Inspection on 27/02/06 for Cherry Trees

This inspection was carried out on 27th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cherry Trees 07/10/09

Cherry Trees 01/08/07

Cherry Trees 04/09/06

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 Yvette Delaney Unannounced Inspection 27th February 2006 18:00 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.V285511.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. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 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 01788 815049 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.V285511.R01.S.doc Version 5.1 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. 5th July 2005 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. Local buses pass close by. The home is set back off the busy road. A large detached domestic type dwelling converted into a care home.Cherry Trees can accommodate up to 14 old persons over the age of 65 years who have dementia.Pinnacle Care is the company that owns this care home. The services provided are specialist services to meet the needs of people with dementia. The domestic style of the home provides comfort and warmth.Accommodation is mainly in single rooms. There is a call system for the safety of the service users. The care is person centred. Service users needing nursing care receive this from the visiting community nurses. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on a weekday between the hours of 18.30 pm and 02.15 am. This was the second visit for this inspection year. The inspection started with the Senior Care in charge of the home, the Home Manager later came into the home for the inspection. Staff in the home co-operated fully with the inspection. Managers and staff were proactive in their response to the inspection and were keen to improve practices and the environment to ensure the residents’ needs are met. The inspection process involved a small tour of the home, discussions with the manager and other care staff, examining care profiles, case tracking, discussions with residents who were able to have short conversations. Records related to residents, staff, the environment and operations in the home were examined. These include maintenance, servicing contracts, care profiles, copies of the duty rota, accident records and policies and procedures. Details in a pre-inspection questionnaire sent to the home prior to the inspection provided factual information on the home. Comment cards sent to the home and given to residents and relatives also informed this report. Four comment cards were received from relatives. Their views are detailed in the following table: Outcome of Relatives/Visitors Comment Cards – 4 received Yes 4 4 3 3 4 2 1 2 3 3 2 3 2 1 1 Yes/No* No Comment 1 Do staff/owners welcome you in the home at any time? 2 Can you visit your relative/friend in private? 3 Are you kept informed of important matters affecting your relative/friend? 4 If your relative/friend is not able to make decisions, are you consulted about their care? 5 In your opinion are there always sufficient numbers of staff on duty? 6 Are you aware of the home’s complaints procedure? 7 Have you ever had to make a complaint? 8 Are you made aware of forthcoming inspections? 9 Do you have access to a copy of the inspection reports on the home? 10 Are you satisfied with the overall care provided? Other comments made include: Cherry Trees 1 1 DS0000004217.V285511.R01.S.doc Version 5.1 Page 6 “Just to say I’m pleased with everyone and the way everything is done at the home for the residents. Everyone works hard. Thank you.” “Feel that more attention should be paid to how residents look throughout the day.” “Bedding always looks dirty – mattress ripped” “Room always dirty, especially under bed.” “Everyone appears to be given the same meal, salad/meat, difficult when resident has no teeth.” “Team are always friendly/helpful to me on arrival.” *“There has been a high staff turnover this year; new team seem to be a new start.” What the service does well: What has improved since the last inspection? What they could do better: The registered owner must ensure that the requirement s made following inspections carried out are acted on with evidence available to confirm the action taken. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 7 The manager must ensure that sufficient and appropriately qualified staff are available at all times to meet the assessed needs of residents. An effective and appropriate method of monitoring and maintaining a record of visitors to the home is required. The current system has the potential to put visiting relatives and other visitors to the home at risk if there were to be an emergency. Bathing and toileting facilities need to be reassessed to ensure that they are suitable, meet the assessed needs of residents and are easily accessible. The communal toilets provided on the first floor are small, access is poor and it would be difficult for residents to use this facility safely on their own or with the support of a carer. Work needs to be carried out to ensure access to the garden is area is safe by a very steep slope or stairway. There is an empty swimming pool on one side of a low level fence. The fence is in need of repair, and the swimming pool is partially covered by a sheet of tarpaulin. Some bedrooms have been decorated and there are clear plans to continue with this program. One of the important aspects that need improvement in relation to the environment is that there is no suitable and safe level access provision to all entrances and exits to the home. 