Inspection on 06/12/05 for Conifers The

This inspection was carried out on 6th December 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Conifers The 12/10/07

Conifers The 09/12/04

Conifers The 29/07/04

Conifers The 01/11/02

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Conifers The 473-475 Green Lanes Palmers Green London N13 4BS Lead Inspector Caroline Mitchell Unannounced Inspection 6th December 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 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. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Conifers The Address 473-475 Green Lanes Palmers Green London N13 4BS 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) 020 8882 3249 020 8882 6160 conifersnursing@btconnect.com Mrs Bridget Murray Ms Olivia Moyo Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: The Conifers is registered as a care home with nursing care for up to thirty older people. The home is a privately owned, family- run home and the proprietors own one other care home in Totteridge, North London. The home, which is situated in Palmers Green, is a detached, two-storey building in the busy Green Lanes area. It is close to all local amenities; shops, restaurants, pubs, churches etc. The upstairs can be accessed by use of the lift. There are twenty six single rooms and two shared rooms. Fourteen rooms have en- suite WC and shower facilities, which have been adapted to provide wheelchair access. The stated aims of the home are to provide long-term nursing care for older people. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It took place over one afternoon and took around four hours to complete. During the inspection the inspector spoke to several residents, a small number of relatives and visitors, and the floor manager, who is the daughter of the registered person. The registered person also popped in to greet the inspector. The inspector was shown around the home and reviewed a number of the written records and policies that are kept in the home. There was a festive feel in the home in the run up to Christmas. What the service does well: What has improved since the last inspection? What they could do better: It would ensure that the Greek and Turkish speaking service users have more opportunity to converse in their first language if there were more staff in the team who were able to speak Greek and Turkish, and the inspector has made a recommendation for future recruitment to be targeted to this group. A small number of staff files need to include a recent photograph of the staff member concerned. The registered person has been reminded to report any incidents Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 6 to the Commission without delay. There is a need for one service user to be referred for a specialist heath assessment. The annex to the laundry is in need of re-decoration and more time has been given to the registered person to ensure that this task is completed. 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. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 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 Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 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): 1&3 Service users are given the information they need to make an informed choice about whether the home is suitable for them, and their needs are assessed prior to them moving to the home. EVIDENCE: The inspector noted that the service users guide is in large print so that it is more accessible to the service users. The home’s statement of purpose has is clear and has been regularly updated. At the previous inspection the registered person was required to ensure that the statement of purpose was revised to clarify the description of the needs that the home can and cannot meet. The inspector was able to confirm that this had been addressed. The inspector examined one service user’s files for a service user who had recently been admitted. This contained all of the necessary pre-admission assessment information so that the home were clear about the needs of the service user. There was evidence that senior staff visited the service user from the home, prior to admission and a good quality assessment had been undertaken. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 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 The health and personal care needs of service users are generally well met and there is a clear and consistent care planning system in place that is satisfactory overall. In order to safeguard the welfare of one service user a referral to a relevant health care professional is necessary. The arrangements for the storage, recording and administration of medication protect service users’ welfare. EVIDENCE: The written records for three service users were examined. Service users each had an individual care plan, and generally the level of information contained in their files was good. The inspector was able to view risk assessments held on file for a number of service users and noted that all risk assessments were completed appropriately, signed, dated and maintained up to date. They were seen to cover all areas of risk, which were relevant to each individual service users’ needs. There were good records of visits and appointments with the GP, who visits the home regularly, and evidence on service users’ files to indicate that they had appropriate access to a range of health care services and professionals such as dentists and speech therapists. In discussion with the floor manager it became evident that there were some concerns about one Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 10 service user and a requirement is made for the home to request the input of a psychogeriatrician regarding this issue. Cot sides were being used for a small number of service users. The service user’s relative had given consent and the use of cot sides was recorded as part of the service user’s risk assessments. At the last inspection the registered person was required to ensure that the risks assessments were developed further for each service user for whom cot sides are used, including the risks associated with their use and to ensure that service users plans include the settings of air flow mattresss in relation to individual service users weight. The inspector was able to confirm that these issues had been addressed. In addition the floor manager explained that the home has arranged further training in the use of pressure relief equipment for the staff team. The inspector reviewed the records and the arrangements in the home for storing and administering controlled drugs. These were found to be satisfactory. A record is kept of any medication that is received and disposed of by the home. The inspector was also provided with the most recent report of the visit by the pharmacist who provides medication to the home and it was noted that this was of a positive nature. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 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): 12, 13 & 15 Service users can be confident that they will be facilitated to maintain contact with their family and friends. There is room for improvement in terms of meeting the cultural needs of service users from Cypriot backgrounds. The home provides high quality food in a pleasant and relaxed environment and service users can be confident that their preferences will be catered for. EVIDENCE: The Christmas decorations were up and there was a festive atmosphere. The details of the Christmas party were advertised around the home and an entertainer was booked to come to do an old time music hall show. Children from the local school had been to sing carols. The inspector spoke with four service users in private during the course of the inspection, and they all confirmed that staff are caring and sensitive in their approach. The inspector noted that there are a number of service users who are from Greek and Turkish backgrounds. However, the staff team does not reflect this and it is recommended that the registered persons target recruitment to Greek and Turkish speaking staff. Having said this, the inspector saw lots of evidence that the home make efforts to enable the service users to converse in their first language. The floor manager explained that the hairdresser who comes regularly to do service users’ hair is a Greek speaker and spends a lot of time talking to the service users. Two volunteers come from a local school for Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 12 two hours each week, to sit and speak with the service users, and they both speak Greek. One Greek-speaking service user was listening to a Greek channel on the radio when visited in their room by the inspector. The floor manager added that one service user, who is from a Cypriot background, has a very large family who visit regularly and always spend time talking to the other service users so as to include them in their visit. During the inspection the service users were served lunch and the inspector noted that one service user was served with a selection of Greek food. Several staff were noted to be helping service users to eat their lunch, in a gentle and discreet fashion. All of the service users who spoke to the inspector said that the quality of the food served in the home was good and indeed, it did smell and look very appetising. At the previous inspection it was recommended that the service users whose food is pureed, be provided with meals with each food pureed separately. The floor manager told the inspector that this was tried and some people preferred everything pureed together and some preferred some foods pureed separately. Thus, service users now have their food pureed as to their individual preferences. The inspector saw the records of accidents that are kept in the home. The nurse manager monitors these records. The inspector evidence that where service users have fallen, that risk assessment are reviewed as a result and guidance is in place for staff of how to minimise the risks of further falls for these people. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 13 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 & 18 Service users benefit from both a complaints procedure and an adult protection protocol that ensure that their views are heard and that they are protected from abuse. EVIDENCE: The complaints procedure was examined and found to be nice and clearly set out. The three complaints that were recorded in the record of complaints that is kept in the home were thoroughly documented and the outcomes were noted. None were upheld and satisfactory solutions had been found to all three. The inspector was aware that one service user and a member of their family had posed some difficulty for the management team by making a number of complaints and allegations against staff members. This had lead to an adult protection strategy meeting being held. The meeting acknowledged that the home had not been at fault and had reported the issues to the placing authority appropriately. However, there was some delay in reporting the allegations to the Commission and a requirement is made in respect of this. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 14 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): 19, 21, 22, 24 & 26 The Conifers provides a pleasant homely environment that service users can regard as their home and their bedrooms are personalised to reflect this. Service users benefit from a home that provides suitable specialist equipment to maximise their independence and provides plenty of communal space and toilets and bathrooms. This is a safe, well-maintained, clean and pleasant environment for service users to live in. EVIDENCE: Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 15 During the tour of the building the inspector noted that a number of bedrooms have been re-decorated since the last inspection. The overall standard of the fabric and decoration in the building was good. The home employs a handyman who carries out most of the repairs and maintenance at the home. The annex to the laundry room is in need of re-decoration and a requirement was made in relation to this at the previous inspection. This has not been achieved and this requirement is restated in this report and as this issue does not have a direct effect on the care of service users the timescale for compliance has been extended. The home has sufficient toilets, shower and bathroom facilities. The bathrooms have are fitted