Inspection on 31/03/08 for Cherrytrees

This inspection was carried out on 31st March 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

Cherrytrees 09/01/07

Cherrytrees 01/12/05

Cherrytrees 15/07/05

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 Inspection 31st March 2008 09:30 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 Cherrytrees DS0000012475.V359242.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. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherrytrees Address 149 Park Road Cowes Isle Of Wight PO31 7NQ 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) 01983 299731 F/P 01983 299731 Mrs Dorothy Mary Gustar 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 DS0000012475.V359242.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Cherrytrees is registered to provide personal care for up to 25 older people, the home may also provide care for up to 6 older people with a mental disorder. The home is a converted period property 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. Transport is provided by the home for appointments. 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 building is accessible with a passenger lift or stairs providing access to the upper floor. However, due to the layout of the building, which has been extended, part of the first floor is only accessible via a short flight of steps from the passenger lift. The current scale of charges is from £336 to £460 per week with additional and varying charges for chiropody, newspapers, hairdressing and toiletries. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was, a ‘Key Inspection’, which is part of the regulatory programme that measures services against core National Minimum Standards. The fieldwork visit to the site of the agency was conducted over six hours, where in addition to any paperwork that required reviewing we (the Commission for Social Care Inspection) met staff and management. The inspection process involved pre fieldwork activity, gathering information from a variety of sources, surveys, the Commission’s database and the Annual Quality Assurance Assessment information provided by the service provider/manager. The response to the Commissions surveys was reasonable, with five service users and two professional returning surveys. The information provided via the service user surveys indicates that people are generally happy wth the service provided at the home. What the service does well: What has improved since the last inspection? Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 6 A new ‘Arjo’ bath has been fitted in one of the top floor bathrooms. The new bath is hydraulically operated, which allows the bath to rise and lowering making access to the resident in the bath simpler. Off road parking at the home has been increased with the revamping and block paving of the existing car parking facility. 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. The summary of this inspection report can be made available in other formats on request. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can expect to receive a visit from a member of the management team and to undergo an assessment, prior to receiving an offer of accommodation at the home. The home does not provide and intermediate care facility. EVIDENCE: The home tell us through their AQAA (Annual Quality Assurance Assessment), that they: ‘invite potential service users and families to look around the home if they wish, give them homes leaflets/service user guides, invite them to spend the day/afternoon in the home to get to know staff/other service users prior to making any decisions. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 9 Each service user is given a contract, detailing terms and conditions on entering the home and is only admitted after a full assessment of need has taken place by the manager/ senior care, trained to do this and a written care plans is put in place’. Two of the four ‘service user plans’, seen during the fieldwork visit, belonged to new residents and both contained details of the pre-admission assessment carried out. The assessment tool is based on a modified ‘activities of daily living’ (ADL) model of care, which provided a good indication of the persons’ abilities and support needs measured against physical and emotional health care criteria. The review of the care planning process established that clear links exist between both the assessment tool and the care plans, as the latter are also based upon the modified ADL programme. Information taken from residents surveys indicate that all five respondents felt they had received sufficient information about the service prior to moving in and four of the five confirmed they had received a contract. One relative, who had completed the survey on behalf of their next-of-kin adding ‘the contract is in my hands as the residents son. I have also filled in the rest of the questionnaire, as my mother has advanced dementia’, providing further evidence of the home’s management of people’s admissions. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are provided with individually prepared care plans, which reflect both their health and social care needs. People are being appropriately supported to accessing health and social services and their medications are handled and stored safely. EVIDENCE: The service tell us via their AQAA that they produce an: ‘assessment of service users needs prior to entry, a clear/detailed care plan is written up from this, these are then reviewed monthly or whenever changes occur. Contact relevant agencies, District Nurse (DN), General Practitioner (GP), etc, as and when required to maintain health, ensuring privacy and dignity when being visited by these professionals’. Four ‘service users plans’ were reviewed during the fieldwork visit and found to be both well structured and set out documents. The plans are a recently introduced system/style, which are divided into the following sections: index, personal information sheet, client history, care plans that are broken down into Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 11 22 sections, risk assessments, General Practitioner and Allied Professional visits, medication records, running record, moving & handling records/ assessments, general assessment tools and details of the initial assessment. The care plans provided clear and concise instructions to staff on how people’s needs are to be met and entries made by the staff support the claim that each plan is reviewed on a monthly basis. Observations made during the fieldwork visit suggested