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 Trees DS0000004217.V285511.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 Cherry Trees DS0000004217.V285511.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): 1 and 2 The home has produced a Statement of Purpose and Service User Guide, which provides information for potential residents and relatives to make informed choices on the suitability of the home to meet their needs. Each resident has a written contract of terms and conditions of the home, which supports their human rights. EVIDENCE: Copies of the Statement of Purpose and Service Guide are available to residents, relatives and other visitors on request. This decision to make these documents available on request is based on the residents destroying the documents when left on display due to their mental health problems. In the absence of the manager at the time of the inspection care staff were unable to locate copies of the documents. A contract of residency is available for all residents, which details the terms and conditions for living in the home. Cherry Trees DS0000004217.V285511.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, 8, 9, 10 and 11 Resident’s health, personal and social care needs are not suitably recorded and information is missing which may result in an oversight of care and poor or inconsistent health care provision. Medicines are not safely managed within the home, which places residents in a position of risk of harm. Residents’ care needs during the period leading up to their death and at the time of their death are not suitably recorded, which may result in inconsistent care provision. EVIDENCE: Two residents care records were examined they were disorganised in that information could not easily be found and the plan of care could not be easily followed. This could result in new staff not referring to the information available and poor care practices occurring with the possible increase of harm to the residents. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 11 Care plans were examined these were not updated in a timely manner to reflect the current needs of residents. A care plan for a resident whose physical well being had deteriorated had not been updated to reflect the current care needs and the action to be taken by staff to meet these needs, were not clearly identified. There was no mention of the deterioration and therefore no action plan to describe how care staff should meet these needs and ensure that deteriorating health care needs are met. Care plan documentation is completed in different coloured pens. Daily statement entries are not consistently dated and timed and signatures are not consistently maintained to ensure an effective audit trail. Evidence was not available to demonstrate that residents and/or relatives are involved in the care planning process. Weighing scales are not readily available to ensure that residents are weighed at least monthly or more frequently if required. Risk assessments have been undertaken and include the prevention of falls and moving and handling. Residents have access to health professionals, which include District Nurses, Community Psychiatric Nurses, Optician and Chiropodist. Records are maintained in residents’ profiles to demonstrate the outcome of these visits. Examination of Medicine Administration Records (MAR) charts demonstrate that not all medicines had been administered as prescribed. Medicines had been signed as administered when they had not been and some gaps were seen on the Medicine Administration Record (MAR) chart. It could not be demonstrated whether the medicines had been administered and not signed or not administered. The reasons for non-administration were not recorded. One medication identified that there was ten tablets remaining in a box of prescribed medication when there should have been eleven. Medicines are stored in locked cupboards within the conservatory. The home has a dedicated refrigerator but the maximum, minimum and current temperatures were not recorded daily to ensure the medicines are stored within their product licences. Controlled Drugs prescribed for a resident had been removed from the box in which they were dispensed. In the absence of the box, prescribing details for administration of the drug was not available and could not be cross-referenced with the MAR chart prior to administration. Care staff were observed speaking to residents politely and in a friendly manner. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 12 A care plan for a resident whose health was deteriorating had not been written, however staff are to be commended for their detailed daily reports describing the care given during their illness and at the time of death. The statements demonstrate the sensitivity and respect towards the resident and family. Cherry Trees DS0000004217.V285511.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): 12, 13, 14 and 15 These Standards were not assessed at this inspection. EVIDENCE: Cherry Trees DS0000004217.V285511.