Inspection on 15/07/05 for Cherrytrees

This inspection was carried out on 15th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Cherrytrees 31/03/08

Cherrytrees 09/01/07

Cherrytrees 01/12/05

Cherrytrees 02/03/05

Cherrytrees 01/12/04

Cherrytrees 07/01/04

Cherrytrees 10/05/03

Cherrytrees 16/08/02

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

CARE HOMES FOR OLDER PEOPLE Cherrytrees 149 Park Road Cowes Isle of Wight PO31 7NQ Lead Inspector Mark Sims Unannounced 15th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cherrytrees Address 149 Park Road, Cowes, Isle of Wight, PO31 7NQ 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) 01983 299731 01983 296084 Mr Laurence Woodford Gustar Shirley Anne Carley Care Home 25 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia - over 65 years of age (6), Old age, of places not falling within any other category (25), Physical disability over 65 years of age (9) Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2/3/2005 Brief Description of the Service: Cherrytrees is registered in respect of 25 places and provides care for people falling within the older persons categories. The premises is a converted town house set within its own gardens and is within easy reach of the town and all of its amenities and facilities. For those individuals unable to walk into town or without other means of transport the local bus company operates a scheduled bus service which runs directly past the home. If service users, visitors or representatives have their own transport then car parking is available to the rear of the home or along the roadside. The premises has two floors, although due to the fact that the home is created out of two buildings the first floors are split with transit between the two only possible via a small flight of stairs. This obstacle does not normally cause a problem, however as the lift only services one side of the home anyone living on the opposite requires a good degree of mobility to ensure they can access their bedroom. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out unannounced and lasted 4 hours, during which time the inspector spoke with the service users, inspected key documents, met with staff and discussed operational issues with the management team. What the service does well: What has improved since the last inspection? Since the last inspection the proprietor(s) / management team have overseen the refurbishment of a downstairs bathroom, making the facility far more pleasant for service users and includes a new bathroom suite and replacement of a window. The proprietor(s) have also purchased for the management team a new computer and associated office items, with which the manager will be able to update and maintain documents and records. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 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. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 1, St 3 The statement of purpose documentation is clearly and readily accessible within the front entrance hall and contains all relevant information and a copy of the most recent Commission inspection report. The management team ensure all prospective service users are assessed prior to offering, or declining to offer, accommodation at Cherrytrees. EVIDENCE: Whilst undertaking a brief tour of the premises the opportunity arose to review the home’s statement of purpose documentation, which was accessible within the front entrance hall. On reading through the statement of purpose the inspector could easily identify all those areas of the document created in accordance with the recommendation of the National Minimum Standards and also the date of review, 8 March 2005. In addition to the information contained directly within the statement of purpose the management had also provided access to copies of previous Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 9 Commission inspection reports, those available being the reports for 1 December 2004 and 2 March 2005. As the inspector’s premises tour drew to an end the manager and deputy manager returned to the home, having been out on a pre-admission assessment visit. The inspector took the opportunity to review the assessment process with the management team, determining that the information gathered during the preadmission assessment had been very detailed and that the manager and her deputy, based on this assessment, and information gathered, had decided not to offer the prospective client a place at the home. The reasoning behind their decision being based on the person’s mobility difficulties and the fact the home’s only available bedroom was upstairs, which was felt to be inappropriate and unsafe for the service user’s needs. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 7, St 9, St 10 The care planning process has been reviewed and revised by the management team, who have created a document that provides staff with information pertinent to their roles and based on the needs and wishes of the service users. The approach of staff to administering service users’ medications was both safely and appropriately conducted. Service users and their relatives felt the staff were respectful and conscious of peoples’ rights to the promotion of dignity and privacy. EVIDENCE: The deputy manager, supported by the manager, has undertaken to review and revise the home’s care planning process, the aim being to improve on the old system, whilst creating a service users’ plan package that is simple to use and easy to access. On reviewing several of these documents it was evident that a great deal of time and commitment has been put into the creating of a new system, with several areas of the older system completely revamped. In general the new care plans were found to be detailed and comprehensive documents that were Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 11 well laid out and structured and achieving the desired aim of being more readily accessible. The evidence from the staff perspective is that running records and details of professional contacts, etc. are appropriately and clearly recorded and that review dates are being maintained. Whilst socialising in the lounge with the service users the inspector had the opportunity to observe the staff dispensing service users’ medications and to interview the staff with regards to medication systems and training. In discussion with the staff member undertaking the medications round it was established that training, via distance learning packs had been provided, which was generally thought to be useful and informative. That medications were mainly administered using a ‘Monitored Dosage Systems’ (MDS), which cut