A monitored dosage (‘blister packed’) system is used. Medicine administration records (MAR) were completed correctly. Audits of the medication of the people involved in case tracking were undertaken and were found to be accurate indicating that people living in the home have their medicines administered accurately. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 14 People living in the home were observed to be treated with respect and their dignity maintained; for example, personal care was provided in private and residents were spoken to respectfully. During observation of working practice it was evident that staff are knowledgeable about the likes and dislikes of people living in the home and were kind, caring and attentive towards them. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. Quality in this outcome area is good. People living in the home are supported to maintain their independence and enduring interests which enhances their quality of life. Mealtimes are celebrated as a social occasion and residents benefit from a varied and nutritious choice of food. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has an ethos of building on a person’s strengths and abilities. This is reflected in the case files of each person where a ‘life history’, interests, important relationships and personal preferences are recorded to assist staff in providing ‘person centred’ care. The home does not have a planned programme of activities but staff support people living in the home to participate in activities and plan how to spend their time on a day to day basis, depending on their preferences for that day. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 16 On the day of this unannounced visit there were no structured group activities taking place but residents were observed to be engaged in various individual activities throughout the day. For example, one resident enjoyed the beautiful weather with a walk around the garden with the support of a staff member, one resident read a newspaper, several residents assisted with domestic tasks such as helping with the washing up. People living in the home were observed to treat the care home as if it were their own home; people were comfortable ‘pottering about’ and using all the spaces in the home. Residents interacted well with each other and with staff. Staff spoken to were familiar with the preferences of residents and the type of activities that might engage and stimulate each individual. The home has an open visiting policy. People are encouraged to maintain links with their family, friends and local community. The inspector joined residents at 12.30pm for their midday meal. Most of the residents attended the dining room in the conservatory area of the home. Tables were beautifully set with linen tablecloths and slip cloths which lent a ‘restaurant type experience’ to the social occasion of people coming together to enjoy their meal. It was observed that even the most physically dependent residents in the home were supported to use ‘proper’ cups and saucers as opposed to plastic cups or beakers to promote their self esteem and dignity. Residents were offered a starter of prawn cocktail followed by a choice from roast chicken, faggots or cheese omelette accompanied by mixed vegetables, roast and mashed potatoes and gravy. Dessert was a choice of chocolate sponge and custard or fruit flan. Staff offered each resident a choice of meal at the table; those people who found it difficult to choose were assisted by staff who brought the meal to them as a visual prompt. One resident asked for ‘a bit of everything’ and staff provided the meal requested. The meal was well presented, nutritious and tasty. Residents made positive comments about the food they were offered in the home and told the inspector that if any choice of the main meal was not their preference an alternative was offered. Food was plentiful and ‘seconds’ were offered. One resident said, ‘the food’s always good’, another said ‘there’s always plenty to eat’. Staff offered assistance to those people who required it in a sensitive and discreet manner. The most recent Environmental Health Officer’s inspection of the home’s kitchen awarded a Gold Standard for Food Hygiene in July 2006. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed. Quality in this outcome area is good. People living in the home can be confident that their concerns will be listened to and acted upon. Staff training in abuse awareness ensures people living in the home are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a formal complaints policy which is accessible to people living in the home and their families. People are encouraged to raise their concerns with the manager. Information shared with us in July 2007 raised concerns about the qualifications of the person delivering Moving and Handling training to staff. This was found to be satisfactory during this key inspection and did not result in any requirements being made. The home maintains a record of complaints and their response; there have been no complaints recorded by the home since the last key inspection. Records could be enhanced by recording verbal concerns received so that the home can actively demonstrate how they respond to the concerns of people living in the home. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 18 Discussion with the manager evidenced that she was familiar with local Adult Protection Procedures and how to refer allegations of abuse. Most staff have received training in recognising and responding to signs of abuse. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 were assessed. Quality in this outcome area is adequate. Residents benefit from homely and ‘lived in’ surroundings but some working practices do not protect people from the risk of infection and residents have restricted access to toilets in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents ‘pottered’ about the home happily and used all spaces available to them. The home is not purpose-built and has been altered and extended over the years in to be a dementia care home for 14 people. Consequently, there are a number of shortcomings in the environment readily observed during an inspection that are difficult for the home to overcome. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 20 Corridors are narrow, leading to the home being unsuitable for wheelchair users within the home. Bedrooms do not have en suite facilities but most have a handbasin, the kitchen is so sited that it is a thoroughfare to the office, and the laundry. The manager advised that laundry is carried outside to the laundry during the day. Improvements made in the last 12 months were included in the home’s AQAA and have included new carpets in corridor, the redecoration of the small lounge, new carpets in some bedrooms and a ‘revamp’ of the steps to the garden from the conservatory. The natural slope of the land means that the conservatory, used as the dining room, is high above the large garden area, which is accessed by a ramp. The manager said that the steps from the conservatory to the garden have been renewed since the last inspection to provide residents with easier and safer access to the garden. The home has benefited from the recent recruitment of a housekeeper. The environment was generally clean. The bedrooms of three people case tracked were viewed. Rooms were pleasantly furnished and decorated creating an environment where residents can feel comfortable. It was evident that residents are encouraged to personalise their rooms with their own items such as photographs or soft furnishings. Each room looked as though it ‘belonged’ to the person living in it. One room, identified to the manager on the day of this visit, had an overpowering offensive odour that does not promote the dignity of the person accommodated there. The manager said that staff were experiencing a particular challenge with supporting the person accommodated in the room with their continence needs. The cracked tiles in the upstairs bathroom have been replaced in response to a requirement made at the last inspection. On the day of this visit a commode pan was soaking in the bath. This is not safe or hygienic practice and increases the risk of cross infection. The upstairs bathroom and several downstairs toilets are used for storage which restricts residents’ safe access. This needs to be reviewed to make sure residents have safe access to these areas. Two of the upstairs toilets were having replacement flooring fitted on the day of this visit and were not accessible to residents Access upstairs is by stairs or by shaft lift, which worked appropriately and which the manager advised is regularly serviced. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 21 There is one double bedroom. The team leader advised that the two ladies currently sharing this had made a positive decision to do so, based on their wish for company. All bedroom doors are now lockable. The team leader advised that all residents were given the option of having keys, but only a small number wished to. Some bedrooms have been refurbished, all bedrooms were personalised with photographs, paintings and ornaments or individual furnishings and furniture items in some instances. The garden is accessed by a rather steep ramp and has tables and chairs and a large grassy area. The whole area slopes and dips, and a low picket fence separates one section, where there is a disused swimming pool. This is covered by a tarpaulin and, as it is on the other side of a fence, residents showed no interest in it. There are risks assessments in place, the manager is aware that these would have to be revised if a resident ever showed an inclination or ability to clamber over the fence. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed. Quality in this outcome area is good. There are sufficient numbers of staff on duty most of the time to meet the needs of people living in the home and training is provided to make sure people are cared for by competent staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were observed to have good interactions with the people living in the home; residents were at ease asking for assistance and making requests. It was evident from observation that staff were knowledgeable about the needs of the people they were caring for and gave sensitive care and support. The manager confirmed that the usual staffing complement for the home is: 7.30am – 2.30pm 2.30pm – 9.30pm 9.30pm – 7.30am 3 Care Staff 3 Care Staff 2 Care staff (who are awake throughout the night) The manager’s hours are supernumerary but she occasionally works ‘on the floor’ as a carer to cover eventualities such as annual leave or absence due to sickness. There is a member of catering staff in the kitchen between 8am and 1pm each day to prepare breakfast and the main midday meal. Kitchen staff Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 23 prepare the evening meal but it is heated and served by care staff. The home has one person undertaking cleaning duties between 8am and 12.30pm during the week; there are no cleaning staff on duty at the weekends. Care staff undertake laundry duties. Two weeks of the home’s duty rota between 21st July and 3rd August 2007 was examined and demonstrated that the staffing levels set by the home (in the table above) are achieved. The home does not use agency staff to cover holidays or unplanned absence such as sickness but relies on permanent staff working overtime. This means that people living in the home have some continuity and are cared for by staff that are familiar with their needs. There is currently one vacancy for a Team Leader Care Assistant. A vacant housekeeping post has very recently been filled. Five of the 12 care staff employed in the home have a National Vocational Qualification in Care (NVQ) at level 2 which, at 42 , is just below the National