Inspection on 12/12/07 for Green Trees

This inspection was carried out on 12th December 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 10/07/07

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 12th December 2007 11:00 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.V354776.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.V354776.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 admin@greentreescarehome.co.uk 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.V354776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th July 2007 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.V354776.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 12 December 2007 and was unannounced. The inspection took six hours to complete. The inspector looked around the home and spent time speaking individually or in groups to the people living in the service. The inspector also interviewed two of the care staff and a volunteer who works in the home. After the inspection the inspector spoke to a number of healthcare professionals who visit the home. The inspector also looked at all the relevant records including service user records, staff files and health and safety information. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission for Social Care Inspection prior to the inspection. The inspector also received six completed surveys from residents who had all been supported by relatives or friends to provide the information. The inspection is the second annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People and assess the progress made in meeting the requirements from the previous inspection. The inspector would like to thank the residents and staff for their assistance with the inspection process. 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. One resident said in the survey “Green Trees has a homely feel about it. The manager and staff are very welcoming and friendly”. The atmosphere in the home is friendly, with the residents enjoying each others company and chatting with the staff. One person said in their survey “the staff find time to listen to you”. Visitors are made very welcome when they come to the home. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 6 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 residents 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. What has improved since the last inspection? At the last inspection there were 19 requirements and eight of these have been met fully and four partly as follows: • • • • The home now has a policy and procedure for the use of bed rails and this is being used as needed, which improves safety for the residents. The home is keeping a separate and accurate record of healthcare appointments for each resident. Each resident is being supported to have their weight checked on a monthly basis and where there are significant weight changes this is being addressed. Two staff have attended training on the provision of activities for people with dementia and an external physiotherapist has been booked to come to the home once a month to do a gentle exercise session, which it is hoped will lead to more stimulation for the residents. Soap is available in the communal bathrooms, which improves health and safety. Each staff member has a copy of their photo ID in their staff record, which helps to ensure the correct recruitment checks are in place. Each staff member has a copy of their signed terms and conditions. Some specialist training has been accessed for the staff on pressure care, continence and epilepsy to provide them with skills needed to perform their work. A quality assurance exercise has been undertaken by the home, which enables the views of relatives and other care professionals to be taken into account. The fire safety risk assessment has been completed, although there is some further fire safety work to undertake and fire drills have taken place. The portable electrical appliances have been checked. The care plans including the recording for people at risk of developing pressure sores has been improved. DS0000010646.V354776.R01.S.doc Version 5.2 Page 7 • • • • • • • • Green Trees • Guidelines have been prepared to clarify for staff when PRN medication should be administered. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Green Trees DS0000010646.V354776.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.V354776.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 and 4 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. People who use this service can be assured that the home will receive and consider their assessment as part of their admission process to the home. Information about the home is available to help them decide if the service is right for them but needs to always be given to relatives or other representatives. EVIDENCE: I read the resident surveys. These all said that they had received adequate information about the home prior to admission, although one person said in the homes internal quality assurance exercise that they did not remember Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 10 receiving the resident’s handbook. The home has developed a very attractive and informative website. 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 no record. The manager said that where a person is funded by social services the resident is just given a copy of the terms and conditions but a copy of this was also not available for this resident. The inspector pointed out that homes usually have the same contract for residents who are self-funding or being funded by social services. The case notes for the two people most recently admitted to the home 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. I asked the manager if she had been to assess these residents prior to their admission and she said she had used the written assessment and had spoken to the social worker. It is good practice to meet and assess the residents prior to their admission as it ensures that the home can confidently meet their needs. The service does not provide intermediate care and so standard 6 was not inspected. Green Trees DS0000010646.V354776.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 using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and wellbeing of the people living in the home is maintained. Risks are assessed and residents treated with respect and their privacy protected. Medication is generally well managed although records show that staff training has not taken place for most staff in the last two years. EVIDENCE: I looked at the care plans for four people living in the home. These documents have been developed further since the previous inspection and 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 on a monthly basis. The most current care plans and monthly reviews are held on the computer and need to be printed off so that they are easily accessible to all the staff. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 12 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 year, although one person had not yet been in the home for a year. It is recommended that each person’s social worker and / or relative are invited to an annual review meeting and this is outstanding from the previous inspection. I also spoke to a member of care staff and they explained that at the moment the key worker system is not being implemented and the staff member stated that she key-works all the residents. It is recommended that a key working system is implemented that enables staff to provide specific support to individual residents. This is also outstanding from the previous inspection. The case notes that I inspected showed that areas of risk were assessed. These included moving and handling, nutrition, infection control and pressure care. The home has also started to keep a record of each persons weight on a monthly basis. I asked a member of staff if anybody’s weight had changed significantly in the last four months. The staff member explained that one person had lost a lot of weight and was receiving medical attention. 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 had not been updated to reflect the current pressure sore. The records did however show that the person had received medical input and had been referred for district nursing input. The manager explained that unfortunately the local tissue viability nurses post is vacant so they cannot access this support. The case notes showed that the home has now set up a separate record of healthcare appointments for each resident. These showed that the residents were receiving primary healthcare input and being referred for specialist input as needed. I spoke to a GP from one of the surgeries accessed by residents in the home. They said the home contacts the surgery appropriately and provides accurate information when they make a home visit. The manager explained that most of the residents can now only access a private dental service and that relatives have been informed of this. One resident has had emergency NHS input to repair some broken dentures. It is recommended that the home liaises with the PCT about dental input. The manager explained that one person in the home is using bedrails. Since the last inspection the home has produced a policy and procedure on the safe use of bedrails. I could see this was being implemented appropriately. 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 Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 13 who moved in very recently and these help to ensure the medication is 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 and guidelines have been put in place to say when this should be administered. The staff training records were inspected for four staff and only one person had received medication training and no training date had yet been identified. 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. The residents survey asked if residents received the care and support they needed. The responses were mainly “always” or “usually”. One person said “I’ve been discharged from hospital even though I was still very ill and the Green Trees staff have nursed me back to health”. One relative did say that they felt the home could have reacted faster to their relatives changing healthcare needs. One questionnaire completed as part of the homes internal quality assurance exercise said that (my relative) “was visited and found to be lying in a wet bed several times”. The standard of care on the day of the inspection was observed to be of a good standard. Green Trees DS0000010646.V354776.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. Residents are supported to enjoy a healthy and nutritious diet that meets their individual needs. Activities need to be further developed to ensure people are offered stimulation on an ongoing basis. 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 majority of questionnaires said that activities were never organised or just sometimes organised. I spoke to the volunteer activities organiser and a carer who had both attended training through the Alzheimer’s Society on the provision of Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 15 activities for people with dementia. It was evident that this had given them some ideas and that they had started to put some of these into practice. It was however necessary to purchase some more equipment and do some more planning in order to have a wider variety of activities available. The manager also explained that an entertainer is coming to the home on a monthly basis and they have also arranged for a physiotherapist to visit monthly to do a gentle exercise class. One relative commented in the survey that they had seen the entertainer and this had provided considerable pleasure for the residents. The staff and residents explained that visitors are made welcome in the home and this was reflected in comments from one relative in the questionnaire who said they felt “warmly received” when they visited the home. The home has a cook and during the inspection lunch was prepared. All the food was home made and used fresh produce. The meal was healthy and nutritious and enjoyed by the residents. Three people needed to be fed in their bedrooms and this was done slowly and carefully. The feedback in the surveys was positive about the food, with everyone saying they usually or always enjoyed the food. One person described the meals as a “five star performance” and another person said, “the meals are individually prepared to meet your needs”. Green Trees DS0000010646.V354776.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 adequate 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 understand the principles of safeguarding vulnerable adults but the homes procedure needs to be amended to reflect current practice. EVIDENCE: The complaints procedure is available in the service user guide and includes details of who complainants can contact. The surveys returned as part of the inspection process showed that the relatives mainly knew how to make a complaint of behalf of the residents should the need arise. The self-assessment completed by the home said that no complaints had been received since the previous inspection. 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. The homes safe guarding procedure was inspected and this Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 17 needs to be amended as it says that the manager would investigate any allegations, whereas the decision on who should investigate would be agreed at an adult protection strategy meeting. 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.V354776.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. 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 the toilet was leaking but the assistant manager explained that repairs had been arranged. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 19 One relative in the survey said that their relative’s room always smelt of urine. I visited the bedrooms and there were no unpleasant odours on the day of the inspection. The care staff said that the carpet cleaning equipment was working well. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 20 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 have access to an ongoing programme of training. 