Inspection on 10/07/07 for Green Trees

This inspection was carried out on 10th July 2007.

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

Green Trees 28/10/08

Green Trees 08/04/08

Green Trees 12/12/07

Green Trees 04/05/06

Green Trees 07/11/05

Green Trees 21/07/05

Green Trees 24/01/05

Green Trees 03/06/04

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

CARE HOMES FOR OLDER PEOPLE Green Trees 21 Crescent East Hadley Wood Hertfordshire EN4 0EY Lead Inspector Jane Ray Key Unannounced Inspection 10th July 2007 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 Green Trees DS0000010646.V341532.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. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Trees Address 21 Crescent East Hadley Wood Hertfordshire EN4 0EY 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 8449 6381 020 8449 2008 lanarhnrn@aol.com www.greentreescarehome.co.uk Mr Brian Colin Haydon Ms L June Haydon, Mr Simon John Kidsley Ms L June Haydon Care Home 16 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2006 Brief Description of the Service: Green Trees is a small family owned residential care home specialising in the holistic care of the frail elderly and those who suffer from dementia. Green Trees home is a detached Edwardian property located in a residential area of Hadley Wood registered to provide care and support for 16 older people. The home is near to local shops. The home has 12 single and 2 double rooms available on two floors. Ten of the single bedrooms have en-suite facilities. There are two bathrooms, both with hoists, a shower room with toilet and a ground floor toilet. The home has a lift. The home has a spacious lounge and dining room. The attractive rear garden is designed to be accessible for the residents. Mrs Haydon is one of three providers and she has managed the home for approximately fourteen years. The other two registered providers are Mr Haydon and Mr Kidsley. The home’s stated aims and objectives are to make the resident’s stay as happy and as comfortable as possible, giving high quality care to enable the highest level of independence, choice, privacy, dignity and fulfilment that individual abilities will allow. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges range from £500 to £575 per week. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 10 July 2007 and was unannounced. This inspection was the annual key inspection and all the core standards were inspected. The inspection also checked how the service was progressing in meeting the requirements from the previous inspection that had taken place on the 23 November 2006. The inspection took seven hours to complete. The inspector looked around the home and spent time speaking individually or in groups to the people living in the service. In the afternoon the inspector was able to meet some relatives who gave some feedback on the home. The inspector also interviewed a member of the care staff and a volunteer who works in the home. The manager and other senior staff assisted with the inspection. The care records, staff records and health and safety records were also inspected. What the service does well: Many of the service users and their relatives were full of praise about their lives at Green Trees and the care they receive from the staff. The atmosphere in the home is friendly, with the residents enjoying each others company and chatting with the staff. Visitors are made very welcome when they come to the home. The individual staff were observed to be providing a high standard of personal care. The staff were very positive about their work and when they spoke to the service users they demonstrated a good knowledge of their individual needs and a caring approach. The home was clean, tidy and homely throughout. The lunch that was served during the inspection was tasty and nutritious. The residents are encouraged to bring personal items with them to make their bedrooms homely. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Nineteen requirements and three recommendations were made at this inspection. The inspector was concerned as several of these related to healthcare and health and safety issues that could potentially have a direct impact on the safety and welfare of the residents. The manager of the home needs to ensure that the home is professionally run at all times and the staff appropriately managed. Six requirements and two recommendations were made under the heading health and personal care. These were to ensure each resident is supported to have a dental check, have their weight checked on a regular basis and to have an accurate record of healthcare appointments. Comprehensive care plans need to be in place if a person has a pressure sore and a procedure needs to be available for the use of bedrails. Staff need to be trained on medication handling and administration. The two recommendations are to arrange annual Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 7 review meetings with the relatives and care manager and to fully implement the key working system. A requirement was made in the daily life and social activities section to ensure that the volunteer who arranges activities has the appropriate training and equipment to ensure all the residents have access to a range of stimulating activities suitable to meet their individual needs. In the environment section one requirement was made to provide soap in all the communal bathrooms. In the section on staffing five requirements were made. These are to recruit a new cleaner, ensure all the staff have photo ID available, ensure all staff have a completed record of their terms and conditions, ensure all staff have a completed induction record and that ongoing training is provided on the specialist needs of the people living in the home. Six requirements were made in the section called management and administration of the home. Firstly the manager needs to start the NVQ level 4 in management and care in order to receive management training. Secondly the home needs to undertake an annual quality assurance exercise. Thirdly the staff need to be supported to have regular individual supervision. From a health and safety perspective the home needs to have the portable electrical appliance check, complete a fire safety risk assessment and regular fire drills and ensure all staff have completed the essential health and safety training. 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. