Inspection on 30/01/08 for Cherry Trees Care Home

This inspection was carried out on 30th January 2008.

CSCI found this care home to be providing an Good service.

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 10/01/07

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 HOMES FOR OLDER PEOPLE Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN Lead Inspector Patricia Flanaghan Unannounced Inspection 30th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry Trees Care Home DS0000032656.V355391.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. 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.V355391.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 cherrytrees@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Limited 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) vacant post 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.V355391.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. 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. Barchester Healthcare Ltd owns the home. 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 younger people with physical disabilities. The home is divided into dedicated living units for each client group. The homes décor, furniture and furnishings are generally of a high standard, however some areas are beginning to show 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, the stairs in the dementia unit of the home or go outside 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. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 5 Information about the fees is not included in the Service User Guide but is available on request to the manager. Fees should be checked at the time of deciding to use this service as the range of fees differ on each of the three units. Additional charges are made for hairdressing, chiropody, toiletries and sundries such as newspapers. Residents also contribute to external activities. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The inspection took place on Wednesday 30th January between 10:00am and 08:00pm and was conducted by two inspectors. This report uses information and evidence gathered during the key inspection process that involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of case files. We had the opportunity to meet several of the residents by visiting them in their rooms, spending time in the communal lounges and talking to some of them about their experience of the home. We also spoke with two visitors to the home. One of the inspectors undertook a 1 ½ hour period of observation in a communal area in the dementia care unit looking at the way residents interacted with staff and each other. These observations were used alongside other information gathered to assess the quality of care. Eight people in total, selected from each of the home’s three units, were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information, and talking to them about their experience of the home. This is part of a process known as ‘case tracking’ where evidence of the care provided is matched to outcomes for the people using the service. Documentation maintained in the home was examined including staff files, training records and policies and procedures. A tour of the building and several bedrooms was made. We received one complaint about this service since the last inspection. The complaint related to insufficient staff being on duty in the dementia care unit on a particular day. We found no regulations had been breached by the home. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 7 The home manager and the newly appointed deputy manager were present during the inspection. We also spoke to several nursing staff, care staff, ancillary and activity staff. 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. Residents are treated with dignity and respect and have their right to privacy upheld. People said they enjoyed living at Cherry Trees. Some of the comments received include: • • • “It’s like a four star hotel.” “I’m treated like a queen.” “ Everyone is very kind.” Discussion with staff and observation of practices revealed that staff had a positive attitude and respect for residents. Staff talked to residents in a sensitive and respectful way. Visitors are welcome to the home at any time so residents can continue to enjoy their enduring relationships. Comments from residents and observation showed residents are provided with a wholesome and nutritious diet. • • • “The meals are lovely”, “The food is excellent”, “There are nice choices”. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. People are provided with clean, attractive, well-furnished and comfortable surroundings to live in and enjoy. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 8 There are sufficient staff on duty to meet the health and personal care needs of people living in the home. The manager has organisational support to ensure the service is run in the best interests of people living in the home. What has improved since the last inspection? What they could do better: Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 9 We have not made any requirements during this inspection but have made recommendations for improving good practice. Communal areas should not have any offensive odour. This is to ensure that people live in comfortable and hygienic surroundings. The quality of the service provided to residents should be kept under review so people living in the home can be sure that the improvements implemented are sustained. Staff should receive supervision at least 6 times a year to ensure that they continue to be suitable to care for vulnerable people. 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.V355391.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. People who are considering moving into the home benefit from having their care needs assessed so that they can be sure the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case files of three residents, two from the elderly frail unit and one from the dementia care unit, were examined to assess the pre admission assessment process. All three files contained a pre admission assessment of each person’s needs and abilities. Residents had their weight checked and recorded when they moved into the home so that staff can be alerted to any significant weight gain or loss. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 12 Risk assessments (such as risk of falls and pressure sores) together with strategies for minimising risks had been prepared. The information was recorded in enough detail for staff to develop preliminary care plans and allow the service to confirm they could meet this person’s needs. Although the admissions procedure and documentation were not specifically looked at in the physical disability unit, there were concise community care assessments provided by the referring professionals and organisational pre admission assessments that were fully completed, dated and signed for the two people that were chosen for case tracking. This documentation confirmed that the home seeks relevant information prior to admitting prospective residents to ensure that it will be able to meet their assessed needs. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. People living in the home are treated respectfully and have a plan of care and access to health care services so that their health and personal care needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the previous inspection a considerable amount of work has been undertaken to update and improve the care planning system throughout the home. Eight care plans were looked at as part of the case tracking process. Five of these were for people in the frail elderly unit, one for a person in the dementia care unit and two for people in the physical disability unit. The care planning process has been reviewed and each care file has a standard layout which should make it easier for staff to access the information contained in them. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 14 The plans in the physical disability unit were all well ordered, and contained considerable information that provided staff with the information necessary to meet peoples assessed needs. Each of the two plans looked at in this unit were broken down into fourteen individual areas of care and support, which included communication, tissue viability, mobility and dexterity, nutrition and hydration and gender, sexuality and relationships. Records were available to confirm that each aspect of the care plans is reviewed in house on a monthly basis, with more formal reviews taking place annually. On a daily basis progress and evaluation sheets are completed which form a running record of the care and support provided to each person. In one plan looked at the last formal review was recorded as having taken place in April 2007. It was also recorded that the relatives of the person were involved and had commented that they were both happy with the care received. In the second plan looked at the review notes recorded that the person’s relatives felt that “the care is wonderful, the staff are good and we cannot say how much it is appreciated”. The care plans seen on the elderly frail and dementia units have also improved since the last inspection which should mean that staff have clear direction about what they need to do to meet the identified needs of individuals. Each person had a care plan which described the actions necessary to meet each of their identified needs. There was evidence that care plans are regularly reviewed each month. Records of care reviews demonstrated that residents and their relatives have the opportunity to discuss the care planned for them. Care plans are more person centred containing information about the personal preferences about people living in the home to empower them to have some control over their lives by involving them in agreeing plans of care to meet their needs in a way that is acceptable to them. For example, one person’s care plans had been developed with their involvement and reflected their personal preferences for how they spent their day. The care plans were signed by the person to indicate their agreement. Risk assessments pertinent to the individual concerned were also available within the care planning documentation. These were detailed and informative. The risk and any actions to be taken to minimise it were clearly defined, and records confirmed that they were reviewed in line with the areas of care and support. Examples of identified areas of risk included smoking, moving and handling, possibility of choking and the possibility of falling. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 15 Records were available to confirm that the people living in the home are supported with maintaining their health via regular appointments with routine healthcare professionals such as the dentist, GP, optician and chiropodist. In addition people are supported to access more specialist healthcare services such as a dietician, speech and language therapy, consultant psychiatrists and physiotherapists. None of the people living in the home were responsible for administering their own medication. The home manages this for them on their behalf. Medication continues to be supplied by Lloyds Chemist, with accompanying medication administration record sheets (MARS). Medication is stored in the offices on each of 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 continues to have 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 generally completed appropriately, however a couple of gaps in recording were noted which were discussed with the manager and deputy manager who undertook to investigate the reasons behind this. The number of tablets checked corresponded with the number received and administered. Following discussion during the inspection the manager is reminded that medication for those people who require it to be administered via a peg tube must be prescribed by the GP for administration via that route. This is because it was advised by one nurse on duty that one person has a particular medication that is prescribed for oral administration dissolved in water and administered via the peg tube. During the inspection the residents in the frail elderly were offered a glass of wine with their lunch. No thought had been given as to whether these interacted with the medication prescribed. Concern was raised for a resident where this could have caused an interaction with their current medication. The manager undertook to discuss this with the person’s GP. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 16 Throughout the inspection it was apparent that staff treat the residents with dignity and respect in all of the units. Staff were observed to knock on bedroom doors before entering, residents were appropriately dressed in smart freshly laundered appropriate clothes, and were addressed politely and with respect by the staff who also bantered jovially with the people living in the physical disability unit throughout the day. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 and 14 Quality in this outcome area is good. People who use the service are able to make choices about their life style. Social and recreational activities meet individual expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection the home had one dedicated activities organiser, however the manager said that another had been recruited and was commencing work shortly. A programme of activities was planned for each day with this information posted at various points throughout the home to inform the residents. During the inspection a group of local school children visited the home to participate in activities with the residents. The activities organiser said that this was a weekly visit that both the children and the residents enjoyed. Activities taking place throughout the home during the inspection included a singing session in the physical disability unit and a quiz and poetry reading session in the frail elderly unit. It was pleasing to note that people from the other units were joining in the quiz session. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 18 Daily records of activities participated in were maintained in all the care plans viewed throughout the three units. These included things such as sensory stimulation sessions, visits from family and friends, watching television, listening to music and attending organised events within the home. In addition to the daily records, a monthly activities review takes place to assess what activities have been enjoyed, what haven’t and what changes can be made to activities offered based on this information. Three people from the physical disability unit spoken with during the inspection commented that they enjoyed the activities that they were offered, and were pleased that there was “something different to do with the home each day”. A person in the frail elderly unit commented, “there is always something to do, you can join if you want to, or sometimes I like to go to my room and read. Staff don’t mind and respect my privacy.” Throughout the inspection it was pleasing to see that visitors were welcomed and appeared comfortable in the home. Two people from the physical disability unit had visitors during the inspection. In conversation both of these sets of relatives said that they were very happy with the service their relative received. “It is an excellent service”, “we are very happy with the care provided”. All of the meals provided for the residents come out of the homes main kitchen. The kitchen was looked at briefly, and was found to be clean and tidy after lunch. The menu for the day is displayed throughout the home, and people are supported to choose what they wish to have for lunch and supper at breakfast. Lunch in the dementia care unit was a pleasant experience. The meals arrived in a hot trolley and were served by a hostess. Staff had a record of what each person had chosen for their meal and ticked it off each time a meal was dished up. A number of people required support with eating their meal and there were plenty of staff around to provide this on an individual basis. Also, a number of people required their meals liquidised. It was pleasing to note that these were served on the plates as if they weren’t liquidised which allowed people to experience the tastes of individual foods. People spoken with about the food provided commented that “the meals are lovely”, the food is excellent”, “there are nice choices”. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 19 Lunch was also observed in the elderly frail unit. A member of staff said that each resident is asked what they would like to eat for lunch earlier in the day, but they can change their minds at the point of serving if they wish. If they do not like the options residents are encouraged to make other choices. Comments from residents and observation showed residents are provided with a wholesome and nutritious diet. One inspector undertook a period of observation in dementia care unit between 12:30pm and 2:00pm. Lunch was served during this time. The inspector used the Short Observational Framework for Inspection (SOFI) to enable us to have a look at residents’ welfare and staff interaction during this period. Staff were observed interacting with residents while they served meals or assisted them to eat. An analysis of the results showed that staff interaction with residents was good and took place not just to meet personal care, but also to meet a social or recreational need. This is good practice. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People who use the service are able to express their concerns and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure which specifies how complaints may be made and who will deal with them, with an insurance that they will be responded to within a maximum of 28 days. A copy of the complaints procedure was displayed in the reception area of the home. People spoken with, who were able to express a view, were aware of the procedure for raising any concerns. Most people said they would talk to the manager or a nurse if they were unhappy or dissatisfied with any aspect of the service. One person said they would talk to their family and they would “sort any concerns out.” Records of any complaints were held and the information recorded includes the date the complaint was received, name of the complainant, details of the complaint/concern and outcome. Evidence was available to demonstrate that the home had responded to all complaints and concerns within 7 days and that the complaints had been resolved within 28 days. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 21 Since the last key inspection we have received one complaint, which raised concerns about insufficient staff on duty in the dementia unit on a date in November 2007. We looked at the duty rota and also spoke with a nurse who had been on duty in the unit on the particular date identified. The duty rota indicated that there were 2 nurses and 5 care assistants working in the unit, which is considered satisfactory. We found no regulations had been breached. Staff interviewed demonstrated an awareness of the procedure to be followed when responding to allegations of possible abuse. Staff training records showed that staff have attended adult protection training. This will ensure that the home can be confident that staff understand how to protect vulnerable people from abuse and can respond to any suspicion or allegation of possible abuse appropriately. People spoken with indicated that they were well treated by staff. Comments received included: • • “Everyone is very nice here.” “They (staff) have so much patience, they realise we can’t go as fast as we used to.” Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 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 is a purpose built modern home and 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. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 23 The manager said that the home is scheduled for a complete refurbishment this year, at which point changes to the provision of the units is planned. This will include reprovisioning the physical disability unit so that it is all on one floor, rather than over two as it was at the time of the inspection. The décor of the home throughout was beginning to look a little tired and worn, but it was still a pleasant environment that was clean and tidy. There was a pervading odour at the entrance to the dementia unit on the second floor, but the manager was aware of this and was taking steps to eradicate it. One or two bedrooms that were looked at had unpleasant odours, but the staff took immediate action to rectify this. Storage in the physical disability unit was still a problem however, the manager and deputy manager hope that this will be addressed during the major refurbishment work. 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. 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. The laundry room was clean, tidy and well organised. Hand washing facilities and protective clothing were available. Alginate bags were in use for soiled laundry to minimise handling and reduce the risk of infection. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each unit continues to be individually staffed with its own dedicated staffing rota. Records seen show that some staff continue to work ‘long days’ if they wish to, but do not work excessive hours without a break as the manager continues to ensure that they are given a regular day off so that they do not get over tired. It was advised on the morning of the inspection that the frail elderly unit was short staffed due to sickness, however there appeared to be plenty of staff around and this did not impact negatively on the care give. The dementia unit and the physical disability unit were staffed as per the rota, which appeared to be sufficient for the numbers of people resident in each of these units. A number of staff had been recruited since the last inspection. Four new staff files were looked. All of these contained information and documents such as an enhanced criminal records bureau check, a POVA First check, two written Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 25 references a full employment history and accepted forms of identification. This confirmed that the home operates a thorough and robust recruitment process that safeguards the residents. The Home has a designated training coordinator who is responsible for ensuring that staff receive both mandatory and more resident specific training at the required intervals. Each member of staff was seen to have their own training file, a number of which included a training plan in which training goals and objectives were recorded. Training records looked at confirmed that the majority of staff completed all of the necessary mandatory training such as fire safety, first aid, food hygiene and moving and handling in 2007. The training matrix available confirmed that refresher training for the mandatory subjects is provided at the necessary intervals. Additional training provided for the staff included risk assessment training, death and dying, person centred care, care planning, continence management and peg feeding. Staff spoken with said that the training that they receive from the home is very good and is always tailored to the job that they do. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. The manager has organisational support to ensure the service is run in the best interests of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for approximately one year and has applied to be registered with us. She is a registered general nurse and is undertaking the Registered Manager’s Award (NVQ Level 4). She is supported by a deputy manger who is a registered mental health nurse. There are clear lines of accountability in the home; each of the three units has an identified ‘nurse in charge’ who reports to the home manager. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 27 Staff feel well supported by the manager and they feel that they are able to approach the manager to discuss ideas and share concerns. There is a relaxed atmosphere amongst the staff who work well together. There is still no formal Quality Assurance system in the home although the manager showed us evidence of how she had surveyed the residents for their opinions on both the food and activities provision in the home. As a result, menus had been adapted to reflect peoples’ wishes and a second activities coordinator was appointed. Staff meetings and residents meetings are held on a regular basis. We saw the minutes of recent meetings and it was clear that issues raised by residents, relatives or staff are acted upon by the manager. She reports back, either during the current meeting or at the next meeting if issues raised cannot be resolved at the time. This means that the opinion of people living in the home is considered so the home is run in their best interests. Formal supervision of staff has not been occurring on a regular basis. The deputy manager said she has taken steps to deal with this and systems are being implemented to ensure all staff arrangements are being made to ensure all staff appropriate recorded supervision. This is to ensure they become familiar with all aspects of service and any training needs are identified and acted upon. The service no longer keeps residents’ personal monies or valuables for safe keeping. The manager said people now have individual bank accounts. We obtain information from the home before inspections. This information includes confirmation that all necessary policies and procedures are in place and are up-to-date. These are not inspected on the day but the information is used to help form a judgment as to whether the home has the correct policies to keep residents’ safe. Health and safety is generally well managed and there are good operational systems in place. Policies and procedures are regularly reviewed and if necessary revised to reflect any changes. The fire records were examined and were found to hold details of when fire drills, fire training and weekly fire alarm checks were carried out. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP26 OP33 OP36 Good Practice Recommendations Communal areas should not have any offensive odour. This is to ensure that people live in comfortable and hygienic surroundings. The quality of the service provided to residents should be kept under review so people living in the home can be sure that the improvements implemented are sustained. Staff should receive supervision at least 6 times a year to ensure that they continue to be suitable to care for vulnerable people. Cherry Trees Care Home DS0000032656.V355391.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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.V355391.R01.S.doc Version 5.2 Page 31 - 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. 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