Inspection on 17/12/05 for Cherrytrees @ Abbotsbury

This inspection was carried out on 17th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cherrytrees @ Abbotsbury 11/01/08

Cherrytrees @ Abbotsbury 18/05/06

Cherrytrees @ Abbotsbury 23/09/05

Cherrytrees @ Abbotsbury 05/10/04

Cherrytrees @ Abbotsbury 16/04/04

Similar services:

Maple Lodge

Heathlands

Inspirations

Westmead

Hopwood Court

Coton Hill House

Doddington Lodge

Innage Grange

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

CARE HOMES FOR OLDER PEOPLE Cherrytrees @ Abbotsbury Pettiver Crescent Hillmorton Rugby CV21 4JD Lead Inspector Yvette Delaney Unannounced Inspection 17th December 2005 12:45 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 @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 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 @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cherrytrees @ Abbotsbury Address Pettiver Crescent Hillmorton Rugby CV21 4JD 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) 01788 540163 01788 540163 Pinnacle Care Ltd Mrs Patricia Hanlon Care Home 2 Category(ies) of Dementia - over 65 years of age (2) registration, with number of places Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mrs P Hanlon is to achieve the NVQ award in Health and Social Care at Level 4 by 1st September 2006. 23rd September 2005 Date of last inspection Brief Description of the Service: Cherrytrees at Abbotsbury provides respite care and day care facilities and services for people over the age of 65 years who have been diagnosed as having dementia. The service is provided on the ground floor, at the rear of an existing local authority residential care home, with its own entrance and reception area. The home provides two single bedrooms with en-suite facilities; there is additional space, which includes a communal lounge, dining area and kitchenette, and a small laundry. The home also offers up to eight places each day for older people assessed as requiring day care services, the day care provision is not subject to regulation procedures and therefore not registered with the Commission The accommodation is light and airy, and has a range of equipment and adaptations for service users who have physical disabilities. Access is available to a landscaped enclosed garden at the rear of the building. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection, carried out on a Saturday during the hours of 12.45 pm and 6.00 pm. Records were examined, which include care plans, risk assessments, duty rotas, staff files and medication administration records. Conversations were held with the members of staff on duty and the two residents receiving respite care and the day care residents. The inspection focused on the progress made on the requirements and recommendations made at the last inspection. Staff were receptive and positive throughout the inspection with a good level of knowledge about residents in their care. Residents were happy with the home, relaxed and able to speak openly about their day-to-day life in the home. What the service does well: What has improved since the last inspection? What they could do better: Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 6 There remains the need to ensure that all residents admitted to the home have an up to date assessment of their needs completed. The outcome of the assessment must be used to complete individual care plans, which address the current needs of residents at each admission. Staff must also ensure that all documents contained in residents care profile is completely up to date and out of date documents archived. The practice of putting pictures on mirrors in communal areas is still practised. This practise must be reviewed. The implementation of this practice and any similar practice carried out in the home must be based on available clinical evidence. It is normal for an individual to look in a mirror and see their image. It would not be considered normal unless a resident is proved to be distressed when looking at his or her own image, for an individual to look in a mirror and see a painted picture or a collage. A risk assessment must be completed for those residents affected and an appropriate care plan implemented, which is based on identified research and evidence-based practice. 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 @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 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 @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 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 the following standard(s): 3 The lack of up to date pre-admission assessments means that potential residents cannot be assured prior to moving into the home that their care needs will be met. EVIDENCE: Care plans examined for the two residents receiving respite care on the day of inspection evidenced that an updated assessment of their care needs prior to admission had not been carried out. This practice did not ensure that the current care needs of residents are identified. Staff working in the home are unable to give families and resident’s the assurance that the home continues to have the resources to meet their needs. Resident’s spoken to and visiting relatives expressed satisfaction in the care being delivered. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9, 10 and 11 Detailed care plans based on an updated initial assessment are not produced and risk assessment details were not complete. Consequently residents health, personal and social care needs may not be fully identified, which could lead to omission in care. The storage of medicines in the laundry room does not ensure that medicines are stored safely. Some practices in the home do not ensure that residents are treated with respect at all times, which could result in a decrease in self-esteem and general wellbeing. Policies and procedures in the home related to death and dying will support staff to meet the needs of residents’ and their families with sensitivity and ensure their wishes are respected if they need to provide care for residents who are dying and at the time of their death. EVIDENCE: Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 10 Two care profiles were fully examined these contained evidence of incomplete paperwork and care plans, which were not updated. Assessment and care planning information had not been fully updated to identify current needs. Documentation was dated to suggest that a review had taken place but there was no written information to confirm that this had taken place. One of the care profiles was dated April 2005 and there was no current information available to provide details of the current admission. The lack of information and inconsistencies between in the level of record keeping maintained does not support staff in meeting the needs of residents. Care profiles contained a mixture of information from previous admissions but a lack of updated information and detail as to how individual needs are to be met. Risk assessments, which include nutrition and moving and handling, had been partially carried out and found to be incomplete. Some care plan information related to care needs were also out of date and related to previous admissions. A resident has access to health care services from the community, which include District Nurses to administer insulin. These visits had not been documented. Policy’s/procedures for the safe storage and administration of medication are available and only designated and trained staff administer medication. Medication procedures continue to show improvement there were no omissions on the Medication Administration Records (MAR) charts and the use of a pencil to complete the charts identified in the inspection of September 2005 had ceased. The storage of medication in a locked cupboard in the laundry was still being practised. Care practices, communication and interaction observed between residents and staff during the inspection evidenced that staff were always respectful towards the residents. Residents looked cared for and were encouraged to retain their independence. Those residents who were able had free access around the home and were observed to be relaxed walking around the home. It was evidenced that staff in the home continue the practice of covering mirrors with pictures. Staff were unable to provide evidence to explain why this is done in relation to the current residents using the services in the home. The pictures were removed at the time of inspection. Cherrytrees (Abbotsbury) offers residents a respite and day care service the likelihood of a death occurring in the home is therefore minimal. There have been no reports of deaths in the home since the last inspection. A policy is available in the home should a death occur. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 13 and 15 The current system for monitoring visitors to the home has the potential to put visiting relatives and other visitors to the home at risk. The residents receive a wholesome appealing and balanced diet in nice surroundings increasing the experience of a social event. EVIDENCE: The home has an open visiting policy, details of which are included in the service users guide. Visitors were observed to visit the home at the time of inspection and although only a short visit were not asked to sign the visitor’s book. A book to be signed by visitors is available but not readily accessible to visitors as they enter the home. Examination of the book showed that it was not consistently completed. Food is varied and nutritious with the main meal of the day being prepared and provided by the adjacent local authority care home. The dining area in the home is comfortable, and provides residents with the opportunity for them to dine altogether. Residents were asked about their preference and drinks and snacks were served throughout the day. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 16, 17 and 18 Procedures are in place to ensure that complaints are dealt with promptly, in a structured manner, objectively and within stated timescales. The service ensures that resident’s legal rights are protected and have systems in place to protect them from the risk of abuse, increasing their feeling of safety and their quality of life in the home. EVIDENCE: A detailed complaints procedure is available and accessible to residents, staff and visitors in the home. The inspector was advised that there has not been any complaints received since the last inspection. Residents are encouraged and supported to exercise their legal rights. Access is available to advocacy services and social services and families provide further support to residents. A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that some staff had attended recent adult protection training sessions. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 22, 25 and 26 The home is well decorated and presented providing a well-maintained homely environment with sufficient and suitable equipment and facilities for residents. To further ensure that residents and staff are in safe and comfortable surroundings, policies and procedures to promote the prevention of cross infection must be implemented. EVIDENCE: Specialist equipment and aids are provided in the home to meet the needs of residents. There is one communal bathroom with a hoist chair for ease of accessibility for residents. Pressure mats are available for each bedroom; these ensure that night staff are alerted when residents require assistance. The home is warm, clean and maintained to a good standard. Observations made while walking around the home evidenced that it was hygienic and generally free of offensive odours. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 14 Laundry facilities are equipped with a wash hand basin and have secure storage space for cleaning chemicals to be held. Window restrictors are fitted to resident’s bedroom windows. Hot water is supplied, controlled and monitored by the adjacent care home pre set valves have been fitted in order to ensure hot water is provided at a temperature close to 43°C. There continues to be no paper towel dispensers in communal toilets and bathrooms. Residents and staff continue to use a communal towel in these areas, which does not promote good infection control practices. An immediate requirement was issued to request that this practice stops or evidence is provided to demonstrate that this is good practice, which is based on clinical guidance. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The numbers and skill mix of staff on the day of inspection were insufficient to meet the needs of residents accommodated in the home, which could lead to omissions in care provision and possible harm to residents. EVIDENCE: Copies of staff rotas show that three staff are on duty each morning from Monday to Friday and each member of staff has a different start time, which takes into account the arrival of eight service users attending for day care. Rotas’ show one team leader on duty during the evening and one waking night care assistant. Designated team leaders are on call during the late and nightshift to provide support for the member of staff on duty if needed. Duty rotas show that there are two members on duty at weekends. On the day of the inspection there was a Senior Carer (Team Leader) on duty with another member of staff who was working as a carer. The records of the carer evidenced that she was under the age of 18 years. Observation and information on file evidenced that the carer was involved in delivering personal care to residents. Evidence showed that the home was not adequately covered to ensure the safety of residents and an immediate requirement was issued. Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed at this inspection. EVIDENCE: Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 17 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 2 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X X 3 X X 3 2 STAFFING Standard No Score 27 1 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The manager must ensure that a full pre-assessment of needs is conducted prior to admission to demonstrate that the assessed needs can be met by the home. (Outstanding from inspection dated 23/09/05) The manager must ensure that the care plans are up to date and address the current needs of individual residents. (Outstanding from inspection dated 23/09/05) The manager must ensure that the resident and/or the family are involved in the care planning process where possible. The manager must ensure that the care planned reflects the actual needs of the residents and when changes occur these are clearly indicated and new plans developed. The manager must ensure that all residents have full risk assessments and where a risk is demonstrated an appropriate plan of prevention must be implemented. DS0000029373.V274513.R01.S.doc Timescale for action 31/03/06 2 OP7 15,13, Sch.3 31/03/06 3 OP7 15 Sch.3 15 Sch.3 31/03/06 4 OP7 31/03/06 5 OP8 14,15,17, Sch.3 Sch.4 31/03/06 Cherrytrees @ Abbotsbury Version 5.1 Page 19 6 OP8 Sch.3,13 7 OP9 13(2) 8 OP10 12(4) 9 OP13 Sch.4(17) 12,13 10 OP26 13(3)(4) 11 OP27 18,19 12 OP28 18(1)(a) Care profiles must contain information, which provides details of visits made to residents by other professionals external to the home. This information must include the date, time, purpose and outcome of visit. The registered manager must make arrangements for ensuring that the safe storage of medication is adhered to at all times. A review of the storage of medication in the laundry must be reviewed. (Outstanding from inspection dated 23/09/05) A review must be carried out on the practice of sticking pictures to the mirrors in the home. (Outstanding from inspection dated 23/09/05) An appropriate system must be implemented to ensure that an accurate and up to date record is maintained of all visitors to the home. Paper towels must be available in a suitable dispenser in identified communal areas where staff would be expected to wash their hands to maintain standards of hygiene. (Outstanding from inspection dated 23/09/05) The registered provider must ensure that persons under the age of 18 years are not employed to carry out personal care for residents. The registered provider must confirm to the Commission the plans for ensuring that a minimum of 50 of care staff are qualified to NVQ level 2. (Outstanding from inspection dated 23/09/05) DS0000029373.V274513.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 Cherrytrees @ Abbotsbury Version 5.1 Page 20 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 @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherrytrees @ Abbotsbury DS0000029373.V274513.R01.S.doc Version 5.1 Page 22 - 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!