Inspection on 19/04/05 for Cherry Trees Care Home

This inspection was carried out on 19th April 2005.

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

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

Other inspections for this house

Cherry Trees Care Home 03/12/09

Cherry Trees Care Home 08/05/09

Cherry Trees Care Home 30/01/08

Cherry Trees Care Home 10/01/07

Cherry Trees Care Home 04/10/05

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 Jo Johnson Unannounced 19 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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 E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cherry Trees Care Home Address Stratford Road, Oversley Green Alcester, Stratford-upon-Avon B49 6LN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01789 764022 BB Barchester Healthcare Homes Limited N Care Home with Nursing 81 Category(ies) of DE(E) Dementia - over 65 Number 67 registration, with number OP Old age- Number 67 of places PD Physical disability Number 14 Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Provider must ensure that all nursing and care staff receive accredited /certificated training in caring for people with dementia. Date of last inspection 6 December 2004 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 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 with dementia and younger people with physical disabilities. The home is divided into dedicated living units for each client group. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 11 hours over 2 days and was unannounced. This was the first visit of the inspection year. A majority of the inspection was spent talking with and observing the people who live at the home. Care records were inspected. Eight staff, eleven of the sixty seven residents and four visitors were spoken to. What the service does well: What has improved since the last inspection? The manager said that more staff have been recruited since the last inspection and a Deputy Manager has been appointed. Improvements have been made to the quality assurance system at the home. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 6 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. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 7 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 Standards 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 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 8 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. 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. Prospective service users have an opportunity to “test drive” the home. 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5 Assessment format and procedures that are in place do not always have sufficient information to ensure that resident’s needs can be met. Residents and or their families have the opportunity to visit the home in order to decide the suitability, quality and facilities of the home. EVIDENCE: There is a pre admission assessment format that is completed by the Manager and Deputy Manager who determine whether an individual’s needs can be met. This assessment was not evident in two of the eight care records seen. Assessments for residents with complex needs and or dementia were not in sufficient detail for staff to be able to meet their needs. Assessments completed by other health and social professionals, that are relevant to a resident’s care, were not evident or easily accessible in the working care records. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 9 Staff on duty in the dementia care unit knew little information or detail about the residents’ life histories and understanding the relevance of these details to be able to effectively meet their care needs. Residents and relatives spoken to said that they had visited the home, spent time with the manager and had a tour of the home prior to making a decision to move in. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Important elements of resident’s personal and social care needs are not set out in care plans. Staff do not have all the information required to fully meet residents’ needs. Residents have good access to health care and relevant health professionals and their health needs are fully met. Residents’ medication is managed by the systems in place at the home. Overall residents are treated with respect. Some poor staff practices places residents’ safety, well-being and rights to dignity, privacy and respect at risk. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 11 EVIDENCE: Some individual care plans seen did not have sufficient information to ensure that residents personal care, health and social needs are planned for and fully met. The care plans were not person centred or did not focus on individual’s strengths and abilities. Important information from other professionals involved in residents’ care was not easily accessible. Daily recording did not reflect the day-to-day lives of the residents. Personal profiles used by the activities co-ordinator were not all completed. Staff do not routinely look at them. Residents with dementia had no detailed life histories and staff interviewed had very little knowledge or understanding of the people they were working with. Staff do not have access to relevant good practice information with regard to dementia care. Staff working with the people with disabilities had a good understanding of their needs. Residents on the ground floor told the inspector that they were happy with the care provided and were well looked after by the staff. Residents spoken to during the visit were unaware of their care plans and there was little documented evidence of resident/relative involvement in care reviews. One resident spoken with self-administers her medication. The administration of medication and records were observed and were correct. There is evidence of medication being reviewed with GP’s. There is good practice in terms of reducing the use of sedative medication on the dementia care living unit. In general there was a good rapport observed between staff and residents. There was some evidence of poor care practices that need to be improved upon including: offering visual choices of food, assistance with eating, ensuring that food is hot when assisting residents to eat and the safe moving of residents. Residents spoken with said that staff respect their privacy. Staff gave personal care in private. There is one pay phone that is located in the main reception. This does not give residents any privacy when making telephone calls. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The current arrangements mean that some residents receive a good quality activities programme Monday to Friday. The limitations of staff time mean that residents are not provided with adequate support to maintain their social, psychological and recreational interests and needs. Meals are well presented, wholesome and provide residents with a nutritious and balanced diet. EVIDENCE: Residents spoken to commented on how good the food was. The inspector ate lunch with residents on both days and found it to be nutritious, well presented and tasty. During the two days of inspection residents who live on the dementia care unit were observed participating in activities with the activities co-ordinator. This included preparing for a 1950’s street party to be held in the evening. Residents were clearly enjoying themselves and residents said the next day that they had enjoyed the party. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 13 There were some times when residents on the dementia care unit were unsettled and staff did not have sufficient time to spend time with residents. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 14 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’ legal rights are protected. Service users are protected from abuse. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Written complaints procedures are in place to ensure that complaints are acted upon and handled within clear timescales. The procedures are not accessible to all of the people living at the home. EVIDENCE: The written complaints procedure is in the statement of purpose and service users guide. Residents spoken to knew who to speak to if they were unhappy or wanted to make a complaint. All of the relatives spoken to knew how to make a complaint. Some people who live at the home who have differing ways of communicating are not able to understand the written complaints procedures. Using other formats including pictures and photographs should be developed. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 15 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 have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is clean, pleasant, hygienic and residents live in a safe, well maintained environment. EVIDENCE: The home was purpose built and designed specifically for the needs of older people and people with physical disabilities. The décor and furnishings are of an extremely high standard. The home is spacious with a number of sitting areas for residents on each floor and in the younger people’s living unit. The dementia care living unit is located on the first floor and is designed so that residents can walk freely. There are different areas set up including an Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 16 office and a nursery with things to do and dolls for residents to pick up. This is good practice. There is a central courtyard garden with raised beds. Residents said that they enjoy spending time in the garden. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28,29,30 There are insufficient staff employed at the home to safely support the needs of the residents. Staff working long hours and subsequent days without sufficient rest periods puts the safety and well being of residents at risk. The staff training programme is compromised by the availability and inflexibility of the staff rota. Staff do not currently have skills base needed to meet the needs of the residents. The procedures for the recruitment of staff are not robust. Appropriate pre employment checks are not being carried out or evidenced in the home thus potentially leaving residents at risk. EVIDENCE: Staff rotas show that staff are working long hours and for up to 9 subsequent days without a day off. There is no flexibility in the staffing numbers to cover for staff holidays or sickness. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 18 Residents, staff and relatives spoke about the long hours worked by some of the staff with the inspector. Relatives reported that staff often appeared tired, particularly in the afternoons. Very few staff are recruited locally, the manager is not involved in majority of the recruitment for the home. This is managed by a specific employment agency who primarily recruit from overseas. Four staff files were seen including the most recently recruited staff. Only one file contained all of the preemployment checks to ensure the safety of the residents. During the inspection new staff were undergoing their induction. Staff spoken with said that the start of the induction had been informative and useful and that they were looking forward to working at the home. A condition of registration was made upon the variation of the home’s registration in March 2005. This means that all staff must receive accredited dementia care training. Three staff spoken with on the dementia care living unit had not received any specific dementia care training. The training manager has training plan that includes a good range of subject matters for staff. Staff and the training manager informed the inspector that training sessions planned are often cancelled due to staff shortages. Staff do not currently have skills base needed to meet the needs of the residents. Residents spoke highly of the staff and some positive relationships were seen. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 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 and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 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 x 2 x 3 2 4 x 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 4 x x x x x x 3 Score Standard No 7 8 9 10 11 Score 2 3 3 2 x Standard No 27 28 29 30 2 3 2 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 x 33 x 34 x 35 x 36 x 37 x 38 x Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 21 no 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 3 Regulation 14 Requirement Timescale for action 01.07.05 2. 7 15 3. 7 14,15 4. 10 12 Assessment of needs must be completed in sufficient detail to ensure that staff can meet the needs of residents. All professional assessments and /or assessments completed by the home must be evident in residents care records. 01.07.05 Care plans must be person centred, based on residents 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 photograph of the resident. Document the involvment of residents and/or relatives in developemnt review of care plans. Life histories must be completed 01.07.05 for people with dementia and people who do not communicate verbally. Residents must not be fed food 16.05.05 or drinks that have gone cold. Staff must sit with a resident Version 1.30 Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Page 22 5. 7,10 12,14,15 6. 27 13,18 7. 27 13,18 8. 29 19 9. 30 18 (who they are assisting) throughout the meal. Staff must talk with residents when assisting them to eat. Residents must be moved and transferred using the correct equipment. Clear moving and handling risk assessments must be in place. The Registered Manager must ensure that staff do not work excessive hours and days without sufficent rest. Staff must work less than 70 hours a week. The Registered Manager must employ sufficient staff to meet the needs of residents. There must be enough staff employed to cover holidays and sickness. The Registered Manager must ensure that all pre-employment checks are obtained prior to staff starting work. Staff must be made available to to attend the training identified in the homes training plan. 16.05.05 16.05.05 01.08.05 01.06.05 01.08.05 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. Refer to Standard 7 10 10 12 12 Good Practice Recommendations Daily recording should reflect the day to day lives of residents. The recording should include the care they have received and how they have spent their time. The payphone should be located in an area that is private. 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. A range of sensory equipment should be purchased that can be used in residents bedrooms. This is specifically for residents with dementia or complex disabilities. E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 23 Cherry Trees Care Home 6. 7. 8. 9. 16 30 30 30 A complaints procedure supported by pictures photographs be devloped. The Alzheimers Society Dementia Care Standards should be used as a basis for good practice in home. Professional journals should be purchased and made available to staff at the home. Internet access should be provided for the training manager to ensure she has access to training and good practice information. Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Trees Care Home E53 S32656 Cherry Trees Care Home V222012 190405 Stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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