with thermostatic mixer valves. The home has a separate laundry with a sluice facility. The are several hoists, and there was clear evidence that they have been regularly serviced. There is a lift available to provide access to the upstairs floor. There is a nurse call system installed. The inspector was pleased to note that many service users’ had their photos on their bedroom doors to help them to identify their rooms. There are two shared bedrooms and the rest are single. The shared rooms are provided with screens in order to protect people’s privacy. The rooms were comfortably furnished, with evidence of service users’ own personal effects being used to brighten the rooms and make them more homely. These included pictures, armchairs, standard lamps and dressers. Many rooms had laminate flooring provided. The home was comfortably warm at the time of inspection and covers have been provided for the radiators. The inspector noted that the home felt comfortable, fresh and clean throughout. One service user was being barrier nursed and there were notices in appropriate places warning of this. The home has a control of infection procedure and staff were observed to be adhering to the procedure. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 16 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, 29 & 30 There are sufficient numbers of staff employed to meet the needs of the service users. Service users are protected by the homes recruitment practices, although there is room for very minor improvement in terms of staff records. The system of induction and ongoing assessment of staff competence in nursing and care tasks is commended as it is well designed to protect the well being of service users. EVIDENCE: The inspector noted that there were good levels of staffing at the time of the inspection. This included the nurse manager, six carers, two qualified nurses, one adaptation nurse and an admin. officer. A sample of staff file were examined for the three staff who had been recruited since the last inspection. All files were found to contain the relevant information specified under the Care Homes Regulations. There was evidence to indicate that all staff had been subject to CRB checks including POVA checks where applicable. However, not all included a recent photograph of the staff member and a requirement is made in respect of this. At the previous inspection the inspector noted that there were a number of adaptation nurses who had been recruited and had provided a CV, rather than completing the home’s application form. Some of these nurses had not accounted for gaps in their work history or provided reasons for leaving some of their posts. A requirement was made in respect of this. The inspector was able to confirm that this issue had been addressed and all applicants provide a full work history. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 17 The inspector saw the system that is in place to provide induction, ongoing supervision and appraisal of each nurse and care staff members’ competence. The inspector was impressed with the comprehensive nature of this system and with the clear and well-organised way in which it was presented. Each staff member has a personal development plan that outlines the training that they have undertaken and highlights their training needs. Evidence that each person’s competence has been assessed in a broad range of nursing and care procedures is also recorded as part of supervision. This takes place weekly in the case of the adaptation nurses, and monthly for other staff members. The inspector was also pleased to note that all three of the recently appointed staff had personal development plans in place. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 18 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): 33 & 35 The service users benefit from the open, well-organised and professional management approach. Service users’ financial interests are protected. There are effective policies and record keeping systems in place. EVIDENCE: The inspector saw the records kept in the home of any incidents and accidents. This was noted to be well organised and staff had provided full and comprehensive information of any accidents and incidents that had taken place. The floor manager explained that the home does not help service users to manage their finances. Where service users need help with their finances this tends to be done by their families. The home provides all toiletries and where other items, such as hairdressing, are needed the floor manager also approaches the service users’ relatives about this. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 19 The inspector saw the records of staff meetings and noted that these had bee held regularly. The issues discussed included Whistle blowing, the importance of service users drinking fluids, reporting changes in service users’ eating habits and health, maintaining privacy when providing personal care, and the use of protective gloves. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X X Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 21 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 OP8 Regulation 13 The registered person must ensure that the service user for whom there are concerns is referred to a psychogeriatrician for assessment. 2 OP18 37 The registered person must ensure that any allegation of misconduct by any person who works at the care home is reported to the Commission without delay. 3 OP19 23(2) The registered person must ensure that the annex to the laundry room is redecorated. The previous timescale of 05/10/05 was not met. 4 OP29 17 (2) The registered person must ensure all care staff personnel records contain a recent photograph of the staff meember concerned. 30/01/05 30/05/06 30/01/06 Requirement Timescale for action 30/03/06 Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 22 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 12 Good Practice Recommendations It is recommended that the registered persons target recruitment to Greek and Turkish speaking staff. Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Conifers The DS0000027805.V264884.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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