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 8 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 Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 9 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): Standards 1,2,3,4 and 5 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be assured that they will be assessed as part of their admission process to the home. They will receive information about the home to help them decide if the service is right for them. They will also be offered a contract between themselves and the home that clearly sets out what they need to pay and what is covered by the fees. EVIDENCE: I read the current statement of purpose and service user guide and both these documents are clear and comprehensive and provide useful information to prospective residents. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 10 I looked at the case notes for four people living in the home. Three of them had a signed contract between themselves and the home and the final person had a record that the contract had been sent to the relatives to sign. These documents clearly state what the home will provide and what residents are expected to pay for themselves. The four case notes also showed that each person had a detailed assessment provided by an appropriate care professional such as a social worker or a nurse from a discharging hospital. In addition the home uses an assessment checklist, which was not completed fully in all cases. There were however care plans in place for everyone and these all included information on each persons care needs covering all the necessary areas. The main need of the people living in the home relates to their dementia. The staff training records show that all the staff have received training on dementia which equips them to carry out their work appropriately. The service user guide says that prospective residents are welcome to visit the home with their relatives. The staff spoken to during the inspection said that most relatives visit the home without the resident as often they come to the service directly from hospital. The service does not provide intermediate care and so standard 6 was not inspected. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 11 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): Standards 7,8,9 and 10 were inspected. People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to access healthcare as needed through the GP and have an individual care plan in place. The service needs to support people to have regular dental checks, have their weight checked and ensure a procedure is in place for the safe use of bed rails. The staff need to receive medication training. EVIDENCE: I looked at the care plans for four people living in the home. These documents covered all the areas where care and support were needed and provided clear guidance to staff on what action they needed to take to meet each persons needs. The care plans had all been reviewed in the previous two or three months and a new form has also been developed to monitor the care plans on a monthly basis and this is being implemented. I could see that where there Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 12 had been significant changes in the residents needs that this was included in the care plan. Only one of the four people whose care plan was viewed had any record of a review meeting with their social worker in the last two years. It is recommended that each persons social worker and / or relative are invited to an annual review meeting. I also spoke to a member of care staff and the manager and they explained that at the moment the key worker system is not being implemented and that the staff are not allocated to focus on supporting named residents in the home. It is recommended that a key working system is implemented that enables staff to provide specific support to individual residents. The case notes that I inspected showed that areas of risk were assessed. These included moving and handling, nutrition, infection control and pressure care. These had mostly been reviewed in the last month. I looked to see if people living in the home were being supported to monitor their weight. Only one of the four people whose case notes I checked had a record of having their weight checked. I looked in detail at the care plan for the one person who had a pressure sore at the time of the inspection. This person did have a care plan in place but this was not comprehensive. The manager said that the home had not received input from the tissue viability nurse on the measures to implement and how these should be recorded for people who have pressure care issues. The case notes showed that the home has still not set up a separate record of healthcare appointments for each resident, although I could see that a form had been developed for this purpose. The record of healthcare appointments could be found in the daily logs. I could see that a visiting chiropodist and optician support the people living in the home. There were however no record of people having a dental check. The manager explained that the dental service that visits the home is no longer available except for an emergency. Alternative arrangements need to be made for people to have a dental check. The healthcare records show that residents are being referred to the GP for healthcare input as required. The manager explained that two people in the home are using bedrails. I looked at their case notes and they both had a record of why this was needed and approval from the relatives and healthcare professionals. The home does not have a policy on the use of bedrails although the manager said she has some guidance available. The requirement for the home to prepare a policy and procedure on the use of bedrails is outstanding from the previous inspection. I looked at the medication system in the home. The home uses a system of dossette boxes organised by the pharmacist. The home has medication administration charts. These include a photo of each resident apart from those who moved in very recently and these help to ensure the medication is Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 13 administered correctly. The medication received in the home is recorded on the MAR sheet and there is a separate book for medication returned to the pharmacy. An audit trail for the medication is available. The MAR sheets were completed correctly. The temperature in the medication trolley is recorded daily. There are several residents who have PRN medication. On the day of the inspection the guidelines on when this medication should be administered were still not available. The manager did however prepare the guidelines and send them to the inspection team immediately after the inspection. The staff training records were inspected for four staff and only one person had received medication training. Control drugs that are in the home are locked in a separate secure cupboard and signed for appropriately when they are administered. Throughout the inspection the staff were observed supporting the people living in the home with their personal care, meals and moving around the home. This was done in a manner that respects the residents’ privacy. People living in the home can see visitors in the lounge or in their own bedroom. Green Trees DS0000010646.V341532.