CARE HOMES FOR OLDER PEOPLE
Cherry Trees Care Centre Cherry`s Road Cundy Cross Barnsley South Yorkshire S71 5QU Lead Inspector
Jayne Barnett-Middleton Unannounced Inspection 9th February 2006 09:50 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 DS0000066494.V284833.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. DS0000066494.V284833.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Cherry Trees Care Centre Address Cherry`s Road Cundy Cross Barnsley South Yorkshire S71 5QU 01226 704000 01226 704004 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) Four Seasons (DFK) Limited Mrs Julie Armitage Care Home 89 Category(ies) of Dementia (34), Mental Disorder, excluding registration, with number learning disability or dementia - over 65 years of of places age (34), Old age, not falling within any other category (45), Physical disability (10) DS0000066494.V284833.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for 34 service users in the category DE/E Dementia Elderly or MD/E - Mental Disorder Elderly. These service users must be aged 60 years and above, however, three service users may be accommodated on this unit aged 55 years and above. The accommodation for these service users is on the lower ground floor in a separate unit. The home is also registered for 45 service users in the category OP Older People. The accommodation for these service users is on the ground and first floor. The OP - Older People service users must be aged 60 years or above. The home is also registered for 10 service users in the Category PD Physical Disability. These service users must be accommodated on the ground floor in a separate unit. With the exception of the PD - Physical Disability Unit, the care staff, qualified nurse staffing levels and the Manager supernumerary time must be maintained at least the levels agreed previously with Barnsley Metropolitan Borough Council and Barnsley Health Authority. (see attached) In the PD - Physical Disability Unit, a registered general nurse must be on duty in the unit 24 hours a day. Staffing levels must at least comply with the `Residential Forum Care Staffing in Care Homes for Younger Adults`, published April 2002. The registered Manager must undertake training in working with service users with Dementia and Mental Health problems. 12th July 2005 2. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: Cherry Trees is situated in Cundy Cross and is 3 miles from Barnsley. The unit is on three levels, is purpose built and has adequate car parking space. The home is registered to care for residents requiring personal and nursing care in the categories of dementia, old age and physical disability. The physical disability unit was registered by the NCSC and opened in 2003. Within a moderate walk of the home there is a full range of amenities including a variety of shops selling provisions, a chemist, optician, hairdresser, post office and newsagents. DS0000066494.V284833.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out from 9.50 am to 3.00 pm. Most of the residents were seen during the inspection. Five residents, six staff and the manager were spoken to. A sample of records was examined and a partial inspection of the building was carried out. Throughout the inspection positive and professional relationships were observed between staff and residents. The inspector wishes to thank the manager, staff and residents for their time and co-operation throughout the inspection process. What the service does well: What has improved since the last inspection?
DS0000066494.V284833.R01.S.doc Version 5.1 Page 6 Resident files contained risk assessments relating to all aspects of residents lives. These had been updated to include nutrition, falls and skin integrity. Equipment in one bathroom and one toilet had been replaced promoting a safe environment. The lunchtime meal observed, was relaxing and residents were given sufficient time to eat their meal. Carers were observed to be assisting residents to eat in a respectful and patient manner. Fire systems and hot water temperatures were being checked on a weekly basis and records of these were maintained. 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. DS0000066494.V284833.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection DS0000066494.V284833.R01.S.doc Version 5.1 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 the following standard(s): 3. Residents were not admitted to the home without their needs being assessed, to ensure that the home was able to meet the residents’ health, social and care needs. EVIDENCE: A full needs assessment was carried out for all residents prior to their admission. This confirmed that the service was appropriate for the resident and provided staff with the information to formulate an individual plan of care. On the day two residents were being admitted to the home. The staff confirmed that they had been provided with sufficient information about their care needs enabling them to provide the appropriate care. The home does not provide an intermediate care service. DS0000066494.V284833.R01.S.doc Version 5.1 Page 9 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 and 10. Care plans were in place for all residents. Two care plans checked required more detail, to ensure that they met the required standard. Residents received personal support, which promoted their privacy, dignity and independence. Resident’s physical and emotional needs were met. There was evidence that a range of healthcare professionals regularly visited the home to meet the resident’s needs. A policy and procedure to ensure that staff adhered to the safe administration of medication was in place. EVIDENCE: Three care plans were checked which set out in detail the action that was required by staff to ensure that all aspects of the residents care needs were met. One care plan checked did not record the residents preferred funeral
DS0000066494.V284833.R01.S.doc Version 5.1 Page 10 arrangements, to ensure that their wishes following their death could be respected. Two care plans did not contain the residents’ preferred daily routines, for example the times that they liked to rise and retire and any recreational interests that they may have. The manager said that a new care plan format had recently been implemented and that the staff was still in the process of transferring information from the previous format. The care plans checked had been reviewed on a monthly basis. Records of healthcare visits were maintained and these evidenced that healthcare professionals, eg general practitioner and chiropodist were visiting residents on a regular basis. Residents said that their healthcare needs were met. One resident commented that, due to the care they had received since admission, their health had improved. Resident files contained risk assessments relating to all aspects of residents lives. They identified the individual risks that were presented to residents on a daily basis and the action required to reduce the risk, which enabled residents to live an independent lifestyle and promoted their safety. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of residents. Medication was checked on a sample basis. The systems in place were well managed and medication had been administered appropriately maintaining resident’s health, safety and welfare. Throughout the day staff were observed to treat residents with dignity and respect. All residents seen were well cared for, they were clean, hair and nails had been attended to and male residents were shaved. DS0000066494.V284833.R01.S.doc Version 5.1 Page 11 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. Routines with the home were flexible and residents were encouraged to spend their day as they wished. A good programme of activities was in place that was appropriate for the needs of the residents. Residents were able to receive visitors at any reasonable time. A good choice of menu was offered and specific dietary needs were catered for. The lunchtime meal was well organised and relaxed. EVIDENCE: Residents were observed to be following their preferred routines. Several residents were spending time in the lounge socialising with other residents whilst others had chosen to spend time in the privacy of their bedroom. Residents said that the routines within the home were flexible and that they were able to spend their day as they wished. One resident commented, “there are no restrictions”. DS0000066494.V284833.R01.S.doc Version 5.1 Page 12 Activity workers were employed at the home and a good programme of activities was available. The activity workers were allocated time in each unit and a varied activity programme had been devised based on the residents abilities and concentration span. Activities included crafts, bingo, flower arranging and movement to music. The activity worker said that trips were organised during the months and that the residents particularly enjoyed outings to a local garden centre. Residents were encouraged to maintain links with their family and friends. Several residents confirmed that visitors were welcome at any reasonable time. A good choice of menu was offered and special dietary needs were catered for. The lunchtime meal observed was relaxing and residents were given sufficient time to eat their meal. Carers were observed to be assisting residents to eat in a respectful and patient manner. Residents confirmed that they were satisfied with the food offered commenting, “we have a good choice” and “it’s very good”. DS0000066494.V284833.R01.S.doc Version 5.1 Page 13 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): 16. The complaints procedure was clear and accessible. Complaints made by residents and their relatives were listened to and action was taken to deal with complaints promptly. EVIDENCE: A complaints procedure was displayed at the home and copies were available in resident’s bedrooms. The complaints procedure ensured that residents and their relatives were aware of how to make a complaint and who would deal with them. Residents spoken to confirmed that they had no complaints. All staff spoke positively about the attitude of the staff and manager and were confident that they would always listen to any concerns that they may have. DS0000066494.V284833.R01.S.doc Version 5.1 Page 14 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 and 26. The home was well decorated and a routine programme of maintenance was in place. Equipment in one bathroom and one toilet had been replaced promoting a safe environment. The home was clean, pleasant, hygienic and odour free. EVIDENCE: The home was clean, tidy and odour free. All areas seen were well maintained and pleasantly decorated. Furnishings were clean which promoted a comfortable and homely environment for residents. At the last inspection a lounge/dining area on the Dearne unit was very hot. Due to excessive temperatures residents had been moved to other areas of the home to ensure their safety. The manager had closely monitored the
DS0000066494.V284833.R01.S.doc Version 5.1 Page 15 temperatures and ultimately an industrial air conditioning unit was hired, temporarily, to reduce the temperature to a safe level. On the day the temperature within the lounge/dining area was comfortable. The manager said that a quote for air conditioning had been obtained and forwarded to the provider. This should be considered to ensure that a consistent and safe temperature can be provided during the summer months. Several bedrooms were checked and all were clean and pleasantly decorated. All the rooms had been personalised by the resident with small items of furniture, photographs and mementoes, encouraging them to retain their own identity. All areas seen were clean and there were no unpleasant odours. The domestic staff had completed NVQ Level 1 training and was scheduled to attend infection control training. Staff stated that they were able to keep the home clean and that sufficient cleaning materials were provided, enabling them to maintain a good standard of cleanliness. DS0000066494.V284833.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30. Many of the staff employed have worked at the home for several years and therefore know the residents well and can offer them a consistent service. Staff had received training to meet the resident’s general and specific needs. The home operated a recruitment policy that promoted the protection of residents. Staff files were well maintained and included all of the required information. EVIDENCE: Residents spoke positively about the staff team and described them as “wonderful”, “brilliant” and “very good”. The manager commented that there was a low turnover of staff, which promoted a consistent quality of care to residents. A training and induction programme for staff was in place enabling them to meet the assessed and changing needs of residents. Staff confirmed that they had attended various training courses that included food hygiene, adult protection, moving and handling and first aid. Staff commented that a good range of training was available appropriate to their job role and that refresher training was offered to ensure that they were up to date with all the statutory training required by the regulations.
DS0000066494.V284833.R01.S.doc Version 5.1 Page 17 A robust recruitment policy and procedure was in place. Two files checked contained a good range of information including two references, declaration of health and qualifications/training. All staff employed had undertaken a Criminal Records Bureau Check at the enhanced level to promote the protection of service users. DS0000066494.V284833.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38. Residents and staff benefited from the ethos, leadership and management approach. Staff morale appeared good and all staff spoke positively above the management team. Resident’s financial interests were safeguarded by the procedures at the home. The homes policies and procedures promoted the health, safety and welfare of service users and staff. EVIDENCE: The registered manager is competent and experienced. She has a relevant nursing qualification and additional clinical qualifications and has successfully completed the Registered Managers Award.
DS0000066494.V284833.R01.S.doc Version 5.1 Page 19 All staff spoke positively about the manager describing her as “approachable” and “supportive”. Arrangements were in place for residents who were unable to manage their monies due to their mental health. Monies were securely stored and records checked evidenced that service users were able to access their monies for hair care and personal items as they wished. The home was well maintained and all areas seen were clean and safe. Fire systems and hot water temperatures were being checked on a weekly basis and records maintained. The staff had received regular training to promote the health, safety and welfare of residents and their colleagues. DS0000066494.V284833.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 DS0000066494.V284833.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 OP11 Regulation 15 15 Requirement Residents care plans must contain their preferred routines. Attempts must be made to seek the residents or their relative’s views as to their wishes after death. The temperature of Dearne Lounge must be monitored and maintained at a safe and comfortable temperature. Timescale for action 31/03/06 31/03/06 3. OP20 23 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP28 Good Practice Recommendations 50 of care staff should have a level 2 NVQ or equivalent by 2005. DS0000066494.V284833.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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