Inspection on 26/01/07 for High Trees Nursing Home

This inspection was carried out on 26th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

High Trees Nursing Home 05/02/08

High Trees Nursing Home 15/09/07

High Trees Nursing Home 07/06/06

High Trees Nursing Home 01/03/06

High Trees Nursing Home 19/12/05

High Trees Nursing Home 04/01/05

High Trees Nursing Home 12/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Trees Nursing Home 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB Lead Inspector Gloria Ashwell Key Unannounced Inspection 26th January 2007 11:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000059925.V328706.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. DS0000059925.V328706.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Nursing Home Address 3 Glenferness Avenue Talbot Woods Bournemouth Dorset BH4 9NB 01202 761380 01202 761189 office@3glenfernavenue.bt.com 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) 3 Glenferness Avenue Ltd Mr Gerard William Martin Thomas Care Home 13 Category(ies) of Dementia (13), Dementia - over 65 years of age registration, with number (13), Mental disorder, excluding learning of places disability or dementia (13), Mental Disorder, excluding learning disability or dementia - over 65 years of age (13), Physical disability (13), Physical disability over 65 years of age (13) DS0000059925.V328706.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Conditions concerning minimum staffing levels remain in force. Schedule of requirements, set out in a separate letter to the provider, to be complied with by 31.12.06. 7th June 2006 Date of last inspection Brief Description of the Service: High Trees is registered with the Commission for Social Care Inspection to provide nursing care for a total of thirteen people with dementia, mental disorder and/or physical disability. The home is situated in Talbot Woods, a residential area of Bournemouth and is close to the shopping area of Westbourne. There is parking space for visitors available at the front of the home. The building is on two floors, with a passenger lift, which enables easy access. Five of the rooms are single rooms and the other four are shared. There is a small comfortable lounge on the ground floor, which is also used as a dining area. Meals are prepared on the premises. There is also an attractive garden and conservatory for residents and visitors use. A nurse is available on the premises at all times and a nurse call system is installed in all rooms. The home is owned by Three Glenferness Avenue Ltd; the registered manager is registered nurse, Mr Gerry Thomas. A hairdresser visits the home each week; there is an additional charge for this service. During each Thursday a reflexologist visits to provide individual private therapy to particular residents; there is an additional charge for this service. A public transport bus stop, for buses to the nearby town centre, is opposite the home. Fees are charged weekly; at present fees range between £600 and £800 per person. DS0000059925.V328706.R01.S.doc Version 5.2 Page 5 Information regarding the subjects Value for Money and Fair Terms in Contracts can be obtained from the web link: www.oft.gov.uk A report entitled Care Homes in the UK - A Market Study is available on web link http:/www.oft.gov.uk/NR/rdonlyres/5362CA9D-764D-4636-A4B1-A65A7AFD347B/0/oft780.pdf DS0000059925.V328706.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. The inspection was unannounced; the inspector arrived at 11.45 and toured the premises, spoke to residents and staff and during discussion with registered manager Mr Thomas examined documentation relating to care provision and the premises. The duration of the inspection was 4 hours. At the time of inspection 11 residents were accommodated in the home. During the inspection, particular residents were ‘case tracked’; for example, for evidence regarding Standards 3, 7 and 8, records relating to the same resident were examined, and the resident spoken with. Additional information used to inform the inspection process included the monthly reports regularly sent to the Commission by the provider organisation. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: High Trees provides a calm and restful home where people with dementia and other mental health needs receive the support and assistance they require from experienced nurses and care staff. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with the local community. The premises are comfortable and homely, with a communal lounge, recently constructed conservatory and attractive garden. Residents say they feel well cared for, staff are kind and helpful to them and they are treated with respect, their privacy is protected and staff understand their needs. DS0000059925.V328706.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. DS0000059925.V328706.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 DS0000059925.V328706.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): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (or their representatives) are provided with information about High Trees and are encouraged to visit in advance of admission to establish their impressions of life at the home and the standard of available accommodation. Prior to admission, the needs of each proposed resident are assessed and recorded. EVIDENCE: The records of a recently admitted resident included details of pre-admission assessment which had been carried out by the registered manager when he visited the prospective resident at a previous address. DS0000059925.V328706.R01.S.doc Version 5.2 Page 10 In advance of making the decision to enter the home the closest relative of the prospective resident visited High Trees to view the premises on the prospective residents behalf because he was too frail to do this himself. It is recommended that following pre-admission assessment and the subsequent decision to offer a place, High Trees should write to the prospective resident confirming the ability to properly care for them. DS0000059925.V328706.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The standard of care is good and in accordance with a written plan of care for each resident ensuring that staff have sufficient information upon which to base their care practice. It is recommended that further information on the management of diabetes is included in the care plan of the resident with this condition, to ensure staff have available sufficient information to guide their work and thereby meet the needs of the resident. Residents health needs are met, all accidents are investigated and periodically audited to minimise risks of recurrence. Medicines prescribed by doctors are safely stored and carefully administered to residents by staff trained in this work, thereby protecting residents from medicine errors. Residents receive prescribed medicines at the correct times and in correct amounts. Residents wishing to do so can manage their own medicines. DS0000059925.V328706.R01.S.doc Version 5.2 Page 12 Residents are treated with respect and their privacy and dignity is protected at all times. EVIDENCE: Residents believe they are properly cared for; comments received from residents during the inspection included “The staff are very kind and will do anything for me”. Care records of 4 residents were examined and contained risk assessments forming the basis for care plans and daily records describing the care of each resident. To ensure correct identification of residents, records contain a recent photograph of each resident. Records are kept of all accidents and in accordance with a recommendation made at the last inspection now include clear and comprehensive details of investigation and consequent actions to minimise risks of recurrence. Medication administration records were properly kept indicating that residents receive prescribed medicines at the correct times and in correct amounts those wishing to do so can manage their own medicines in accord with a risk assessment process; none of the currently accommodated residents manage their own medicines. The handling of medicines is carried out by trained nurses. In the presence of staff residents appeared relaxed, confident and at ease; staff interactions with residents were of a friendly and considerate manner. DS0000059925.V328706.