Minimum Standard for 50 of staff to be qualified. However, a further three members of care staff are currently working towards this award which should mean that people living in the home are cared for by competent staff. The personnel files of two recently recruited staff were examined and both contained evidence that Criminal Record Bureau (CRB) had been applied for, satisfactory Protection of Vulnerable Adult (PoVA First) checks were obtained and satisfactory references received before new staff members started working in the home. These robust recruitment practices should safeguard people living in the home from the possibility of abuse. Training records demonstrate that staff receive mandatory training. Moving and handling updates were undertaken in July 2007, the training is delivered by one of Pinnacle Care’s ‘in-house’ trainers who have attended a ‘Train the Trainer’ course. Fire safety training was undertaken in January 2007, most staff have received abuse awareness training and about half of all the staff have attended infection control training. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 and 38 were assessed. Quality in this outcome area is adequate. The home is managed by a competent and qualified person but working practices are not kept under review to make sure the service is run in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for three years and is registered with the Commission. She has a diploma in Social Care and has completed the Registered Manager’s Award (NVQ Level 4). She is experienced in the care of older people Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 25 There was some evidence of surveying the opinion of people living in the home and their relatives by using questionnaires covering a different aspect of the service received each month. Medicine audits are carried out monthly but the review of other working practices are audited ‘ad hoc’. There was no evidence that the responses are collated, analysed or used to develop action plans where this is necessary. The manager returned a completed AQAA (Annual Quality Assurance Audit) to the Commission before this unannounced visit. The manager must be able to demonstrate that there is a regular review of the quality of care and services being provided and the results of any quality exercise are published in the home with details of actions taken to address any concerns raised. The service does not hold residents’ personal monies or valuables for safe keeping so standard 35 is not applicable and was not assessed. Service users are invoiced for additional costs such as hairdressing or chiropody. A sample of service and maintenance records were examined and found to be up to date; hoists were serviced in April 2007, fire alarm systems are checked weekly, and Electrical Portable Appliance Testing is due in August 2007. Hot water outlet temperatures are recorded weekly and were noted to exceed recommended limits. Action must be taken to reduce the risk of scalds to people living in the home. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 26 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X N/A X X 2 Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 27 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 15 Requirement Care plans must be available for each of the identified needs of people living in the home and contain details of the actions required to meet each need. Care plans must be reviewed and at least monthly or when there is a change in need. This is to make sure that people get the care they need. Systems must be in place to identify any risk to the health or well being of people living in the home and must include details of how any identified risk can be reduced. This must include the risk of developing pressure sores and the use of bedrails. This is to make sure that risks to the health or well being of residents are identified and reduced. Arrangements must be made to make sure the storage of controlled drugs is secure and complies with legislation. This is to protect people living in Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 28 Timescale for action 30/09/07 2 OP8 12 30/09/07 3 OP9 13(2) 30/09/07 4 OP21 13 (4)(a) the home from potential harm. Arrangements must be made to review the use of toilets and bathrooms for storage purposes. This is to make sure people living in the home have safe access to these facilities. Arrangements must be made to eliminate offensive odours form the bedroom identified on the day of the inspection. This is to promote the dignity of residents. Action must be taken to minimise the risks of scalds to residents where hot water outlet temperatures exceed the recommended temperature. This is to protect the people living in the home from risk of harm. 30/09/07 5 OP26 23 30/09/07 6 OP38 13 30/09/07 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 Refer to Standard OP9 OP9 Good Practice Recommendations Arrangements should be made for secure storage of medicines requiring refrigeration to protect people living in the home from potential harm. Arrangements should be made to keep keys to the medicines cupboard on the person responsible for administration of medicines to make sure access to medicines is only available to authorised people. Arrangements must be made for the cleaning and disinfecting of commode pans which should include instructions about the cleaning solutions and method to be used by staff. This should reduce the risk of cross infection DS0000004217.V342317.R01.S.doc Version 5.2 Page 29 3 OP26 Cherry Trees 4 OP33 and safeguard residents from harm. The service should be able to demonstrate the review of working practices and quality of care delivered to people living in the home. This should ensure that the home is run in the best interests of people living in the home. Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Cherry Trees DS0000004217.V342317.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!