Inspection on 10/01/07 for Cherry Trees Care Home

This inspection was carried out on 10th January 2007.

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

The inspector 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 Care Home 03/12/09

Cherry Trees Care Home 08/05/09

Cherry Trees Care Home 30/01/08

Cherry Trees Care Home 04/10/05

Cherry Trees Care Home 19/04/05

Cherry Trees Care Home 06/12/04

Cherry Trees Care Home 21/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN Lead Inspector Jackie Howe Key Unannounced Inspection 10th January 2007 11:00 X10029.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 Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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 Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Trees Care Home Address Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN 01789 764022 01789 764024 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) www.barchester.com/oulton Barchester Healthcare Homes Limited Care Home 81 Category(ies) of Dementia - over 65 years of age (67), Old age, registration, with number not falling within any other category (81), of places Physical disability (14) Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Provider must ensure that all nursing and care staff receive accredited/certificated training in care for people with dementia. 4th October 2005 Date of last inspection Brief Description of the Service: Cherry Trees Care Home is situated approximately half a mile from Alcester town centre along the main road through Oversley Green. The home is owned by Barchester Healthcare Ltd. The area is very rural with infrequent public transport and the nearest shops are half a mile away. The care home can accommodate up to 81 people. The registration of the care home includes older people, older people with dementia and older people with physical disabilities. The home is divided into dedicated living units for each client group. Currently the home is contravening the registration status within the physical disability unit as thirteen of these beds are occupied by people under the age of 65. At least two of these are also occupied by people with a learning disability and no physical disability. The homes décor, furniture and furnishings are generally of a high standard, however some areas of the physical disability unit and dementia care unit, would benefit from repainting as the woodwork and walls are showing signs of wear and tear. The accommodation is provided on two floors with access to these via a passenger lift or stairs. It must be noted that in order to move between the two floors of the physical disability unit, staff must either use the lift or use the stairs in the dementia unit of the home as there are no stairs connecting the two floors within the unit itself. All of the accommodation is single room with en suite facilities. The gardens are well maintained, being accessible to all of the current residents. There are a number of seating areas, which are well used in good weather. There is a vehicle at the home to transport the residents on trips and for appointments. Information about the home is given to prospective residents and their families via the ‘Statement of Purpose’ and other information brochures. Range of fees: £825 - £900 per week depending on assessment. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 5 Additional charges are made for hairdressing, chiropody, toiletries and sundries such as newspapers. Residents also contribute to external activities. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the inspection year 2006/07 and was unannounced. It was undertaken over a period of two days, with two inspectors for both days. The inspection focused on the outcome for residents of life in the home. The acting manager was present through out both the days. The inspectors were able to tour the home, and spend time speaking with a number of residents, visitors to the home and staff. The manager supplied a completed ‘Provider Information Questionnaire’ (PIQ.) Information from this has been included in the report. The inspectors ate lunch with the residents and were able to observe care practices, and how staff interacted with residents in the home. During the inspection the care of six residents from across all three units was examined in detail, by reading their care plans and other documentation, observing care offered to them and checking that staff have the necessary skills to care for them. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. Records including staff files, policies and procedures, health and safety / environmental checks and risk assessments were also read. All of the residents were at home for the inspection. The inspectors would like to thank the residents, manager and staff for their hospitality and co-operation during the inspection. What the service does well: The home provides a bright, cheerful, generally well-maintained environment, and much has been done to ensure that the home, despite its size, has retained some homely touches. The home does not use agency staff therefore providing a continuity of care for the residents in the home. Some relatives spoke positively about the staff, and said that staffing was now ‘very good’ and more settled following a difficult period. There are however still times that staffing levels are not adequate to meet residents needs. The acting manager is having a positive effect on the home, and staff and relatives spoken with said that she was approachable. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 7 The majority of residents and relatives speak highly of the food and menu available, and relatives are welcome to join residents at any time for a meal. ‘ The food is so good that all of the family are coming to join him for lunch’. The home is generally tidy and clean, and the staff uphold good infection control procedures, although in the kitchen it was noted that some areas are not cleaned sufficiently due to a lack of staff hours available. What has improved since the last inspection? What they could do better: Care planning remains poor. The organisation has recently introduced a new care planning system, and staff are currently using care plans, which are not complete, as all the information from the old plan has not been transferred. Care plans generally are not sufficiently detailed to guide staff in how to deliver care to individual residents. This is of particular concern in both the dementia care unit and the physical disability unit where residents are more vulnerable, and often unable to speak for themselves. Despite an increase in staffing resources recently, deployment of staff at key times of the day, is not always sufficient to meet residents’ needs. The home employs two members of staff to provide and organise activities around the home. A new programme of activities is produced each week. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 8 Staff in this area are dedicated and keen to improve the service further as despite the hours available, the elderly frail unit does not always receive sufficient resources, and people from the younger adult unit, sometimes have to go to the dementia care unit for entertainment. Although staff spoken with said that there were plenty of activities undertaken in the physical disability unit, this was not reflected in the records looked at, which indicated that very little is provided for these residents by way of activities. Training in the home has been limited over the past year, with a number of mandatory training courses not taking place. Where this training is in areas of Health and Safety and Adult Protection, this could potentially constitute a risk to residents. Whilst complaints are recorded, the manager does not record the outcomes for those making the complaint and actions taken in response. Some residents and relatives are unaware of the complaints procedure. There is currently no formal quality assurance system in the home. The manager therefore has no formal way to know areas of satisfaction, or be able to implement and monitor change and improvements where they may be required. There has been no formal process for staff supervision until a few months ago. A process has now been introduced but not does not yet meet the standards in regard to content and frequency, as described in the ‘National Minimum Standards’. Staffing currently in the ancillary and support areas such as maintenance, cleaning and catering is insufficient to meet the size of the home, and number of residents. The manager is in the process of employing some new staff, which she hopes will have a positive impact on 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. The summary of this inspection report can be made available in other formats on request. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP1 and 3 and YA 2. Quality in this outcome area is poor. Currently the home is contravening the registration status within the physical disability unit. Prospective residents do not have sufficient and accurate information about the home and the services it provides. Pre admission assessments seen do not provide the manager with sufficient information to fully assess the needs of the potential resident and demonstrate that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager of the home informed the inspectors that the registration status of the fourteen beds for younger adults with physical disabilities had been amended by the previous manager, who had had the ‘younger adult’ Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 11 status removed. This means that the fourteen beds in this section are currently registered for older people with physical disabilities. It was noted during the inspection that thirteen of these fourteen beds were occupied by service users under the age of 65. It was also noted that the home had admitted service users with learning disabilities and no physical disabilities. This contravenes the current registration and must be addressed urgently. The sister on duty in the physical disability unit within the home said that Barchester had recently introduced a new care planning format which was to replace the existing Standex care planning system. Three residents’ care plans were looked at in this unit as part of the inspection. Out of these three only one pre admission document could be located. The information contained within this document was minimal and did not thoroughly assess the needs of the potential service user. As this document related to a resident with learning disabilities it was not possible to identify how the home would be able to meet the social care needs of the person. A pre admission assessment undertaken on a resident prior to admission to the elderly frail unit was also read. It was undertaken in hospital. The paperwork in place guides staff to ask relevant questions, and seek out information in required areas, however the detail contained was sparse in places. The organisation has homes nationwide, and sometimes pre admission assessments are undertaken by staff from another home on behalf of staff at Cherry Trees. One of these assessments was read and was not found to be sufficiently detailed for the manager to make an informed decision about meeting needs. Admission assessments undertaken by staff on admission to the home, and prior to the care plan being formulated, are more detailed. The information available for people to read prior to admission is out of date and does not currently provide prospective residents with all the information they require. As mentioned above, the home is not currently providing a service to residents as described in the ‘Statement of Purpose’. The ‘Welcome to Cherry Trees’ folder is displayed in the entrance hall of the home. Information in the folder is duplicated which could be confusing. Information regarding policies for example the complaints procedure is not detailed as to timescales, and the name of the previous manager is still included. The acting manager said that each resident was given a copy, but a number of residents and their relatives said that they had not read it. The CSCI inspection report on display is not the last inspection undertaken in the home. The acting manager said that she could not find the last report for display, but would ensure that this would be rectified as soon as possible. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP7, 8, 9, 10 and 11. YA 6, 9,18,19 and 20. Quality in this outcome area is adequate. Care plans in use are not sufficiently detailed and minimal or no information is recorded within some sections, so that staff have little guidance in how to meet the personal, health and social needs of residents. Health care needs are identified, but specialist clinical guidance is not always requested. Systems for storage and administration of medication are safe. This judgement has been made using available evidence including a visit to this service. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 13 EVIDENCE: It was apparent across the home that the care plans looked at for case tracking purposes were still in the transition period from the Standex to the new format, as the information contained within the new format was either incomplete or missing. This was confirmed by staff on duty during the inspection. Use of the original Standex care plans had ceased. It was also noted across the home that there was considerable duplication of daily records within residents’ care plans, with both care assistants and qualified nurses making almost the same entries but on two separate sheets of paper. This was discussed with the sister on duty in the physical disability unit and the acting manager who both agreed that it was a waste of staff time and resources. They undertook to look into a more appropriate means of recording information about service users that did not result in duplication. Physical disability unit. The care planning documentation for each of the three files looked at in the physical disability unit, followed the same format, and included sections on personal hygiene, continence, tissue viability, nutrition and promoting adequate sleep patterns. It is to be noted that these are all related to the physical health of the individual. There are also sections within this documentation that relate to the ‘maintenance of cognition’ and ‘social interests and hobbies’. Minimal or no information was recorded within these sections. The sister on duty said that reviews are held on a monthly basis at which point the care plans are updated as necessary. Dating and signing of the care plans was sporadic in the files looked at, and no review dates were recorded. During the inspection a planned review was held with one of the service users chosen for case tracking which was attended by a relative. Risk assessments were available within the three residents files looked at. These were in a similar state of completion to the care plans as they were not complete, not dated and signed or there were no review dates scheduled. The areas covered by the risk assessments were tissues viability, falls, nutrition and mobility (including moving and handling). More specific one relating to individual residents included a continence assessment and smoking. There were no risk assessments in place relating to social care and personal goals such as skills development or community access. Similarly there were no risk assessments in place in relation to those residents that either have or may have dementia. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 14 Information was in place within the files looked at to confirm that residents’ healthcare needs are addressed. Routine health needs were monitored with appointments at regular intervals being made for the dentist, optician and chiropodist. More specialist healthcare needs are also addressed, via the involvement of specialist healthcare professionals such as a dietician, speech and language therapist, consultant psychiatrist, community psychiatric nurse, learning disability community nurse, audiologist and the continuing care nurse. Residents spoken with during the inspection spoke very highly of the unit and the staff team. Elderly Frail and Dementia care units. A number of care plans on both of these units were read, some of them for the purposes of case tracking, and others to look in detail at specific care elements. A selection of care plans were read, some still using the old style documentation, and others the new. One care plan read using the new system as previously reported, was incomplete and some vital information regarding risk assessment and care needs had not been transferred. One care plan for a resident on the dementia care unit showed very limited information, insufficient risk assessment, and no evidence of review. There was also little evidence of life history information. Care plans read did not give details of how staff should manage challenging behaviours, and in one care plan where a resident was proving to have complex needs, there was no evidence of recent professional medical advice or ongoing support, and no recorded evidence that the family had been involved in a review process. Care plans in the dementia care unit are ‘problem’ focused and do not give sufficient detail of retained ability, i.e. what a person can continue to do for themselves, but where some assistance from staff can promote independence and a sense of ‘well being’. There was also evidence that residents are labelled by staff as ‘aggressive’, but with no documented evidence to show this is the case, or if aggression is observed, what the reason for this may be, and the best ways that staff should intervene. This shows a lack of understanding by staff in the processes of care planning and in the rights of people with a dementia. It was noted that in one care plan of the need to ‘orientate to time and place’. Staff need to be aware that the use of reality orientation in people with a dementia, is not always the most helpful way to offer care, and that the rationale behind using these techniques should be fully documented. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 15 Care planning was discussed with the acting manager and area manager during the inspection and the comments taken seriously as a need for improvement in the home. Both the acting manager and area manager are experienced in the care of people with a dementia and showed a commitment to inspectors to improve the home in this area. The home’s care planning systems guide staff into exploring ‘end of life’ wishes. This includes discussing with residents the decisions they may have made regarding resuscitation. One care plan read was very confusing as to directions to staff. It was written ’Not for resuscitation’ but went on to say that admission to hospital should not be ‘unless absolutely avoidable.’ The recording of this was found in the old care plan not currently in use, and therefore staff may have been unaware of these wishes. The manager must ensure that requests made by residents or relatives and medical opinion from GP’s and/or Macmillan and district nurses, are formally recorded and are clearly accessible within care planning documents and understood by all relevant parties. Where signatures are used to show that individuals have read and signed the care plan, it must be clear who this signature belongs to and their relationship to the resident. The homes’ policies should also reflect current practice in regard to the involvement of emergency and ‘on call’ services. Medication is supplied by Lloyds Chemist, and is accompanied by medication administration record sheets (MARS). Medication is stored in the offices on the units in secure cupboards. Photographs of residents are attached to the majority of MAR sheets to aid identification. On the physical disability unit, each floor has its own medication trolley which houses the current prescribed medications for the residents. Most of this is supplied in blister packs. The only exceptions to this are for tablets that cannot be blistered for various reasons. Each resident has an allocated space within the trolley for any medications that are supplied in their original boxes or bottles. Medication administration records checked were completed appropriately, with the number of tablets available corresponding with the number received and administered. A medication round was observed, which was satisfactory, however staff must remember to maintain the privacy and dignity of those service users that receive medication via routes other than oral. The sister on duty during the inspection said that only the qualified nurses administer medication. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 16 On the elderly frail and dementia care units, trolleys are also used for administration rounds and blister packs used in a similar way. Mar sheets checked noted a few omissions without an explanation for the reason for omission. There is a fridge available for medications requiring storage at a lower temperature. The container for eye drops being administered did not have the date of opening recorded on the bottle. This is recommended good practice to ensure that they are discarded within appropriate timescales. A secure small cupboard is within the storage cupboards for the storage of controlled drugs. Examination of the controlled drugs and storage confirmed that they are stored and administered within the legal framework relating to such medication. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP 12, 13, 14 and 15 and YA 12,13,15 and 17. Quality in this outcome area is adequate. Activities are available, but are not always provided for all residents in the home in the way they would prefer. Generally food provision is good, but more could be done to offer a full healthy diet, and in the dementia care unit to ensure that meal times are an enjoyable and safe experience. This judgement has been made using available evidence including a visit to this service. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 18 EVIDENCE: The home employs two activity workers, for a total of 76 hours per week, who offer a service across all three units. Presently they only provide a service Monday – Friday, but there are plans to try and extend this to seven days per week. On the day of the inspection, one of the staff was off sick from work, and the other member of staff was attempting to maintain the programme. The member of staff spoken with is very enthusiastic about providing appropriate activities and shows a particular interest in the dementia care unit. She has not had any training in activity work, but has had dementia care training, and she used to be a carer in the home. The two staff attempt to spread their time through out the home. Both spend the morning on the dementia care unit, one doing 1-1 work, and the other undertaking an activity such as washing up, baking, preparing vegetables, singing, music, exercises and craft work. In the afternoon one member goes to the elderly frail unit and the other to the physical disability unit. External entertainers and activities are also brought into the home. A ‘creative mobility’ exercise class has recently started and on the day of the inspection a singer/musician was undertaking a session on the dementia care unit. A separate activity programme is displayed weekly for each unit. Physical Disability Unit The activity programme for the physical disability unit states that one to one time is provided for the residents each morning, and then a specific activity each afternoon. These include music and video, craftwork, crosswords, puzzles and games, singing with an external entertainer and a pamper session. As the home only has two dedicated activities workers it is presumed that there is a reliance on the care staff to ensure that these activities are offered to the residents. Staff spoken with said that the residents on the physical disability unit enjoy frequent and numerous activities and trips out throughout the week. Unfortunately this was not reflected within the records looked at. The care plan of one resident case tracked states that “…needs the stimulation of one to one sessions and group activities…” however the recorded activities for January up to the date of the inspection were predominantly watching television, chatting with staff and sitting in the lounge. In addition to this one shopping trip and one organised activities session was recorded. Activities recorded for another service user case tracked, included sitting in the lounge and watching television predominantly. One cooking session, one massage and one organised activities session were recorded. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 19 Very few planned activities were seen to be taking place during the inspection, however one care assistant did try and initiate a karaoke session and a bingo session during the afternoon of the second day. One family spoken with in the physical disability unit spoke very highly of the home and staff, stating that their relative is “cared for exceptionally well by friendly and caring staff”. They said that they have had no cause to complain since their relative moved into the home, but would have no qualms about doing so should it ever become necessary. Residents spoken with were very complementary about the food provided, “the food is excellent”, “I like the meals I am given”. Elderly Frail and Dementia care units Some residents and relatives spoken with said that ‘the activities girls work very hard’ and were enthusiastic about what was on offer, although all said that they would like more opportunities to go out. One relative said she would like to see more available on the elderly frail unit. Two residents on the elderly frail unit said that they liked ‘our freedom’ and ‘we do our own thing’, however they did say that they were not taken out much and that they depended on their families to do this for them. There was evidence of a lot of activity work previously having taken place on the dementia care unit, although at the time of the inspection this was limited due to staff sickness. There was also an entertainment of a singer in the afternoon of one day, which appeared to be enjoyed by all. Recording of activities, and which are the most appropriate for each resident, and the outcomes of what is achieved from attending activities is limited. The member of staff spoken with said that she was in the process of bringing in new paperwork, which will be included in the care plans. It is important that this recording is not merely a list of what is attended, but is used to guide staff in what activities however small, are appropriate, and can bring about a sense of purpose and positive outcomes. During the inspection, it was noted that friends and family visited frequently, and a number of relatives spent the majority of the day, a number joining residents for a meal, or were involved in supporting care practices such as feeding. Staff were noted to have good relationships with families. One inspector ate lunch on the elderly frail unit, the other on the physical disability unit. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 20 The menu, which is displayed in the entrance hall, and is available in some dining rooms, is varied and offers plenty of choice. The menu is displayed attractively, and the font used is of a reasonable size, however the background behind the writing is patterned and those spoken with could not read the menu independently. On the first day, the menu was smoked salmon or fruit juice, Roast turkey or fish steaks with seasonal vegetables and potatoes, followed by a sweet trolley. On the second day the menu was fried plaice and chips or Cumberland sausages with herbed mashed potatoes and onion gravy. On the first day lunch provision was observed on the dementia care unit. The focus for this was the way staff intervened with residents, promoted their independence, offered choice, made meal time an event and also how residents who are not eating in the dining room are supported. On the day of the inspection, despite there being seven care staff on duty, the number of residents needing assistance or supervision to eat, out numbered the staff, so that on one table there was a member of staff was trying to help four residents. The result of this was that food was left in front of people going cold, and residents who required feeding were not offered food in a way that was personal to them. One resident who has very challenging needs was given her meal in bed with no supervision. The majority of the meal was spat out on the floor, and as she was lying down to eat, the risk of choking on her food was high. The tables on the dementia care unit were laid sparsely with plastic beakers, and a lack of napkins. One resident wiped her mouth on the tablecloth, and received a telling off from another resident. There was no evident offer of choice as there was no visual choice of food offered and no picture menu seen. Meals are chosen that morning throughout the home, but there was nothing to suggest that the residents were eating the meal of their choice. A number of residents were being given a softened diet as they have difficulty with swallowing. Comments about the food were mixed. One relative was very positive saying that she often ate at the home with her father. Most of those spoken with said that the quality of the food was good, ‘ .. the food is very good and we get lot of choice…’ although a few people on the second day were critical, saying that the fish and chips was ‘dry and tough’, although comments about the sausages were positive. One resident said that generally the food is ‘awful’ and that the meat is tough. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 21 A number of people said that they did not receive enough fresh fruit, one lady said ‘ my family have to bring it in for me, it’s on the menu, but we never get offered it’. It was noted that there was a good stock of fresh fruit in the kitchen stores. Tables in the Elderly frail unit were laid attractively with a copy of the menu, flowers, napkins, glasses and condiments on the tables. The environment is bright, cheerful and well presented. Staff served the meal courteously to residents and offered choice and assistance where required. The home employs one chef and one catering assistant to cater for 81 residents across the three units within the home. Discussion with the chef indicated that this level of staffing within the home’s kitchen is insufficient to be able to maintain the required standards of hygiene as far as cleaning was concerned. Inspection of the kitchen and food storage areas confirmed that all of the health and safety checks and records pertaining to good food hygiene were in place and up to date. Food was stored appropriately, and was correctly dated and labelled. Personal protective clothing was being worn by staff. Risk assessments applicable to the kitchen and storage areas were in place. It was noted that although the kitchen staff hold their own supply of cleaning materials in a locked cupboard, the food storage areas were in need of a good clean. The chef said that these areas are cleaned as best as they can, but it is very difficult to ensure that they are cleaned effectively with only two staff working in the kitchen. Food is transported to the physical disability unit ready plated and covered, on a trolley. Staff in the unit said that they frequently reheat meals in a microwave for the service users as they have cooled down by the time they are given out. There was no temperature probe available within the unit on either floor to test the core temperatures of reheated foods, thus it was not possible to confirm that once reheated, they complied with food hygiene regulations, and were safe for the service users to eat. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 22 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP 16 and 18, and YA 22 and 23 Quality in this outcome area is adequate. A number of residents and their relatives are unaware of the complaints procedure, although some are happy that their complaints and concerns are listened to. Policies in place protect residents from abuse, however a lack of recent staff training could mean that potential abuse situations are not always recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and their families spoke about the complaints systems in the home. Information provided by people using the service prior to the inspection, indicated that over past months complaints were not listened to and that there was a ‘lack of faith in the complaints system’. Two relatives said that they had written a number of letters raising concerns, and felt happy that they were always responded to. One relative said she had used the complaints procedure to make her comments known, and said that she had received positive responses from the area manager. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 23 Residents spoken with in the physical disability unit, were very clear on how to complain should the need arise. One resident spoken with on the elderly unit said: ‘I would not know how to complain, I have spoken to the staff but it is not followed up or resolved’. Another resident said that she had never seen the procedure and did not know there was one, however she said she would go straight to the office. The manager keeps a record of all complaints, but does not record the outcomes or whether the complaint has been upheld. Records show that over the past year, a number of complaints have been received about the service, and some of these have been brought to the attention of the commission, with relatives expressing concerns about staffing levels, and standards of care. One relative spoken with said that she had over the past few months been very concerned, but that she was pleased to note that things under the new manager were improving. The home has policies and procedures in place for responding to allegations of abuse. In the past year, staff have not attended training in Protection of Vulnerable Adults (POVA), although staff did demonstrate an understanding on what constitutes abuse, and of the home’s ‘Whistle blowing’ procedure. The manager has not had any reason to make a report to the POVA register. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 24 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP19, 23 and 26, YA 24, 26 and 30. Quality in this outcome area is good. The home is a modern purpose built building, which in most areas provides residents with a well maintained, clean and safe environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 25 The inspectors toured the home with the acting manager. Cherry Trees is a purpose built modern home, now just over 3 years old. The home is divided into three separate units, for people with different assessed needs and ability. The home is on two floors and the different units are accessible through doors, which have keypad locks. There is a passenger lift for people to assist access. The entrance to the home is welcoming, and very well presented. Visitors to the home can speak immediately to a member of staff on reception, and also gain easy access to the administrator and the managers office. The day’s menu is on display, as is information about the home. The home has a large laundry, with 2 dryers and 2 washing machines, which are suitable to wash clothes at high temperature if required. Each unit is self contained with sluices, kitchenettes / servery and bath and shower rooms Physical Disability Unit The Physical disability unit consists of 14 single en suite bedrooms over two floors, separated from the rest of the home by key coded locked doors. Five rooms are on the ground floor and nine rooms are on the first floor. There is no stair access between the two floors in the unit. A lift is available just outside the unit. As well as the bedrooms, the ground floor consists of a lounge / dining room, a bathroom with toilet, a sluice room and a small office. The first floor has a dining room, a lounge, a bathroom with toilet, a sluice room and a small office as well as the bedrooms. It was noted that the unit has very little storage space on either floor for equipment such as hoists, shower chairs, wheelchairs, an armchair and laundry bags. On the first floor a hoist, shower chair and four laundry bags were stored in the bathroom. Staff have to move these out into the corridor whilst the bathroom is in use. This then creates a health and safety hazard. The bedrooms within the unit are nicely decorated to resident’s tastes, with lots of personalisation in the form of photographs, ornaments and personal belongings. The décor of the communal areas on each floor would benefit from painting however, as they are beginning to look tired and worn. It was pleasing to note that consideration had been given to placing light switches at a height appropriate for people who use wheelchairs. Resident’s spoken with said that they were pleased with the décor of their bedrooms, and thought that overall the unit was pleasant without any offensive smells. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 26 Elderly frail unit The elderly frail unit consists of 32 single rooms with en- suite facilities. The layout is a large loop, with bedrooms and lounges off a main corridor. There is a selection of communal rooms, which are well decorated and with good quality furnishings. It was pleasing to note that some communal rooms do not have a TV, offering a choice of a quiet area to sit. There is also a small storage area for lifting equipment and wheel chairs. The hairdressing room, which is used by the visiting hairdresser to the home, is also located in this unit. The manager said it was normally kept locked, but it was found open during the tour, and bottles of shampoo not locked away. The manager needs to ensure that this does not constitute a risk to residents. Rooms contain items of interest, old style music players, a piano and a budgie, which is looked after by staff. Residents were noted to use all areas of the unit, including chairs that have been placed in the wide corridors where people can sit and watch the comings and goings of people in the home. Pictures on the wall are of Stratford on Avon. Bathrooms are well decorated with patterned tiles to avoid a clinical feel, although it was noted that laundry trolleys are stored in these when not in use. Bathrooms and toilets are equipped with aids to help mobility and independence. Personal rooms seen are large enough for people to bring in personal items of furniture. Rooms are well presented, and relatives are supported and encouraged by staff to make these as personal as possible with pictures and photographs. Notice boards are placed in each room, and the name of the key worker, and named nurse is displayed, as well as other information such as appointments and calendars, which are relevant to individuals. As previously mentioned the dining room is very well presented and bright and cheerful. The unit also benefits from being on the ground floor of the home. There are large picture windows onto the garden and seating areas with easy access. Residents on the unit spoken with said that they were happy with their rooms and with the home. ‘ I can’t criticise the place’ ‘it is very homely’. Dementia Care Unit Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 27 This unit, which is on the first floor has 35 beds and is of a similar layout to the unit below. There is also a choice of communal space and one small lounge is left with items which may be of interest to the residents on the unit, for example a hat stand, dolls and a cot, a dolls house, guitar and books and games. There is a further activity area off the main lounge, and the activity worker explained that activities of daily life are undertaken there such as cooking and washing. Examples of residents’ artwork are displayed on the wall. The acting manager said that there was more to be done to the unit to enhance the environment for this client group, but it was obvious that positive changes have been made, with the introduction of ‘tactile boards’ and displays such as jungle scenes. There were some strong odours noted around the unit, but the manager said that they were taking action to reduce these, and replace carpets, sometimes with laminate flooring. Some of the corridors are looking a little tired and in need of some redecoration. Artwork on the wall was noted to be suitable. In the dining room there are pictures of food, and old style packaging, and also pictures displayed of warplanes. Bedrooms seen were as on the other unit, and personal to individuals. Some doors on the dementia care unit were decorated with personal items and pictures to assist people to find their room unaided. There are large garden and seating areas around the home, with patio areas in which to sit, and items of interest such as bird tables and baths and a water feature. One relative spoken with said that she felt the gardens had been neglected over the past year, but that things were beginning to improve with employment of staff. She said that the introduction of the relatives meeting was a good forum to pass on comments about the gardens, particularly ensuring that there were good places to walk and good wheel chair access. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards OP 27,28 29 and 30 and YA 32,34 and 35. Quality in this outcome area is adequate. Staff are consistent and offer continuity of care, however staffing levels at times mean that residents’ needs are not always met in a way that promotes their well being. Shortfalls in training opportunities mean that staff are not equipped to meet assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager said that each unit is individually staffed with a written staffing rota held for each unit. There were four requirements made in this outcome group at the last inspection, and some of these have been met. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 29 Records seen show that staff are not working excessive hours without a break, and whilst it is acknowledged that a number of staff are willing to work overtime, the manager ensures that staff are given a regular day off so that they do not get over tired. Shifts are normally worked as: Early shift 8 – 2pm, Late shift as 2-8pm and nights as 8pm – 8am. Staffing levels on each unit differ due to the different care needs of the residents. Staff on each unit are supported across the home by the activities staff, cleaning and laundry staff and by a ‘host’ role, which provides drinks, changes water jugs and takes meal orders. The acting manager said that staffing at the home after a period of high turnover was more settled and that the home does not employ agency staff. The acting manager said that local recruitment remained a problem, not helped by the fact that the home is in a rather rural location, and that there are other care homes nearby. The organisation has a department, which oversees the employment of staff from overseas. It was noted at the inspection that there are a high number of staff employed from overseas, but the manager said that she felt comfortable with their standard of English. Comments received from relatives prior to the inspection, showed that there have been over the past months and more recently, some concerns about staffing levels in the home and in the spoken English of some of the staff. One comment received was that the lounge on the dementia care unit looked like a ‘holding area’, as there were so many residents, and only one member of staff. Elderly frail unit Staffing levels on the elderly frail unit are rotad as two qualified nurses and five carers per day shift. On the day of the inspection, the unit appeared to have a calm atmosphere and staff were visibly interacting with residents on the unit. One of the nurses on the unit was spoken with. She has worked at the home for over a year and has a nursing qualification from her native country Swaziland that is accepted in England. Her English was noted to be good. She had a good understanding of the needs of the residents in the unit, and of the policies and procedures in the home. She had received an induction at the time of starting, which included fire safety, first aid and protection of vulnerable adults, but stated that she had not attended much training recently. Staff at lunchtime on this unit had sufficient time to serve the meal to those in the dining room, and in their own rooms in a calm manner, and offer support appropriately as required. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 30 Dementia Care Unit Staffing levels on this unit are rotad as two qualified nurses, and seven care staff. It was noticed during the inspection that the frailty on this unit is high and that a significant number of residents are cared for in bed. There are also a number of residents with challenging needs, which at times require higher staff time, even at times 1-1 care. The acting manager said that this increased frailty had been noted, and that a number of residents were no longer able to make use of some of the facilities on the unit. Lunchtime on the unit on the day of the inspection, was not conducive to a good therapeutic environment. Staff were trying to feed all the residents at the same time, and this meant that some received a lack of necessary supervision. In the morning staff were seen to be very busy, and at times there was little interaction taking place. The acting manager needs to, using a dependency tool, review the staffing of this unit particularly at peak times to demonstrate that she has sufficient staff to meet the assessed needs of residents at any given time. Two of the staff from this unit were spoken with. They spoke enthusiastically about some of the dementia care training that they had received, but admitted that other training had been minimal over the past year, and that they had not attended training in protection of vulnerable adults, infection control, or health and safety for over a year. Staff on the dementia care unit are receiving training from the ‘Yesterday, Today, Tomorrow’ Alzheimer’s accredited training video, and the home is also accessing in house training including the Barchester ‘Memory Lane’. Staff spoken with confirmed that they had not had a 1-1 supervision, but did attend unit meetings, and demonstrated a good knowledge of the residents on the unit. Physical Disability Unit The residents on the physical disability unit are supported by a staff team of sixteen, consisting of a Sister, three staff nurses, seven senior care assistants and five care assistants. Copies of rotas provided during the inspection Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 31 indicate that each shift is lead by a qualified nurse, with six care staff on the morning shift, five care staff on the afternoon shift and three staff in total over night. These numbers were reflected on the days of the inspection. Staff spoken with said that the staffing levels during the day shifts had recently been increased as it was felt that the previous numbers were not sufficient to meet service users needs. Staff also said however, that they feel that the levels of three staff over night is not sufficient to meet the complex needs of the service users on both floors of the unit throughout this time. This was discussed with the acting manager during the inspection. As recorded earlier in this report the home employs a considerable number of foreign nationals. The recruitment records for four of these staff were checked as part of the inspection. All of the required documentation was in place in the files looked at. In addition information confirming that the staff had been granted leave to work in the United Kingdom by the Home Office was also available. Of the four files looked it was noted that one staff member had resigned in June of 2006. The acting manager said that this person had since been reemployed by the home, however there was no updated information to confirm this in the file and a new Criminal Records Bureau check had not been sought. This was discussed with the administrator responsible for this area who undertook to rectify the omission. Staffing recruitment records seen, from staff employed from this country were found to be in good order. There was evidence to show that references had been received, and that necessary police and other checks had been undertaken prior to confirmation of employment. It was not possible to look at the staff training records during the inspection, as the training co-ordinator was not available on the second day. The acting manager was asked to forward a copy of the training plan and confirmation of where staff are at with regards to their mandatory training. At the time of writing this report this has not been received. It must be noted that none of the staff in the physical disability unit have received training in how to care for and support service users with a learning disability. This will have to be addressed once the registration status of this unit has been sorted out. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 32 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 33 Standards OP 31,33,35,36 and 38 and YA 37,39 and 42. Quality in this outcome area is adequate. The acting manager is reviewing and improving management systems within the home including the introduction of relatives’ meetings and staff supervision. There are currently no formal quality assurance systems in place, and some storage restrictions constitute health and safety risks for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager has been in post since November, following the previous manager leaving the home. The acting manager is a qualified nurse, and has worked in the home for a few years. She was the deputy to the previous manager, and although she has been given some additional support hours, still retains some of those responsibilities, whilst receiving management support from the area manager. As previously mentioned a number of concerns had been raised over past months about the home, staff turnover had increased, training had reduced and staff morale was poor having a detrimental effect on care standards. It was apparent from staff, residents, and relatives spoken with, that the home was now much improved, and that the attitude and approachability of both the acting manager and area manager were largely responsible for this. Staff spoke highly of the acting manager, saying that she was very approachable, and had a good understanding of their work. Relatives spoken with were also very positive saying that they were happy with the relatives meetings that had started. These are held for the relatives of each individual unit. Minutes of the most recent meeting held in the physical disability unit were seen. One relative said whilst she had not seen minutes of the meeting, she had seen improvements and changes already. One example of this is that the names of the key workers, and named nurses are now written on the notice boards in the room. There is currently no formal ‘Quality Assurance’ system for the home. The organisation does use questionnaires, and monthly quality audits in some of their other homes, but these have not yet been introduced to this home. Whilst it is positive to see that relatives are having an opportunity to pass on Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 34 suggestions and concerns in a meeting, the manager currently has no formal way to demonstrate how the home is responding to comments on the quality of the service, and monitor the affect of changes made. The organisation has recently changed its procedures for handling resident’s personal money, and no longer holds money for residents in the safe. This caused some concern for relatives at the time, but it would appear that the reasoning behind the change was explained to relatives. The new arrangement is that staff give those residents who are going out on a trip, or to the shops etc, some petty cash, and then relatives are invoiced for the money spent, and receipts kept as evidence of expenditure. Residents are still able to keep their own money in their room should they choose to do so, in a locked draw. Records show that the home still has a bank account where money for a few residents is held under an ‘umbrella’ name. Some of these amounts are in excess of £100, and the member of staff was unable to explain what happened to the interest accruing on this money. This is not safe practice, and the organisation must review this to ensure that monies are not pooled. The acting manager has recently introduced a system for staff supervision. This is something that is new to the home, and not yet being done as recommended regarding timescales and content. The acting manager is aware of this and hopes to develop this further, using nursing staff to undertake some the supervision of the care staff. The newly employed training coordinator will be undertaking training with those who are doing the supervision, to ensure that there is a consistent approach. The acting manager is hoping that supervision will take place 4 times yearly as a group, with 2 individual sessions, and an annual appraisal. Generally the systems within the home to maintain the health and safety of residents, staff and visitors to the home are good. The company employs maintenance workers to do safety checks such as fire safety and water temperatures, with external contractors to check the large pieces of equipment. Staff have also received training in portable appliance testing, so that any small electrical items such as radios and personal televisions, can be immediately checked for safety. Fire safety checks are undertaken as per the standards required. On the day of the inspection, the lift for the home was causing a problem. It had been checked by an engineer who had given instructions that it was ‘usable with caution’. Notices to this effect had been placed near to the lift, and staff were all aware. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 35 As recorded earlier in this report the lack of storage space for items such as hoists, shower chairs and laundry bags in the physical disability unit creates a health and safety issue, which requires addressing. The acting manager said that now a training coordinator was in post, it was intended that all staff would receive training in all aspects of Health and Safety, Control of Hazardous Substances (COSHH) and Risk Assessment. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 36 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 2 x 3 1 4 x 5 x 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 ENVIRONMENT Standard No Score 19 3 20 x 21 x 22 x 23 3 24 x 25 x 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 x 33 2 34 x 35 1 36 2 37 x 38 2 Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 37 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 RQN Regulation CSA 2000 Requirement The registered person must ensure that the registration of the physical disability unit within the home is appropriate to the service users resident in the home. The registered person must ensure that the ‘Statement of Purpose’ and ‘Service Users guide’ are accurate and kept updated to reflect current practice. The registered person must ensure that pre assessment documentation is completed in sufficient detail to demonstrate that the home can meet the needs of assessed residents. The registered person must ensure that residents’ care plans are person centred and are based on resident’s strengths and abilities. They must include attention to communication, psychological, personal care and social care needs. Care plans from other professionals must be evident in care records. Care plans must include a recent DS0000032656.V323995.R01.S.doc Timescale for action 30/06/07 2. OP1 4, 5 30/04/07 3. OP3 YA2 14 31/05/07 4. OP7 15 31/05/07 Cherry Trees Care Home Version 5.2 Page 38 photograph of the resident. This requirement has not been met. Previous timescales 01/07/05 and 01/01/06) 5. OP7 14,15 Life histories must be completed for people with dementia and people who do not communicate verbally. This requirement has not been met. Previous timescales 01/07/05 and 01/01/06) 6. OP7 12, 13 The registered person must ensure that risk assessments are undertaken and regularly updated to promote the health and welfare of the residents. The registered person must ensure that the resident and where appropriate their representative is involved in care plan reviews. The registered person must ensure that advice from health care professionals is sought for residents with specialist and challenging needs. The Company must review the policy in regard to palliative care and resuscitation. This must ensure that requests made by residents or relatives and medical opinion, are formally recorded and are clearly accessible within care planning documents. The policy should reflect current practice in regard to the involvement of emergency services. The registered person must provide sufficient and suitable activities for residents within the physical disability unit that are DS0000032656.V323995.R01.S.doc 31/05/07 31/03/07 7. OP7 15 31/03/07 8. OP8 13 31/03/07 9. OP11 12 31/03/07 10. YA12 16 31/05/07 Cherry Trees Care Home Version 5.2 Page 39 11. OP15 12 12. OP16 22, 17 13. OP27 YA33 18 14. OP30 18 15. OP33 24 based on individual interests and hobbies. The registered person must ensure that staffing at meal times is sufficient to allow staff to offer assistance to residents, in a way that is individual and encourages and supports them to eat independently and safely. The registered person must ensure that a record is kept of all complaints made and the actions taken in respect of any complaint, and if the complaint is upheld. The registered person must ensure that sufficient staff are on duty in the physical disability unit overnight to ensure residents safety. The manager, based on a dependency assessment, must ensure that there are sufficient staff to offer care to residents at all times, which meets their assessed needs. The registered person must ensure that all staff receive mandatory training including fire safety, protection of vulnerable adults (POVA) COSHH, infection control, manual handling and risk assessment and that this training is regularly refreshed to ensure staff are up to date. All staff working on the dementia care unit must have attended training in providing dementia care. The registered provider must ensure that suitable quality assurance and monitoring systems are in place, the outcome of these must be shared with the Commission and reports available for inspection. 31/03/07 30/04/07 30/04/07 30/06/07 31/05/07 Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 40 16. OP35 20 17. OP36 18 The registered person must ensure that money belonging to an individual resident is not paid into a bank account where money is pooled with others. The registered person must ensure that all care staff receive regular recorded supervision. Records must be maintained and available for inspection. The registered person must ensure that proper provision is made as to the safety and welfare of residents. This is in particular regarding the storage of chemicals and equipment, and the training of staff. 30/04/07 31/05/07 18. OP38 YA42 12 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP9 OP10 OP10 OP12 OP12 OP16 Good Practice Recommendations The date of opening of eye drops and any liquid medications should be written on the bottle to guide staff of safe timescales. Consider how the payphone can be used in a private area and any possibilities should be implemented. Residents with dementia and or complex ways of communicating should be offered visual choices of food. A dementia care mapping exercise should be undertaken to establish whether residents are in well being. The activities workers, should attend training in offering varied activities, and contact organisations such as NAPA to seek advice and ideas. A complaints procedure supported by pictures and photographs be developed. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 41 7. OP29 The recruitment procedure should include the procedure the manager should follow if disclosures are noted on a CRB check. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Cherry Trees Care Home DS0000032656.V323995.R01.S.doc Version 5.2 Page 43 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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