that the residents and the staff have developed good relationships and that the staff understand and appreciate the needs of the clients. One person approaching the staff to ask if they could go for a lie down later in the afternoon and the staff noted later approaching the person to enquire if they wished to go for their rest, which they informed us was not an uncommon request for the client. Information taken from residents surveys indicate that all five respondents feel they receive the care and support they require, with additional comments indicating that people feel you: ‘Could not wish for better’ and ‘The staff here are wonderfully kind to me and very caring’. The residents’ surveys also indicate that people feel they are being appropriately supported when accessing health care services, all five people ticking ‘always’ in response to the question: ‘ do you receive the medical support you need’. This view is also reflected through the professional surveys, with both professionals indicating ‘always’ in response to the questions: ‘are individuals health care needs met by the care service’ and ‘does the care service seek advice and act upon it to manage and improve individuals health care needs’. Additional comments provided by the professionals also indicate that staff are: ‘Particularly good at managing residents with complex functional psychiatric disorders (depression and anxiety and schizophrenia)’ and ‘Provide a safe homely environment where residents feel comfortable and staff are attentive to their needs, friendly and caring’. The ‘service users plans’, as mentioned above, contain details of the service users involvement with health and social care services and provided evidence of the steps taken by the home to monitor people’s health and wellbeing and to act appropriately should any deterioration occur. One record indicating that the staff were concerned that a client might have an infection and so called ‘Island Doctors On Call’ (IDOC), a second record documents the outcome of the visit, the diagnosis of an infection and the prescribing of antibiotics, a third record establishes the receipt of the antibiotics into the home and the commencement of the course on the same day, the initial record is then used to record the client’s progress. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 12 Records also identify the residents’ involvement with allied health care services, with documented evidence of chiropody visits, outcomes of visits to opticians and dentists available and the manager’s diary used to keep track of forthcoming appointments. Within the home people can choose to either entertain visiting professionals within their bedrooms, as all rooms are single occupancy, or within the home’s training room, which can be used as a quiet lounge if necessary. The service tell us via their AQAA that over the last twelve months they have: ‘undertaken more medication training, with outside agencies and completed a review of the service users medications with the local General Practice surgery co-ordinator’. A training matrix, maintained by the manager, evidenced or documented that staff had attended a variety of medication training events, the most recent competed by ‘Boots’, whom supply the home’s medications. The ‘Boots’ system in use, is a ‘Monitored Dosage System’ (MDS), which entails the pharmacist dispensing medicines directly into a blister pack, one medication per sleeve. On arriving at the home the manager was observed checking the residents new monthly supply of medications and entering details of those medicine checked into several different records, including the ‘Medication Administration Records’ (MAR). The home’s medication storage facility was considered to be satisfactory, in respect of the storage of routinely prescribed medicines however, the controlled drugs (CD) cabinet will require updating following changes to the ‘safe custody’ regulations, which come under the ‘Medicines Act’. Staff were also noted to have access to both the home’s own medication procedure and a copy of the ‘Royal Pharmaceutical Societies’ guidance on the management and administration of medications within care homes, as the documents were pinned to a notice board within the main office. A resident or their relative, via the surveys, indicate that: ‘I am aware of the medication my next-of-kin is on and have seen this dispensed conscientiously’. No resident is currently self-medicating, although one persons’ records indicate that they had a bottle of cough mixture brought to them by their relative, which the staff decided to remove from their bedroom and administer themselves. This was discussed with the manager, as this was an opportunity to promote independence. Risk assessment documentation is available to the staff, which Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 13 could have been used to determine if the person was capable of take their cough mixture correctly and safely. Each bedroom is supplied with a lockable facility and so the medication could have been stored safely. As mentioned above the accommodation at Cherrytrees’ is single occupancy, which affords the residents’ privacy during meetings with health care professionals or during the delivery of personal care. The home’s training room or second office can be made available to residents that do not wish to have visitors in their bedroom, although access to this room is hindered by a flight of four steps. Communal facilities, toilets and bathrooms, were fitted with locks that were of a suitable design given some of the physical and cognitive impairments suffered by the residents and staff were observed knocking on toilet doors before entering, when supporting clients. Information taken from the residents surveys indicate that people feel they are treated with dignity and respect by the staff and that the staff listen and reacted appropriately to their requests. The professional surveys also indicate that people are treated with respect and dignity and their privacy upheld, both parties ticking ‘always’ in response to the question: ‘Does the care service respect individuals privacy and dignity’. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that residents receive appropriate support when choosing or participating in social events and enables them to maintain contact with friends and family, via visits to the home or outings into the wider community. The food served at the home is well cooked, well presented and nutritionally balanced. EVIDENCE: The service tells us, via their AQAA that: ‘we provide activities that service users request and enjoy. These are discussed at residents’ meetings and changes to suit present service users. We have a mixture of outside agencies, as well as homes’ staff to undertake activities’. On entering the home the notice board in the hallway was noted to contain details of the forthcoming entertainments, which included dates for film shows, reminiscence sessions, communion visits and musical entertainments. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 15 The ‘service user plans’ contained information about both the persons previous occupation and life-history, as well as details of their preferred hobbies and/or recreational activities, which the manager states is used to support the client. Minutes of residents’ meetings, as mentioned above, are retained and do provide evidence of people’s involvement in shaping and/or influencing the home’s activities programme. During the fieldwork visit, the staff were observed trying to get people to participate in a game of dominos, this however, generated little interest and the carer end up playing with one resident who enjoyed the one-to-one opportunity. The residents’ surveys create a confused picture with regards to the home’s activities programme and its suitability, two people indicating that activities are ‘always’ available, two people indicating they are ‘never’ available and the last person that activities are ‘usually’ available. A comment provided by a resident or their representative suggests that the activities arranged by the home are not always suitable: ‘Unfortunately I dont think there is any activity that could be arranged that my mother could join in. Sunday activities are arranged, which the other residents or some of them seem to enjoy’. A view that seems to be shared by one of the visiting professionals who indicates that people are supported to live the life they choose ‘within the confines of the residential setting’. However, the overall picture indicates that the residents are provided with access to reasonably good activities and entertainments. Visitors were observed coming and going throughout the fieldwork visit, with several people stopping to speak with us and to inform us of their pleasure with the service provided at the home and how well their next-of-kin was being cared for and supported. These comments reflect those provided by relatives who helped their next-ofkin complete the residents surveys with people adding remarks such as: My visits are timed irregularly and without warning and I always gain a favourable impression of the staff, however, I have never visited late at night or early morning’ and ‘having visited several care homes during my professional career I feel that Cherrytrees is amongst the best’. Details of the home’s visiting arrangements are contained within their ‘service users guide’, copies of which are maintained by the manager, who states she provides these to people, as part of the pre-admission information pack, as discussed earlier. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 16 The opportunity to meet with people in private was also discussed earlier in the report, with the manager making it clear during the fieldwork visit that people are supported to entertain guests either within their own bedrooms or should the wish the home’s training room / second office, which can be made available. The professional view of visits to the home is also positive with one of the professionals commenting, via the survey, that: ‘I would like to particularly praise Shirley the Home Manager who is always polite and extremely helpful when I visit - finding patients for me etc. She has an excellent knowledge of her residents and is prepared to set aside time when I visit to discuss their needs carefully’. The AQAA indicates that: people are provided with the opportunity to comment on the service delivered via ‘residents meetings’, for which there are minutes, these were seen during the visit. Observations made during the fieldwork visit established that people were offered the opportunity to participate in activities and that the majority of the people approached declined the invitation to play dominos. This could suggest that the range of activities provided does not meet everyone’s needs or wishes, although as discussed above this is not the overall picture created. It does however, indicate that people were asked if they would like to participate and allowed to decide for themselves that they would rather continue with the activity they were already undertaking. People were also supported by staff in meeting their personal objectives or requests, the example used earlier, of the person asking staff if they could rest on their bed later and the staff noticed later approaching the client to check if they still wished to retire for a rest, providing evidence of the efforts made by staff to respect people’s needs/wishes. The home could still make improvements in this area, supporting people in make choices or maintain control of their lives, by using their risk assessment process to enable people to take risks, i.e. self-medication, which as discussed earlier the service seems to take control of rather than supporting the person to manage this themselves. This issue was discussed with the manager at the time of the fieldwork visit, when she agreed to look at the risk assessment process with a view to supporting people in making decisions and maintaining control. The home no longer has a set menu, as this was dispensed with following a residents meeting were people indicated that they would prefer a wider choice or variety of meals be offered each day. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 17 In response to this request the service now offers a choice of three meals per lunchtime, whilst still offering a range of alternative dishes should the choices offered not appeal to the residents. Information taken from the residents’ surveys indicate that people are generally satisfied with the meals provided, three people indicating that they ‘always’ enjoy the meals provided, with the over two respondent indicating that they ‘usually’ enjoy the food provided. A relative, who supported their next-of-kin to complete the survey added: ‘my mother is a fairly fussy eater but I know that the staff do their best to give her food she enjoys. It seems fine to me’. A visit to the kitchen established that the cooking environment if both clean and well maintained and that records are maintained of the food served and/or the choices people make. It was also noted that during their last and/or most recent ‘Environmental Health Inspection’ the home was awarded a five star rating for its kitchen. The tour of the premise enable us to determine that the lounge/diner is large enough to accommodate all of the service users in one sitting, although some people where noted to have chosen to dine in their rooms. Mealtimes were generally felt to provide people with an opportunity to socialise, people observed in conversation with others sharing their table or interacting with staff. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user and their relatives are aware of the home’s complaints process and confident that any concerns will be appropriately addressed and managed, whilst protecting them from harm and/or abuse. EVIDENCE: The service tell us via their AQAA, that people are made aware of the home’s complaints procedure through the ‘service users guide’, which is provided to all new residents at the pre-admission visit and in house as a copy of the home’s complaints procedure is on display within the hallway. The dataset establishes that details of the home’s complaints process are made available to staff via the company’s policies and procedures, which was last reviewed and updated in the December of 2007. A review of the home’s complaints logging system indicates that no complaints have been received by the service since December 2006. Evidence supported by the dataset, which records that the home has received no complaints in the last twelve months. The residents’ and the relative who assisted in the completion of the surveys indicate that people are aware of whom to speak to if they are unhappy about Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 19 any element of the service provided and four of the five people responding also indicated that they are aware of the homes complaints process. Information provided by the professional, via their survey, indicate that they believe the care service does/would responded appropriately if they or the person using the service raised concerns about their care, one person adding: ‘any concerns have always been addressed promptly and appropriately’. The service state via their AQAA that: ‘the staff are trained in protecting vulnerable adults’, a statement confirmed during the fieldwork visit when reviewing the staff training records/matrix. The dataset indicates that the homes ‘safeguarding’ procedure’s were last reviewed and updated in December 2007, whilst we observed within the main office, that copies of Isle of Wight and Commission guidance on safeguarding adults was available. Staff spoken with during the fieldwork visit were very clear in their roles and responsibilities and confirmed that they understood how to initiate a safeguarding response and where they could access the services policies if required. The view of the professionals visiting the service is that the service: ‘provides a safe homely environment where residents feel comfortable’. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and well-maintained environment for the residents’ that is also clean and hygienic throughout. EVIDENCE: The service tell us, through their AQAA, that they have refurbished an upstairs bathroom and fitted and ‘Arjo’ bath that is height adjustable, this was seen during the fieldwork visit. They also state that new windows have been fitted in a downstairs bedroom and bathroom, new carpets have been fitted in several bedrooms, the hallway door and stair banister have been repainted, a flat screen television has been supplied in the lounge and new fencing has been erected around the revamped car park. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 21 During the tour of the premise the manager discussed the home’s plans for all corridor and stair carpets to be replaced and stated that quotes were being sought. The home employs domestic staff; who were observed during the visit undertaking their duties. Information taken from the residents’ surveys indicates that people feel the home is: ‘clean and fresh’ throughout. The AQAA also indicates that staff receive access to training on the management and control of infections and that policies and procedures are available, these were last reviewed and updated in December 2007. Communal toilets and bathrooms were noted to contain liquid soaps, paper towels and bins for the disposal of waste and all chemicals were stored in accordance with the ‘Control Of Substances Hazardous to Health’ (COSHH) regulations. The laundry is located within the main building and the staff are responsible for laundering residents clothing and returning this to the client room. Clothes are labelled to reduce the possibility of lose or the item being returned to the wrong person, although the manager admitted from time to time items errors can occur. However, in discussion with residents and their relatives this was never raised as a concern or a problem. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs staff in sufficient numbers and with the appropriate skills and experience to meet the clients’ needs. Staff training and development opportunities are good and the recruitment and selection process robust and well operated. EVIDENCE: The service states within their AQAA that: ‘staffing levels are maintained at a level suitable to ensure the service users needs are meet and that the staff team bring together a mixture of age, experience and qualifications. Several staff cover both day and night shifts and therefore they have an overall picture of the service users needs. Staff receive training in all areas of care, thus providing a good standard of care to the service users and a staff roster is on display ensuring all parties are aware of the shift patterns being worked up to four weeks in advance’. Copies of the home’s duty rosters were seen on display during the fieldwork visit and were available for the forthcoming month, as stated within the AQAA. The manager provided us with sight of the training matrix, which evidenced that staff have complete / attended a number of training events over the last Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 23 twelve months including: moving and handling, infection control, Protection of Vulnerable Adults (POVA), food hygiene, first aid training, dementia care, challenging behaviour and medication training. The large majority of the training provided is in house training; the manager utilising training videos and distance learning packs to ensure the staff maintain the skills and knowledge required. The manager also produces training and/or reference