Inspection on 05/07/05 for Cherry Trees

This inspection was carried out on 5th July 2005.

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 27/02/06

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 05 July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cherry Trees Address 242 Dunchurch Road Rugby Warwickshire CV22 6HS 01788 816940 01788 815049 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Pinnacle Care Ltd Miss Sharon Evans Care Home 14 Category(ies) of Dementia, Number 1 registration, with number Dementia - Over 65, Number 14 of places Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home may also provide care to the person named in the application for variation of registration dated 21 June 2004. Date of last inspection 9 November 2004 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 E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on a weekday between the hours of 10.00 am and 18.30 pm. This inspection took place over a total of 8.5 hours. This was the first visit for this inspection year and the main purpose of the inspection was to assess the progress made by staff at the home in respect of the requirements and recommendations made at the last inspection. During the inspection a tour of the premises was carried out with one of the carers. Six residents, seven members of staff and two visitors were spoken with. Residents had varying levels of confusion therefore most of the outcomes for residents were mainly determined by visual observation of residents, care practices, care plan profiles and discussions with staff. What the service does well: What has improved since the last inspection? What they could do better: From various issues raised during the inspection and expressed in this report there are areas that have not been consistently monitored. The manager must ensure that sufficient and appropriately qualified staff are available at all times to meet the assessed needs of residents. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 6 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. There were no activities observed to take place on the day of inspection and a programme of activities offered was not available to evidence if there are choices available to residents. A formal menu is not available for residents, which would help to demonstrate that a choice of meals is being offered. 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. The inside and outside of the home was observed to be in need of improvement to ensure that a safe environment is accessible to residents at all times. Access to the garden is 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. 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 E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 5, 6 Prospective residents are assessed prior to moving into the home, which forms the basis of ensuring that care needs can be met. Potential residents and/or their family are able to visit the home prior to admission offering them the opportunity to make a choice about moving into the home. The home is not registered to provide intermediate care but does offer a day care service. Additional resources had not been identified to meet the needs of this service and the impact of this service on the lives of long term residents living in the home could not be demonstrated. EVIDENCE: Two care profiles were examined both of which contained comprehensive preadmission details. Examination of care records showed that they contained the necessary information required for staff at the home to provide the care needed. Staff spoken with were aware of the individual needs as well as the likes and dislikes of residents for whom they provide care. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 9 Information contained in care profiles provides evidence that potential residents had been given the opportunity to visit the home with their families prior to admission to support them in making a choice about the home. Residents referred by the care management team had summaries of care needs on file and ongoing review information was available. This home is not registered to provide intermediate care. On the day of inspection two people for whom day care was required were resident in the home. The inspector was informed that the home provides a day care service for two extra residents four days per week and one extra resident on the remaining three days per week. There was no evidence to state that the home intended to provide day care. Additional resources separate to those provided for the services registered by the Commission for Social Care Inspection were not evidenced. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The personal and social care needs of residents have been identified. The health care needs of residents were not consistently assessed to ensure that current needs are identified. Appropriate action is needed to ensure that there is no omission in meeting their holistic needs. The administration of medicines by care staff needs to be improved to ensure that residents are protected from harm by the homes policies and procedures for dealing with medicines. Resident’s dignity is not always respected, which could result in reduced selfesteem and mental wellbeing. EVIDENCE: Two care plans were examined both evidence that staff have developed comprehensive individual care plans, which clearly identify the personal care needs of residents currently accommodated in the home. Care plans were updated and gave details of resident’s needs. Risk assessments had been carried out and the outcome and prevention measures had been identified with written details available. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 11 Although communication with residents was limited due to the varying levels of confusion, some residents were able to confirm through conversation that their health care needs were being met. Evidence in care plans and care practices observed, which include the use of special mattresses for those residents at risk of developing pressure sores and protective bumpers for use on the bed to prevent residents falling out of bed also confirmed that health care needs were being met. The management and prevention of pressure sores is carried out with the support of the District Nurses and risk assessments have also been written to ensure the safe use of these pieces of equipment. There were no residents with pressure sores at the time of inspection. Care plans also evidenced that a Dentist, Chiropodist, Optician, Community Psychiatric Nurse had seen residents and the GP was visiting the home on the day of inspection. There was a concern that care plans state that residents will be weighed three monthly, these were not done, the inspector was informed that this was due to the scales not working. Evidence also showed that although