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): 18 Policies and procedures concerning the protection of vulnerable people are appropriate and support staff in protecting residents from harm. EVIDENCE: A policy/procedure for responding to allegations of abuse is available. The document provides suitable guidance for staff to follow and would therefore support staff to suitably deal with an allegation or evidence of abuse. Training records examined demonstrate that staff have attended training on the protection of vulnerable adults, which includes information on the following topics, prevention of abuse, whistle blowing and Protection Of Vulnerable Adults (POVA) procedures. To date there have been no allegations or suspicions of abuse and staff spoken to were able to discuss issues related to this area with confidence. Cherry Trees DS0000004217.V285511.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 and 26 Improvement is needed throughout the home in relation to the safety, maintenance, comfort and cleanliness of the home to ensure that residents live in a safe, well-maintained environment, which provides a positive experience and maintains quality of life. EVIDENCE: A review of this section of the report evidenced that there remain a number of areas that need to be addressed. A programme of planned maintenance and plans for ongoing re-decoration and refurbishment of the care home are not available. Bedrooms are decorated as they are vacated; one bedroom has been refurbished and redecorated in neutral colours. The décor in a number of bedrooms is not appropriate for residents with a diagnosis of dementia. A number of carpeted areas in the home remain stained and in need of replacement. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 16 There is only one suitable bath available to be shared by 14 residents. Soap dispensers are available in bathrooms and toilets. The communal toilets provided on the first floor are small, access is poor and it would be difficult for residents to use this facility safely with the support of a carer. Toilet roll dispensers are not within easy reach as they are attached at a high level on the wall. The door opens inwards which lessens the space available when accessing the toilet. A further toilet is provided for use by a resident under the stairwell on the ground floor of the home. The area is also used for storage purposes a curtain is used to separate the two areas. There was no evidence that action has been taken to confirm that access to the garden and the area around the empty swimming pool has been made suitably safe and free from the risk of any hazard. Evidence was not available to confirm that entrances and exits to the home have been suitably assessed to provide level access for residents. The kitchen in the home is used as the main throughway for access to the manager’s office and to get to the laundry. Medication has been removed from the manager’s office to locked cupboards in the conservatory. The laundry is a small room and has been tidied making this area more presentable and clean. During the inspection a resident was incontinent of urine while walking from the managers office and through the kitchen passing urine on the journey. Staff cleaned up the area and the dignity of the resident was maintained. Risk assessments and procedures to be followed by staff to prevent cross infection on these occasions were not in place. Care staff carried out laundry duties during the inspection, night staff carrying laundry through the kitchen into the laundry. This is contrary to previous information when the Inspector was advised that laundry is not taken through the kitchen. This provision of access through the kitchen presents risks of cross infection. Staff accessing the laundry from the front of the building at night to get into the laundry, creates a dangerous situation and puts residents and staff at risk. Risk assessments were not available to demonstrate the risks associated with these practices had been assessed and preventative or safety measures implemented to minimise or exclude risk. There continues to be no paper towel dispensers in communal toilets and bathrooms. Residents and staff continue to use a communal towel in these areas, which does not promote good infection control practices. A general risk assessment has been completed, which is not detailed to identify potential risks due to cross infection from everyone using the same towel. Risk assessments and policies and procedures are not available to evidence that this is good practice, which is based on current clinical guidance. The Warwickshire Fire and Rescue Service visited the home in April 2005. The following matters were identified as needing rectifying: Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 17 • • • Self-closing door to bedroom sticking open due to carpet. Lumnare at top of stairs permanently on to be re-checked. Housekeeping in corridor adjacent to lift and within laundry to be improved ‘Rugby Fire Protection’ also carried out a visit in January 2006 who also identified matters that required attention: • • • Both batteries (Fire Panel) failed ampage test and require changing ASAP to ensure panel continues to function correctly in the event of a power fail Emergency Light far end of first floor requires to be repaired or replaced Call point by panel does not activate system, fault is intermittent There was no information available to evidence the action taken to address the above matters. A visit was undertaken by the Environmental Health department in 2005 to carry out routine microbiological analysis of food samples the result was satisfactory. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 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 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): 27, 28, 29 and 30 There have been insufficient numbers and skill mix of staff on duty at times, which could result in the care needs of residents not being met. There are insufficient care staff who are qualified to National Vocational Qualification level 2 or 3 in care employed in the home, which does not ensure that residents are in safe hands. The employment of staff is carried out in accordance with the homes’ policies and procedures ensuring that residents are supported and protected. An ongoing training programme has been identified; training is not currently up to date, which could result in inappropriate care being given. EVIDENCE: Examination of four weeks staff rota identifies that there have been occasions where insufficient staff on duty during the day. There is currently a heavy reliance on existing staff working extra shifts to cover staff shortages. On average there is three care staff on duty during the morning, three care staff in the afternoon and two at night. There has been an active approach to recruiting new staff and an energetic effort by all staff to cover shifts. As part of their duties care staff undertake laundry and catering duties. The time allocated for these additional tasks are not identified on the duty rota. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 19 Records examined showed that four of eleven staff (36 ) have a NVQ 3 or NVQ 2 qualification in care. This level of qualified carers does not support staff in increasing their understanding and skill in caring for residents. Observation and discussion with staff confirmed that they are aware of residents needs and are able to meet these. Employment records for two employees were examined one file was for a newly appointed member of staff. New employees are checked to ensure that they do not have a criminal record that would affect their ability to protect the residents. Staff are also checked to ensure that they have not been placed on the Protection of Vulnerable Adults list. All these checks, including references ensure that the residents are protected and safe from abuse. Statutory training was evidenced to need updating for all staff, these include fire awareness training, manual handling, food hygiene and infection control. There was evidence to confirm that ongoing training in dementia care is available to staff. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 20 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): 35, 36, 37 and 38 Residents’ financial interests are managed and safeguarded by their own appointed representative. Supervision procedures have been implemented to monitor care practices delivered by individual staff and ensure that residents’ health, safety and welfare is maintained at all times. Records are organised, accessible and securely stored, which should safeguard residents’ rights and best interests. Observation and examination of records indicates improvements to health and safety practices in the home, which will safeguard and protect the interests and welfare of residents. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 21 EVIDENCE: There are no personal monies available in the care home. Records were available to demonstrate that supervision procedures implemented, monitors care practices delivered by staff. Care staff spoken with were able to confirm that they had been supervised. Details in the pre-inspection questionnaire and discussions with the manager confirmed that staff in the home are not involved in the financial management affairs of residents or hold any personal monies. Individual residents records and other personal confidential information related to staff and residents are secured in locked cabinets, in the manager’s office. Computers in the home are password protected. It was evidenced through maintenance records and contracts that all equipment and appliances used in the home, which includes the lift, hoists and bath have been serviced and certificates examined were up to date. The outcome of the visit by the lift engineer in January of this year identifies work that needs to be carried out. Visits to the home by The Warwickshire Fire and Rescue Service and ‘Rugby Fire Protection’ identified matters, which required attention. Information was not available to evidence and confirm the action taken to address any of these matters. Data sheets related to the Control of Substances Hazardous to Health are available in the home. Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 22 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 2 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 2 2 2 3 2 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 3 3 2 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 23 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 OP1 Regulation 4, 5 Requirement Care staff must be aware of how to access copies of the Statement of Purpose and Service Users Guide in the absence of the manager. The registered manager must ensure that care plans are up to date and address the needs of residents and are related to up to date clinical guidelines. The registered manager must ensure that the resident and/or the family are involved in the care planning process where possible. The registered manager must ensure that following monthly evaluation of care plans changes to care needs are clearly identified. The registered manager must ensure that a care plan is developed for residents whose condition has deteriorated and/or are dying. Timescale for action 30/05/06 2 OP7 15, 13, S. 3 30/05/06 3 OP7 15 S.3 30/05/06 4 OP7 15, 13, S. 3 30/05/06 5 OP7OP11 15 30/05/06 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 24 6 OP8 14, 17, S.3, S.4 7 OP9 13, 17 Sch.3 8 OP9 13(2) 9 OP9 13(2) 10 OP9 13(2) 18(1) 19(1) 11 OP9 13(2) 18(1) 19(1) 13(2) 12 OP9 The registered manager must ensure that all residents are weighted at least monthly and where this is not possible an explanation must be available in the residents records. The quantities of all medicines received or balances carried over from previous MAR charts must be recorded to enable audits to take place to demonstrate staff competence in medicine management. All medicines must be administered to the right person at the right time and at the right dose and all records must reflect the exact transaction. The MAR chart must be referred to before the administration and signed or the reason for nonadministration recorded immediately afterwards. Staff drug audits must be undertaken for all staff that handle medicines on a regular basis to demonstrate staff competence in medicine management. Appropriate action must be taken when discrepancies are found. The practice of removing Controlled drugs from the labelled box in which they were dispensed must cease. The refrigerator temperatures (maximum, minimum and current) must be recorded daily and all must lie between 2°C and 8°C to ensure the medicines requiring refrigeration are stored in compliance with their product licences to guarantee their stability. 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 25 13 OP12 16(2)(m) (n) 14 OP13 17, Schedule 4 (17) 16, 15, S.3, S.4, 12 15 OP15 16 OP15OP26 OP38 13, 16 17 OP19OP38 23, S.4(14) A planned varied programme of activities must be developed, which considers the needs and capabilities of all residents and takes into account residents’ individual interests. Brought forward from last inspection of 5 July 2005, Standard not assessed at this inspection. An appropriate and active register of all visitors to the home must be maintained. Outstanding from 5 July 2005 Evidence must be available, which demonstrates how residents’ are supported to make choices in choosing meals. Menus must be presented in a format suitable for residents. Brought forward from last inspection of 5 July 2005, Standard not assessed at this inspection. A risk assessment, which also considers the risk of cross infection when using the kitchen area as a thoroughway to the manager’s office and laundry area must be, carried out. Outstanding from 5 July 2005 Evidence of the work carried out to address the matters discussed in the two fire safety reports identified must be available in the care home. 30/05/06 30/05/06 30/05/06 30/05/06 30/05/06 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 26 18 OP19OP20 OP22 13(4), 23 A risk assessment must be carried out on the accessibility of the home and grounds for all residents. This must include access to the front and back entrances to the home and the conservatory. The provision of suitable ramps must be provided. The swimming pool in the rear garden must be made safe and access to that area secured. Outstanding from 5 July 2005 Sufficient and suitable toileting and bathing facilities must be installed which are capable of meeting the assessed needs of residents. The accessibility of these areas must be taken into consideration. Outstanding from 5 July 2005 Evidence which demonstrates that a review of residents individual bedrooms has been carried out to ensure that they are appropriately decorated and furnished must be available. This must include an assessment of carpets in bedrooms and communal areas in the home. Outstanding from 5 July 2005 Paper towels must be available in a suitable dispenser in identified communal areas where staff would be expected to wash their hands to maintain standards of hygiene. The numbers and skill mix of staff must be appropriate at all times to meet the health and welfare needs of service users. Any extra non-care duties must be clearly identified on duty rotas and separate to care hours provided. DS0000004217.V285511.R01.S.doc 30/05/06 19 OP21 23 30/05/06 20 OP24 23 30/05/06 21 OP26OP38 13(3)(4) 30/05/06 22 OP27 18(1)(a), 3(a)(b) 30/05/06 Cherry Trees Version 5.1 Page 27 23 OP28 18(1)(a) (c) 24 OP30 18(1)(c) The registered provider must ensure that a minimum of 50 of care staff on duty have a National Vocational Qualification in care. The Registered Manager must ensure that all staff are up to date with Statutory training requirements and attend training related to the care of residents living in the home. 30/05/06 30/05/06 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 28 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 Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Trees DS0000004217.V285511.R01.S.doc Version 5.1 Page 30 - 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. 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