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. Most residents take meals in the communal room on the ground floor; others receive them in their bedrooms. EVIDENCE: The inspector spoke to a number of residents; all indicated satisfaction with the home, including the range of activities, meal provision, staff and premises. Since the previous inspection the home has employed a designated Activities Organiser who arranges one-to-one and small group social and recreational DS0000059925.V328706.R01.S.doc Version 5.2 Page 14 activities. This person works during every weekday between 10.00 am and 4:00 pm. An Occupational Therapist currently visits the home on each Monday and is in the process of assessing the abilities of each resident in order that appropriate recreational and social activities may be provided, tailored to the individual need of each resident. A trained nurse employed by the home has knowledge of aromatherapy and provides this service to residents requesting it. During each Thursday a reflexologist visits to provide individual private therapy to particular residents; there is an additional charge for this service. Visitors of residents are welcome at any time. Residents said they were satisfied with the quality, choice and quantity of food provided; one resident stated “The meals are always good….and there’s plenty to go round”. DS0000059925.V328706.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home adheres to a policy/procedure for the prevention of abuse and all staff have received training in the understanding and prevention of abuse to ensure that they remain vigilant to protect vulnerable residents from such risks. The complaints procedure provides information on the procedure to follow to persons wishing to make complaint and service users know how to complain. EVIDENCE: Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. To ensure residents and their representatives have access to the complaints procedure it is included in the service user guide to the home and a copy is provided to each residents’ relative/representative. Residents know how to complain and feel confident that if they had concerns or complaints they will be listened to and taken seriously. Comments received during the inspection included “I’d go straight to the boss (the registered manager)”. The home keeps records of all complaints received and investigated. DS0000059925.V328706.R01.S.doc Version 5.2 Page 16 The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. DS0000059925.V328706.R01.S.doc Version 5.2 Page 17 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. High Trees is a homely and comfortable home. On the day of inspection the home was clean, pleasant and hygienic and there was evidence indicating that this is the usual standard of provision. EVIDENCE: High Trees is a traditionally built house set amidst gardens, with car parking spaces at the front on the building. It offers good sized bedrooms, bathrooms equipped for the use of persons requiring assistance and comfortable communal rooms. On the day of inspection the home was clean, tidy and comfortable throughout; there were no unpleasant odours. DS0000059925.V328706.R01.S.doc Version 5.2 Page 18 From discussion with service users there was evidence that this is the usual good standard. Since the previous inspection a conservatory suited to year round use has been constructed and provides an additional lounge facility. DS0000059925.V328706.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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home employs enough staff to meet the needs of residents and to ensure their safety and comfort and maintenance of the good condition of the premises. Recruitment practices ensure the protection of residents from potentially unsuitable staff. Staff receive appropriate training and are competent to carry out their jobs. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. Since the previous inspection some working practices have been altered to make better use of staff e.g. an Activities Organiser has been employed enabling provision of more social and recreational activities, and consequently reducing the necessity for care staff involvement at these times. DS0000059925.V328706.R01.S.doc Version 5.2 Page 20 All staff spoken with during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents and are properly supported by the management and training provision. The records of two recently employed staff members were examined and found to contain all essential information including written references, an interview assessment, health details, evidence of identity and of induction training. Criminal Records Bureau (CRB) disclosures are obtained for all staff in advance of employment. The registered manager has an enthusiastic approach to staff training; in addition to the core subjects (fire safety, moving and handling, food hygiene etc.) some staff have received training in urinary catheter management and pressure sore prevention and treatment and arrangements have been made for all nursing and care staff to undertake training in dementia care. The home therefore meets the standard for at least 50 of the nursing/care staff to hold an NVQ or other qualification in care. DS0000059925.V328706.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): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and suitably staffed, and provides residents with a good quality of life. Residents are satisfied with the home and feel staff care for them well and put them at their ease. The home does not manage the finances of residents. The premises and equipment are properly maintained in good condition. DS0000059925.V328706.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the previous inspection Mr Gerry THOMAS has become the registered manager of the home; he has extensive experience in the care of older persons and is well regarded by residents and staff. Systems for quality assurance have been developed and are undergoing implementation to ensure that the home continues to meet good standards. To ensure continuity of approach the home operates in accord with a selection of policy and procedure documents. With the exception of safe keeping some amounts of cash (for which all transactions are confirmed by receipt), the home does not manage the finances of residents. Staff trained in emergency aid are on duty in the home at all times. All staff are supervised and each has a personal profile containing records of appraisal. Details of equipment servicing and maintenance were provided to the Commission in advance of the last inspection. The home has commenced recording of a Health & Safety risk assessment of the premises and working practices; the inspector provided advice on the areas for which this should be expanded to ensure all foreseeable and known risks are included, and the means of managing them. DS0000059925.V328706.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000059925.V328706.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations It is recommended that following pre-admission assessment and the subsequent decision to offer a place High Trees should write to the prospective resident confirming the ability to properly care for them. It is recommended that further information on the management of diabetes is included in the care plan of the resident with this condition. 2. 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