residents had lost weight a decision was not taken to check weights more frequently as a means of monitoring resident’s progress. The medication ordering, storage and administration procedures carried out in the home were examined, these identified that there is a need for improvement in some areas. Written procedures are available and staff are aware of these. Staff who are responsible for administering medication have received training. Medications are stored safely. Bottles containing liquid medication were sticky and not clean, this provides a good medium for bacteria to grow and a potential risk to residents. A controlled drug, which is required to be counted and signed for by two people, was not signed to confirm that it had been given on one occasion. Records available could not be cross-referenced with the medication available. Omissions were identified in Medication Administration Records (MAR Charts) where medication that had been removed from their container but not signed to confirm that the medication had been taken by the resident. Staff at the home promoted the privacy and respect of residents in their care. Staff were observed responding to residents needs sensitively and were able to describe how they attended to residents needs in a manner that promoted their independence and supported them to make choices over their daily life. There was good interaction between residents and staff those residents who were able had free access around the home. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 12 Care staff were observed to knock on doors before entering. Residents looked cared for and their personal appearance with attention to personal hygiene and oral hygiene had been maintained. The dignity of residents were compromised at times it was evidenced that some residents were observed not to be wearing their own clothes and wardrobes in individual bedrooms contained labelled clothing belonging to other residents. An inventory of residents clothing and other personal belongings were either not available or incomplete. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 It was not apparent that the social, cultural and recreational interests are adequately met, whether activities take place or not are reliant on the availability of care staff. The result could be, reduced quality of life and the possibility of increased loss of self-esteem. Residents are supported and encouraged to maintain contact with their family and friends, which helps to maintain mental their wellbeing and ability to exercise choice. Limited opportunities are made available to make contact with the community, which may result in reduced social skills and an increase in the risk of poor mental health. Residents have three meals a day. Meals look appetising but a choice is not available each time, which could result in poor dietary intake and weight loss. EVIDENCE: The inspector was informed that residents are able to receive visitors throughout the day, two visitors were observed to be visiting their relative and were happy with the care being provided. An effective and appropriate method of monitoring and maintaining a record of visitors to the home is not maintained. A list is kept in the Managers office this is completed by staff when visits are made, by relatives and friends. Examination of the list showed that it was not consistently completed. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 14 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 as care staff would not be aware of who was in the home at all times. There were no activities observed to take place on the day of inspection. Residents’ likes and dislikes related to hobbies and past activities were documented in care profiles. Residents at the home have access to a minibus, which the Inspector was informed, is used to transport residents to various community activities outside of the home or to other homes within the organisation where celebratory activities have been planned. Visits outside of the home usually take place on Wednesdays. A formal approach to ensuring activities take place in the home was not evidenced. A relative in response to a quality-monitoring questionnaire carried out by the manager of Cherry Trees expressed concerns about the level of activities, as their relative resident in the home is often bored. There was good interaction between residents and care staff and those residents who were able were encouraged and enabled to exercise choice and control over their daily lives in the home. Residents were observed to be enjoying their meals. A formal menu is not available, which would demonstrate that a choice of meals is being offered to residents. A conversation was held with the cook and procedures and record keeping in the kitchen have improved. Fresh fruit and vegetables are available with other good quality food products. The butcher was seen to deliver fresh meat to the home. A large freezer is maintained on site, the door to gain access to the freezer is not safe and was tending to close and could potentially trap a member of staff. Temperatures were not evidenced and the freezer was in need of organising, to ensure rotation of food. Food was appropriately sealed and dated. The kitchen was used as a throughway throughout the day of the inspection. This area is used to gain access to the managers’ office, laundry and staff lockers. There was no limiting of access for residents, staff or visitors even while meals were being prepared, which could lead to potential risk of a hazard to physical wellbeing and cross infection. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Procedures are in place to ensure that complaints are dealt with promptly, in a structured manner, objectively and within stated timescales. There is a vulnerable adults procedure in the home to ensure an appropriate response to any suspicion or allegation of abuse, staff need to be made aware of these procedures to ensure that the system in the home is robust and supports the protection of residents in their care. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors to the home. The Commission have not received any complaints since the last inspection and the manager advised that they have not received any complaints at the home. A procedure for responding to allegations of abuse is available, with clear guidance for staff to follow. Evidence is needed to confirm that training for staff on the protection of vulnerable adults, which provides information on the following topics, prevention of abuse, whistle blowing and Protection Of Vulnerable Adults (POVA) has been included as part of the ongoing training programme for staff. It is important to ensure the safety of all residents, staff need to be aware of the procedures to be followed if they suspect or witness abuse. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 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 tour of the home was carried out with a member of the care staff. The alarm situated at the back door of the home was observed to not be working effectively. The stairway leading to the first floor of the home is narrow and the main light at the top of the stairs was not working. Some of the rooms were homely and furnished with resident’s own possessions. In a number of the rooms the décor chosen is not appropriate for residents with a diagnosis of dementia. There is a mix of various patterned wallpaper and patterned carpet, which will not help residents who are confused. A number of bedrooms are sparsely decorated, and some bedrooms look bare and dark. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 17 There were unpleasant smells in some bedrooms, a number of carpets identified on the day of inspection were stained and one residents mattress was dirty. The corridors of the home are narrow, carers were observed to not be able to walk beside a resident with poor mobility in the corridor on the ground of the home. To assist the resident one carer had to walk in front leading the resident by one arm and another carer behind the resident. This means of assistance looked awkward and although not intentional distressful for the resident. On the first floor of the home electrical equipment which includes two vacuum cleaners, a carpet cleaner and a hair dryer is stored in the window alcove, these were not appropriately stored and therefore presented a hazard to residents walking in the corridors. Some carpets in bedrooms were noted to have an unpleasant smell and stained. The Inspector was informed that the bath on the first floor is not used as it is not an assisted bath and is too low for residents. This then only leaves on bathroom to be shared by 14 residents. All residents need varying levels of assistance and support to attend to personal hygiene needs and bathing. There are no soap dispensers in bathrooms or toilets, a flannel and a single nailbrush was observed in the bathroom on the first floor presenting a potential risk for cross infection. Steradent tablets were stored on a shelf in a resident’s bedroom but were not safely maintained in locked cupboards. 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 and the door could not open without hitting the ceiling lighting. Radiators in corridors were observed to be dirty the grills providing a dust trap. There is a small lounge, which the residents use as a quiet area and a larger lounge where most of the residents were seated. Access to the garden is by a very steep slope or stairway. The steepness of the slope and stairway is not suitable for residents, either on foot or by wheelchair. There is an empty swimming pool on one side of a low level fence. The fence is in need of repair, the swimming pool is partially covered by a sheet of tarpaulin this area has not been made suitably safe and free from the risk of any hazard. A large conservatory serves as a dining room for the residents. Access to the conservatory requires residents to have to step down into it. There is no level access provision to all entrances and exits to the home. A moveable wooden ramp is used to provide level access. The ramp is of poor quality as the wood is wet and rotting. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 18 The kitchen in the home is used as the main throughway for access to the manager’s office, the medicines, which are kept in the manager’s office and to get to the laundry. The laundry is a small room, which is also used for storage and staff lockers. Care staff undertake laundry duties, throughout the day and night. This includes washing bed linen and residents clothes. The inspector was informed that laundry is not taken through the kitchen, this includes during the night shift. The laundry is accessed from the front of the building this would involve staff leaving the premises at night to get into the laundry, creating a dangerous situation and putting staff at risk. One relative in a quality review carried out by the home expressed that the only fault they have is with the washing of personal clothing, which include cardigans and jumpers which have been ruined due to poor washing procedures and had to be replaced by the relative. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 The numbers, skill mix and availability of trained staff are not consistently maintained on all shifts, this could result in a possible oversight when meeting care needs and could lead to harm. EVIDENCE: Staffing levels on the day of inspection were based on the minimum required to care for 14 residents. The inspector was informed that two extra residents are accommodated four days per week and one extra resident three days per week. There was no evidence to state that additional staff are provided to accommodate the extra residents. Examination of four weeks duty rota worked by staff in the home during the month of June evidenced that on some shifts there was insufficient staff available and the skill mix had not been considered. An example of this is when both Team Leaders are working the same shift leaving no senior cover for the opposite shift. Staffing numbers on the duty rota ranged from three carers to one with no indication on the rota of replacement staff cover provided. On occasions one or two staff were evidenced to be on duty on an early shift there was no evidence to show what cover was provided at these times. 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 staff have attended ongoing training in dementia care. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 20 There is one member of staff employed to clean the home between the hours of 2.30 pm and 5.30 pm. The home has a cook available between the hours of 8.00 am and 2.00 pm four days per week and 8.00 am and 1.00 pm on the remaining three days. Care staff are required to make tea or finish tea for the residents and ensure that the kitchen is left tidy. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38 There are a number of areas related to the homes management and operation which need to be improved to ensure the safety of residents at all times and an increase in their self-worth and quality of life. EVIDENCE: The manager has experience in managing care homes providing personal care and is working towards the registered managers award. There are clear lines of accountability within the home. The area manager was visiting the home on the day of inspection primarily to audit care plans. Observations made and discussions with residents and staff indicate that the manager is approachable. From various issues raised during the inspection and expressed in this report there are areas that have not been consistently monitored. A small quality audit was in the process of being carried out, which involved sending questionnaires to residents ‘Residential Home Questionnaire’ The Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 22 inspector examined four questionnaires, which had been completed by relatives. The manager had not had the opportunity to analyse the results to determine where changes are required. Comments on the whole suggest that relatives are happy with the care provided by care staff and that they find staff friendly and willing. Concerns expressed have been discussed throughout the report. As discussed in this report under environment both the inside and outside of the home was observed to be in need of improvement to ensure that a safe environment is accessible to residents at all times. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION 2 2 2 2 x 2 x 2 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 3 x x x x 2 Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 24 Yes 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 OP1 Regulation 4, 5 Requirement The Statement of Purpose and Service Users Guide must be displayed in an appropriate place in the home, which is accessible to residents, relatives and other interested agencies. An updated copy of the Statement of Purpose and Service User Guide must be forwarded to the Commission for Social Care Inspection The impact on resources of day care services on the registered service provided by the home must be assessed and the outcome forwarded to the Commission. The weight of residents must be monitored as frequently as required following an assessment of need and appropriate intervention taken. The registered manger must ensure that all carers administering medicines carry out approved Royal Pharmaceutical Society guidance on the safe administration of medicines. The registered manager must monitor and randomly audit E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Timescale for action 30:09:05 2. OP1 5 30:09:05 3. OP6 12 30:09:05 4. OP8 12 30:09:05 5. OP9 13 30:09:05 6. OP9 13 30:09:05 Page 25 Cherry Trees Version 1.40 7. OP10 12(4)(a) 8. OP12 OP13 16(2)(m) (n) 9. 10. OP13 OP15 11. OP15 OP26 17, Schedule 4 (17) 16(2)(i), (4), 15(1), Schedule 3 (m), Schedule 4 (13), 12(2) 13, 16 Medication Administration Records to ensure that staff are carrying out the administration of medicines safely and following the homes Procedures. An inventory of residents clothing must be maintained and action taken to ensure that residents have access to their own clothing and are individual residents clothes are not used for other residents. Following assessment and consultation with residents and or their representative about their social interests, arrangements must be in place, which give opportunities for stimulation through leisure and recreational activities both in and outside the home. A planned varied programme of activities must be developed, which considers the needs and capabilities of all service users. An appropriate and active register of all visitors to the home must be maintained. Evidence must be available, which demonstrates how service users are supported to make choices in choosing meals. Menus must be presented in a format suitable for residents. A risk assessment which also considers the risk of cross infection when using the kitchen area as a thoroughway to the managers office and laundry area must be carried out. Evidence must be available to demonstrate that staff training needs have been assessed on the protection of vulnerable adults this must include communication barriers and an 30:09:05 30:09:05 30:09:05 30:09:05 30:09:05 12. OP18 13(6) 30:09:05 Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 26 13. OP19 OP20 OP22 OP25 14. OP21 15. OP21 16. 17. OP22 OP24 awareness of the Adult Protection procedure for the home. 13(4), 23 The issues related to maintenance and safety of the environment and highlighted in this report are to be addressed, which include: Ensuring the gardens and grounds to the rear of the home are accessible to residents. The swimming pool must be made safe and access to that area secured. A risk assessment must be carried out on the accessibility of the home for all residents. This must include acess to the front and back entrances and the conservatory. The provision of suitable ramps must be provided. The fire alarm system must be checked to ensure that it is working. Lighting throughout the home in areas accessible to residents must be checked to ensure that they are working at all times. 13, 16, 23 The registered manager must ensure that liquid soap is available in all areas used by residents and staff. 23 Sufficient and suitable toileting and bathing facilties must be installed which are capable of meeting the assessed needs of residents. The accessibility of these areas must be taken into consideration. 23 Suitable storage facilties must be available for household equipment to be stored safely. 23 A review of residents indivual bedrooms must be carried out to ensure that they are appropriately decorated, furnished and clean at all times. This must include an assessment of Matresses and carpets. E53 S4217 Cherry Trees V238278 050705 Stage 4.doc 30:09:05 30:09:05 30:09:05 30:09:05 30:09:05 Cherry Trees Version 1.40 Page 27 18. OP24 OP30 18, 23 19. OP26 16 20. OP27 18(1)(a), (3)(a)(b) 21. OP28 OP30 OP25 18 22. OP38 12(1)(a), 13(2)(4) (6), 23(4) A review of how staff assist residents in the narrow corridors must be carried out to ensure that this practise is carried out safely an appropriate to the assessed needs of residents. Any required training needs must be identified and met. The standards of cleaning in the home must be monitored. This includes a review of bedroom carpets and radiators, which have collected dust. The Registered Manager must ensure that at all times suitably qualified, competent and experienced persons are working at the care home. Duty rotas, must clearly demonstrate who is covering a shift. A training programme must be developed which details plans for ensuring that: There are a minimum of 50 of care staff with NVQ 2 training by December 2005. Staff sre up todate with Statutory training requirements, which includes ensuring that staff are aware of safe manual handling and moving techniques. The Manager must have systems in place, which ensures the health, safety and welfare of service users and staff. Action must be taken on issues highlighted in this report. 30:09:05 30:09:05 30:09:05 30:09:05 30:09:05 23. 24. 25. Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 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. 1. Refer to Standard Good Practice Recommendations Cherry Trees E53 S4217 Cherry Trees V238278 050705 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection 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. 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