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 there have been no staff changes. On the day of the inspection the volunteer worker was also providing care and the inspector could see that even with her help the care staff were stretched as they were also covering the cleaning duties. It is essential that the domestic post is filled and staffing levels are kept under review when the home is full. The surveys reflected these staffing levels as they mostly said that staff are “usually” available when needed, rather than “always” being Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 21 available. One person said, “there have been occasions when it has been hard to locate a member of staff”. 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. The recruitment records for all the staff were inspected. They all had copies of their ID and a copy of their signed terms and conditions. None of the staff had any record of induction training. All the staff will need to complete a comprehensive induction programme. The manager confirmed that no induction training checklist had been prepared since the previous inspection. Since the last inspection the assistant manager and care staff confirmed that the district nurse had provided training on pressure care and continence support. In addition the manager had obtained information on epilepsy and the team had spent time looking at this. At the time of the inspection no further training was planned for the staff, as confirmed by the manager and assistant manager. Ongoing training is needed on health and safety topics. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 22 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 the manager needs to have the appropriate skills to effectively manage the service. Additional work is needed on staff supervision. The provision of some urgent health and safety training for the staff is needed 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 Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 23 needs to undertake an NVQ level 4 in management and care. She was asked if she had started this qualification and said this had not been booked and she felt she would not be able to pass two of the units. In discussions with the Registered Person at the end of the inspection, the inspector said that the long-term effective management of the service needed to be resolved. 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 had taken place and I was able to see the responses. This raised a number of issues that need to be addressed and an action plan needs to be prepared. The assistant manager explained that he is carrying out the supervision of staff, but using a very basic checklist. This does not facilitate a full discussion of how staff are finding their work and areas for improvement. The assistant manager acknowledged that he needed further training in order to undertake this role. This is outstanding from the previous inspection. The manager and assistant manager said that since the last inspection the only staff training that has taken place on health and safety has been the training of the assistant manager as a fire warden so he can train the rest of the team on fire safety. Staff still need to update their training on first aid, fire safety, food hygiene and moving and handling. This is outstanding from the last inspection. Since the last inspection the fire safety risk assessment had been prepared and had identified some building work that needed to take place to improve fire safety. This work must be completed. Regular fire drills had also taken place. A certificate to confirm the portable electrical appliances had been checked was available. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 2 3 3 x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 3 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.V354776.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 5(1) Requirement Timescale for action 31/01/08 2. OP2 5(1)(b) 3. OP9 13(2) 4. OP12 16(2)(n) The registered person must ensure a copy of the service user guide is given to relatives or other people who represent the resident. The registered person must 31/01/08 ensure each resident or their representative is given a copy of the contract between the home and the resident and it is appropriately signed. The registered person must 28/02/08 ensure all the staff have received medication training from a trainer who can demonstrate that they have the appropriate knowledge. This requirement is amended and restated from the previous inspection. Previous timescale of the 30/09/07 was unmet. The registered person must 28/02/08 ensure the service users have access to regular activities appropriate for people with dementia. This requirement is amended and restated from the previous two inspections. Timescales of the 15/01/07 DS0000010646.V354776.R01.S.doc Version 5.2 Green Trees Page 26 5. OP18 13(6) 6. OP27 18(1)(a) 7. OP30 18(1)(c) 8. OP31 9(2)(b) 9. OP33 24(1)-(3) 10. OP36 18(2) 11. OP38 23(4) and 30/09/07 were unmet. The registered person must amend the safeguarding vulnerable adults procedure to reflect the correct process for investigating allegations of abuse. The registered person must ensure a cleaner is recruited. This requirement is restated from the previous inspection. Timescale of 31/08/07 was unmet. The registered person must ensure all staff have a record of a completed induction training programme. This requirement is restated from the previous inspection. Timescale of 30/09/07 was unmet. The registered person must ensure the manager undertakes the NVQ level 4 management and care training. This requirement is amended and restated from the previous inspection. Previous timescale of the 30/09/07 was unmet. The registered person must collate the results of the annual quality assurance exercise and prepare an action plan. The registered person must ensure all the care staff have regular individual supervision that is a comprehensive two way process and that the person carrying out the supervision has been trained to undertake this role. This requirement is amended and restated from the previous inspection. Previous timescale of the 31/08/07 was unmet. The registered person must complete the fire safety work identified in the fire safety risk DS0000010646.V354776.R01.S.doc 28/02/08 31/01/08 28/02/08 28/02/08 28/02/08 28/02/08 31/01/08 Green Trees Version 5.2 Page 27 12. OP38 13(4) assessment. 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. This requirement is restated from the previous inspection. Timescale of 30/09/07 was unmet. 28/02/08 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. 4. Refer to Standard OP3 OP7 OP7 OP8 Good Practice Recommendations The registered person should meet and assess each resident, prior to their admission to the home. The registered person should arrange an annual care plan review meeting and invite the care manager and relatives. This is restated from the previous inspection. The registered person should operate a key-working system to ensure the needs of each resident are fully met. This is restated from the previous inspection. The registered person should liaise with the local PCT to address dental input for residents living in the home. Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow 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. Extracts may not be used or reproduced without the express permission of CSCI Green Trees DS0000010646.V354776.R01.S.doc Version 5.2 Page 29 - 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. 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