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): Standards 12,13,14 and 15 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users will be supported to enjoy a healthy and nutritious diet that meets their individual needs. Additional staff training is required to support the service users to enjoy stimulating activities both within and outside the home. EVIDENCE: I was able to observe the staff supporting the people living in the home throughout the inspection. The residents are able to exercise choice in terms of when they want to get up and eat breakfast. They can also ask for a drink whenever they want, although drinks are offered throughout the day. On the day of the inspection no structured activities took place. The activity record showed that most of the people living in the home enjoyed having a chat. In addition the hairdresser visits once a fortnight and a beautician comes Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 15 to give people a manicure. A volunteer who comes to the home a few times during the week carries out the activities. I was able to meet the volunteer and from discussions with her she recognised that she would benefit from training and advise on equipment to meet the needs of people with dementia. I could also see from the activity record that there has been no external entertainer visiting the home over the last few months and this was confirmed from discussions with the manager. The manager explained that a vicar from a local church comes to the home to meet with the residents. She also said she is actively requesting a Catholic priest to visit for one of the people living in the home. The staff and residents explained that visitors are made welcome in the home and this was reflected in comments from one relative who said she felt warmly received when she visited the home. I spoke to residents about food in the home. They all said that they enjoyed the meals. The home prepares a weekly menu and this was inspected and was nutritious. There is always a choice of a main meal if needed. During the inspection lunch was served. The lunch took place in a relaxed manner and was seen as a social activity. The needs of residents who required a finely chopped meal were appropriately met. A couple of people needed to be fed in their bedrooms and this was done slowly and carefully. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to access an appropriate complaints procedure. The staff have been trained to understand the protection of vulnerable adults. EVIDENCE: The complaints procedure is available in the service user guide and includes details of who complainants can contact. I asked a resident if she felt able to raise a concern and she said she would speak to the care staff or the manager if she had a problem. The manager said they had not received any complaints but was able to show me some very positive compliments received from relatives. I did explain that it is very unusual for a service not to receive complaints and that when these are addressed appropriately they can help to improve the service. I looked at the staff training records for four staff and they had all received training on the protection of vulnerable adults. I spoke to a member of staff who was able to describe how she would recognise abuse and showed an understanding of what action she would need to take if she thought someone was being abused. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 17 The manager explained that the home does not hold any money or valuables on behalf of the people living in the home. Most of the residents have relatives who help them with their finances and one person has an appointed representative who acts on her behalf. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 18 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): Standards 19,20 and 26 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home have access to an environment that is clean and comfortable. Soap needs to be available in all the shared bathrooms. EVIDENCE: I did a tour of the home. The building is very spacious and there is access through the lounge to an attractive rear garden. The home is well maintained and rooms are redecorated on a rolling programme. Some of the furniture appears a little tired and will need to be gradually replaced. It was observed in one of the communal bathrooms that there was no soap and this needs to be available at all times. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 19 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): Standards 27,28,29 and 30 were inspected. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a small stable team of staff. A cleaner needs to be recruited and the staff need to receive ongoing training to meet the specific needs of the residents. EVIDENCE: The staff rota was inspected. This showed that during the day there are two care staff working in the home and at night there is one waking member of staff. The manager may also be available but may not be working hands-on with the residents. There is also a full-time cook but the domestic post is vacant and the manager explained that no recruitment was taking place at the time of the inspection. Since the last inspection two new staff have come into post. The inspector could see that two care staff have to work very hard to meet the needs of the current residents. If the needs of the residents increased additional staff would need to be available. The manager explained that at the time of the inspection five of the nine care staff have either completed or are undertaking NVQ training, which is an appropriate number of staff. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 20 The recruitment records for the two new staff and four long-term staff were inspected. One new member of staff had a POVA check but not a CRB disclosure and was working supervised. One member of staff did not have ID in her staff record and one did not have a copy of signed terms and conditions. None of the staff had any record of induction training including the two new staff. All the staff will need to complete a comprehensive induction programme. At the time of the inspection no further training was planned for the staff, as confirmed by the manager and assistant manager. I gave the home information on how they could book training on pressure care and continence promotion and these sessions were subsequently arranged. Additional training linked to the needs of the people living in the home needs to be arranged for example one person has epilepsy and training needs to be organised on this health care area. Ongoing training is also needed on health and safety topics. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 21 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): Standards 31,33,36 and 38 were inspected. People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst people living in this home benefit from stable management arrangements, additional work is needed on quality assurance and staff supervision. Some urgent areas of health and safety need to be addressed to ensure the residents have access to a safe service. EVIDENCE: The manager has been in post for fourteen years. She has a number of appropriate care qualifications but no management qualification and therefore needs to undertake an NVQ level 4 in management and care. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 22 At the time of the inspection the annual quality assurance exercise seeking the views of the service users, relatives and other care professionals associated with the home needed to take place. The supervision records were inspected for four care staff and they all had no record of supervision on the last six months. The member of staff spoken to confirmed that she had not been supervised. The staff training records were inspected for four care staff to see if their health and safety training was up to date. One of the four had received moving and handling training. One of the four staff had received infection control training. None of the staff had received fire safety training. One of the four staff had received first aid training. Three of the four staff had received food hygiene training. The manager explained that she does not have dates for the staff to complete outstanding health and safety training. Some fire safety measures were in place. The fire alarm and extinguishers had been serviced. The fire alarm had been checked weekly but drills had not taken place for over 8 months. An emergency fire plan was in place but a fire safety risk assessment needs to be prepared. Certificates to confirm the electrical installations, gas, hoist, lift and water system had been checked were available. There was no evidence that the portable electrical appliances had been checked. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 23 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x 2 x 1 Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 24 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(6) Requirement The registered persons must prepare a policy and procedure on the use of cot sides. This requirement is restated from the previous inspection. Timescale of the 15/01/07 was unmet. The registered persons must ensure that the home keeps a separate record of healthcare input for each person living in the home. This requirement is restated from the previous inspection. Timescale of the 15/12/06 was unmet. The registered persons must contact the tissue viability nurse to obtain input and advise on the care and appropriate recording for residents who have pressure sores. This requirement is restated from the previous inspection. Timescale of the 15/12/06 was unmet. The registered person must ensure all the residents are supported to have dental checks. The registered person must support each resident to check DS0000010646.V341532.R01.S.doc Timescale for action 30/09/07 2. OP8 13(1) 30/09/07 3. OP8 13(1) 30/09/07 4. 5. OP8 OP8 13(1)(b) 12(1) 30/09/07 31/08/07 Green Trees Version 5.2 Page 25 6. 7. OP9 OP12 13(2) 16(2)(n) 8. OP26 13(3) 9. 10. OP27 OP29 18(1)(a) 17(2) 11. OP29 17(2) 12. OP30 18(1)(c) 13. OP30 18(1)(c) 14. 15. OP31 OP33 9(2)(b) 24(1)-(3) 16. OP36 18(2) their weight on a regular basis. The registered person must ensure all the staff have received medication training. The registered person must ensure the service users have access to regular activities appropriate for people with dementia arranged by someone who has been trained to fulfil this role. This requirement is amended and restated from the previous inspection. Timescale of the 15/01/07 was unmet. The registered person must ensure soap is provided in all the communal bathrooms to maintain standards of hygiene. The registered person must ensure a cleaner is recruited. The registered person must ensure each member of staff has a copy of photo ID in their staff record. The registered person must ensure each member of staff has a copy of their signed terms and conditions. The registered person must ensure all staff have a record of a completed induction training programme. The registered person must provide ongoing training on the specific needs of the service users such as epilepsy. The registered person must start to undertake NVQ level 4 management and care training. The registered person must undertake the annual quality assurance exercise seeking the views of residents, relatives and other stakeholders. The registered person must ensure all the care staff have DS0000010646.V341532.R01.S.doc 30/09/07 30/09/07 31/07/07 31/08/07 31/08/07 31/08/07 30/09/07 30/09/07 30/09/07 30/09/07 31/08/07 Green Trees Version 5.2 Page 26 17. OP38 23(4) 18. 19. OP38 OP38 13(4) 13(4) regular individual supervision. The registered person must complete the fire safety risk assessment and carry out regular fire drills. The registered person must ensure the portable electrical appliances have been checked. The registered person must ensure all the staff have completed the necessary health and safety training including moving and handling, food hygiene, first aid, fire safety and infection control. 31/08/07 31/08/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP7 OP12 Good Practice Recommendations The registered person should arrange an annual care plan review meeting and invite the care manager and relatives. The registered person should operate a key-working system to ensure the needs of each resident are fully met. The registered person should arrange an entertainer to regularly visit the home. Green Trees DS0000010646.V341532.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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. 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