down on possible errors within the staff team, although systems were in place to monitor each shift or medicines round to ensure any errors or oversights were identified and addressed. The staff member also demonstrated a good level of understanding for the home’s policies and procedures, including booking of medications into the home, safe storage of medicines and practices associated to the disposal of medications. The inspector also undertook a review of the ‘Medication Administration Records’ (MAR), which he found to be accurately and appropriately maintained and also checked the storage cupboards / facilities, which were felt to be adequate. It was also noticeable, whilst sat in the lounge, that the relationships between the service users and staff and the relatives of service users and staff are mutually respectful and amiable / friendly. People were often referred to by their first name, both on the part of the staff and the service users, and people were happy to engage in conversation or friendly banter when the opportunity arose. In talking with both service users and their relatives it was evident that they appreciated the relaxed and friendly atmosphere created within the home but were quick to point out that regardless of the situation staff always remained professional and polite. One service user and their visitor went to great lengths to praise the home and the staff for the professional way in which they provided care and support, stating that it was thanks to the staff that the resident was back walking around’. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 12 Whilst undertaking the tour of the premises the inspector also noticed how staff always seemed to knock on doors before entering rooms and also checked to see who was around before entering toileting facilities, ensuring that the person’s dignity and privacy were protected. In conversation with residents within their bedrooms, it was established that they found staff polite and respectful, and acknowledged that people knocked before entering bedrooms and that staff always referred to them by their chosen or preferred names. On reading through the care plans it was also evident that measures are taken by the management to establish preferred terms of address on admission and that this information is clearly documented on the service user’s plan. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 12, St 13. Discussions with service users supplied evidence of their satisfaction with the home’s social activities programme. The philosophy of the home ensures service users are supported in maintaining appropriate contact with relatives and friends. EVIDENCE: Whilst touring the premises the inspector noted that a monthly schedule of activities and events is displayed within the front hallway and that the entertainments listed appeared both varied and on the whole interesting. In addition to information about internal events being advertised the area within the front hallway is also used to raise awareness of external / local events that are occurring, although many of these proceedings would prove difficult for unaccompanied service users to access. In discussions with service users, it was established that the amount of activities and entertainments organised within the home are greatly appreciated and very much enjoyed. One group of residents joked about who their favourite entertainers were and discussed openly the types of activities each visitor / group undertook and the relative merits of these performances. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 14 On the day of the visit the service users were awaiting a visit from an activities co-ordinator called ‘Miranda’ who undertakes reminiscence sessions with the residents. People described her visits as excellent and praised her for the innovative approach she takes in generating and stimulating conversation. The service users recounted how ‘Miranda’ brings in items like old confectionery to sample and discuss, picture postcards and as observed during the visit a collection of seashells and artefacts associated with or made from shells. People also discussed the visits undertaken by multi-denominational representatives and their occasional participation in religious observances. Throughout the inspection process families and visitors were observed coming and going, some later accompanying their relative out, whilst others socialised with the service user either within the lounge or their bedrooms. Whilst in the lounge the inspector took the opportunity to talk to service users’ representatives, establishing that people generally felt the home was very good and delivered exceptionally good care to their relatives. People also informed the inspector that they always found the staff to be friendly, polite and ready to offer assistance or advice when required. One particular visitor and their relative was so pleased with the service delivered at the home that they praised the staff for their improving health and mobility. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 16 The home operates a comprehensive complaints procedure, details of which are clearly documented within the statement of purpose / service users’ guide literature. EVIDENCE: It was evident on perusing the statement of purpose / service users’ guide documentation that the home has created a comprehensive complaints process, which covers those areas set out within the National Minimum Standards and Care Homes Regulations 2001. On further scrutiny it was discovered that not only has the management created a comprehensive policy for service users, their representatives and staff to follow should they have concerns to raise, but they have also introduced a complaints logging system, which documents outcomes of investigations undertaken. In conversation with service users and their representatives it was evident that whilst people may not truly understand the workings of the complaints process, they were generally happy to raise concerns with either the staff or management and confident that any response received would be both appropriate and prompt. In discussions with the staff and management it was clear that all parties understood their role within the complaints process, understood the role of the Commission in reviewing unresolved complaints and appreciated the need for good record keeping. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 19, St 21, St 23, St 26. The home is well maintained throughout and provides a pleasant and safe environment for service users. The newly refurbished downstairs bathroom has improved the quality of the communal facilities for service users. The service users interviewed / met during the visit were happy with their personal space / bedrooms. The home was found to be clean, tidy and free from any offensive odours. EVIDENCE: The tour of the premises evidenced that the home is well maintained and that a good decorative standard is continued throughout. The home employs a maintenance person who undertakes routine repairs and remedial works, as well as tackling larger jobs, as evidenced by the recently completed refurbishment of a downstairs bathroom. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 17 The bathroom has been completely retiled, a new bathroom suite installed and a window replaced, thus creating a good quality facility for service users, which is modern and bright. When asked for their opinions of the newly refurbished bathroom, most service users seemed pleased with the improvements, although generally people seemed happy with the environment and the standard of décor maintained throughout the communal areas. On the more specific question regarding their levels of satisfaction with their personal space / private bedrooms, people were far more animated, describing the various locations of their bedrooms, how they are set out and the personal touches added in order to create a comfortable and familiar environment and how in the evenings most residents like to retire to their rooms to enjoy some quiet, private time when they can watch their televisions, read or sleep. On touring the premises visits were made to several residents’ rooms, all of which are single occupancy, where time was spent talking to the occupants or observing the general layout. Observations evidenced the unique character of each room and the efforts made by service users in creating personalised environments. The tour of the premises also demonstrated for the inspector that the home is clean and tidy with no noticeable odours or areas of unsightly dust or grime evident. The home employs a specific domestic staff team, who work alongside the care staff to maintain the hygiene levels of the premises and are responsible for overseeing the cleanliness of all major areas of the home. The management has also introduced reasonable policies and procedures around infection control and attend regularly the ‘Bug Busters’ group, run by St Mary’s Hospital Infection Control Team. All communal and staff toileting facilities were equipped with liquid soap or sanitising liquids and contained a supply of paper towels. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 27. Sufficient staff are employed to meet the needs of the service users. EVIDENCE: On arriving at the home the staff were in the process of completing a period of handover, when one shift is finishing work and another shift is in the process of starting, the handover period enabling important day-to-day information to be passed between shifts. Presently the management team is deploying staff across three shifts morning, afternoon and night shifts with on average 5 care staff working the morning, 3 working the afternoon and 2 wakeful night staff available for the night shift. Details of the staffing numbers and shift patterns operated by the home were available for inspection within the main office and evidence that sufficient staff should be available to meet the needs of the service users. In discussions with the service users it was clear that they felt both adequate staff were available at all times to meet their needs, and that the staff employed were kind, caring, polite and approachable, comments supported by visitors to the home. In discussions with the management it was established that in addition to the care staffing hours documented, both the manager and deputy manager work Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 19 supernumerary within the home and that additional staff are employed to undertake domestic, catering and maintenance roles. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 37, St 38. The home’s records are well maintained, clear and concise documents that are produced and managed in the best interests of the service users. Health and sfety requirements are appropriately addressed, with both service users’and staff health and wellbeing promoted. EVIDENCE: As indicated earlier within the report the management hasdeveloped good working practices when it comes to the creation and maintenance of records. The service users’ plans have been recently reviewed and updated, the assessment tool used to underpin decisions on a person’s suitability for admission to the home, the service users’ guide and statement of purpose available to visitors and residents alike. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 21 In addition to the positive approach the management team and staff take with regards to records and record keeping the home was also found to be appropriately storing information, within a locked cabinet and a lockable office. The manager is, however, reminded that when she transfers any information on to her new computer this will require password protection so that access to any sensitive data is restricted to authorised personnel only. The proprietor(s) have provided the management with a full set of health and safety guidelines, which in turn they make available to all staff within the office. These guidance documents including COSHH data sheets, copies of the environmental risk assessments, individual service user risk assessments (maintained on the care files of each individual), copies of leaflets from the Health and Safety executive and policies and procedures covering a variety of health and safety issues. Training around health and safety is also provided and covers topics associated to moving and handling, fire safety, first aid training, food hygiene and infection control, as discussed earlier within the report (the home attending ‘Bug Busters’ at St Mary’s Hospital). The tour of the premises and grounds also confirmed issues affecting the health and safety of service users or staff are minimised, with external security lighting provided and lighting for the staff summerhouse provided, limiting the possibility of trips, etc. Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x 3 3 Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 23 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 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. Refer to Standard Good Practice Recommendations Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Mill Court Furrlongs Newport, Isle of Wight PO30 2AA 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 Cherrytrees H55H04_S12475_Cherrytrees_V218161_150705 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!