packs for all of the above topics, which are made available to the staff within the main office and which contain good levels of information. The professional surveys indicate that the care staff are considered, generally, to have the right skills and experience to meet the needs of the residents, one person commenting: ‘Care staff appear to however, they may feel there are training needs, which may further improve the care they provide’. Information taken from the dataset and confirmed with the manager, indicates` that currently the home employs seventeen care staff. Nine of the seventeen care staff have completed a National Vocational Qualification (NVQ) at level 2 or above and this provides the home with a ratio of 53 of its care staff possessing an NVQ at level 2 or above. The manager, during discussion, added that three staff from the Philippines are all educated to degree level and that these qualifications are all care based, whilst these are not NVQ’s, it is important to reflect the educational status of these employees. Information contained within the dataset establishes that a recruitment and selection strategy/procedure exists to support the manager when employing new staff. It also indicates that all of the people commencing work within the home over the last twelve months have undergone satisfactory pre-employment checks. On reviewing the files of the two most recently recruited staff all of the required checks were in place, Criminal Records Bureau (CRB) checks, Protection Of Vulnerable Adults (POVA) checks and two references. The files also contained completed application forms, work permits, health declarations, photographs of the employee, interview summaries, personal information and information used to support the CRB application process. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and provides a safe and pleasant environment where the residents and their relatives can comment upon and influence the service provided. EVIDENCE: The manager tells us, via the AQAA, that her qualifications include NVQ 2, 3 and 4 in care and that she completed the Registered Managers Award (RMA). She also states that she continues to attend additional skills training courses, alongside other staff and during the visit provided evidence of her attendance of training on the ‘Mental Capacity Act’. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 25 The manager also states, via the AQAA, that her experience within the care field has seen her working at all levels from care worker to manager and that she, on occasions, undertakes care shifts to cover staff shortages, etc. Feedback provided by the professional visitors establish that the manager is considered to run a good home, with one person commenting: ‘I would like to particularly praise Shirley the Home Manager who is always polite and extremely helpful when I visit, finding patients for me, etc. She has an excellent knowledge of her residents’ and is prepared to set aside time when I visit to discuss their needs carefully. When there are problems with my patients she phones me herself rather than delegate to junior staff with less knowledge, if only there were more managers like her’. Whilst comments provided by the residents’ or their relatives, via the surveys, make statements like: ‘Cherrytrees is a very well run home. The care is excellent. Having visited several care homes during my professional career I feel that Cherrytrees is amongst the best. The home’s approach to quality assurance is reasonable with residents meetings and survey used by the manager to gauge people’s satisfaction with the service. A review of the feedback obtained from the home’s questionnaires, last sent out in July 2007, established that four people provided responses, which the manager described as disappointing, although the feedback was positive and complimented the service on the food served and the cleanliness of the home. Recently, two relatives have completed questionnaires and returned them to the manager, both parties again complimentary about the service provided. The manager also maintains a ‘compliments and comments’ folder, in which she places copies of all letters or cards sent to the home by ex-residents or relatives, these cards provide further evidence of the positive experiences of people who have resided or visited the home. Residents meetings, as discussed previously in the report, occur regularly, with minutes from the meetings displayed within the home for up to two-weeks following the meeting, according to the staff member who arranges and chairs the meetings, copies of the minutes were available for review. The homes’ management and storage of residents’ monies was considered safe and appropriate, with people’s monies held individually and separate accounts or books maintained of the amounts stored. The books or accounts are regularly audited by the manager who signs too confirm completion of her audit, all transactions were double signed and have an accompanying receipt. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 26 The service tells us, via the AQAA and dataset information, that health and safety policies and procedures are made available to the staff and that domestic appliances and personal equipment is regularly maintained and serviced. Health and safety training is being made available to staff, with the training matrix and plan providing evidence of the courses attended and those to be attended by staff, including: health and safety, infection control and moving and handling, etc. The tour of the premise identified no immediate health and safety issues, and the environmental risk assessments do consider both potential areas of harm and how these can be managed, as highlighted by the service’s decision to improve the ramped access at the front of the home. Generally the service users and their relatives are satisfied with the service being provided at the home and raised no concerns in relation to either Health or Safety issues. Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 27 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 X 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 3 X 3 X X 3 Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation Requirement Timescale for action 02/07/08 Regulation The manager must ensure that 13. all of the home’s medication storage facilities comply with the regulations and are safe and secure. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cherrytrees DS0000012475.V359242.R01.S.doc Version 5.2 Page 30 - 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!