This inspection was carried out on 27th October 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.
CARE HOMES FOR OLDER PEOPLE
High Trees Residential Care Home 24 Clay Hill Enfield Middlesex EN2 9AA Lead Inspector
Tony Brennan Unannounced Inspection 27th October 2005 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 High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service High Trees Residential Care Home Address 24 Clay Hill Enfield Middlesex EN2 9AA 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 8363 2238 Mr Khemchand Prakash Hurril Deborah Olive Hurril Care Home 12 Category(ies) of Old age, not falling within any other category registration, with number (12) of places High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: High Trees is a registered care home, which provides care for 12 older people of mixed gender. Mr Khemchand Hurril owns the home. The home is situated in a residential area in Enfield and is easily accessible by public transport. The premises is constructed of two floors with the lounge and dining areas on the ground floor. There are five bedrooms on the ground floor and five bedrooms upstairs. Two bedrooms are shared. There is a very attractive large conservatory at the rear of the property, which leads onto a well maintained garden and patio. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the four areas for improvement found at the last inspection were addressed. The inspection took place over one day. The inspector spoke with four people who live at the home and three staff. The inspector also spent time observing the care being given and the interaction between staff and people living at the home. The inspector toured the building and examined a range of records relating to the care and management of the home. What the service does well: 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. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 6 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 High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 7 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): N/A These standards were not inspected on this occasion. EVIDENCE: High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 8 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 10 Service users do not have sufficient information on how their needs are met. Service users dignity and privacy is always maintained. EVIDENCE: The inspector examined four files for service users admitted to the home since the last inspection and found that three had no care plan to explain how their needs should be met. Two of these service users said that they had had falls prior to admission to the home. The inspector found that this had been highlighted as a reason for admission in the initial assessment of need, but no falls risk assessment or prevention plan had been put in place. Service users said that staff respect their privacy and always knock on their bedroom doors. Service users also said that staff take time to ask how they wished to be assisted. Staff understood how to assist service users in a way that ensures that their privacy is maintained. The inspector observed staff interaction with service users and found that they were accorded respect. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 9 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Service users are provided with sufficient and varied activities, but service users felt that they had not been supported to express their religious beliefs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are able to make choices about how they live in the home. Service users are provided with a choice of varied and balanced meals. EVIDENCE: Service users confirmed that a range of activities were offered. Service users have their own daily newspapers. Service users said that they were not restricted as to what times they get up or go to bed. A service user spoken to had not been able to contact the priest and was not able to watch Songs of Praise on the television. The service user’s initial assessment identified her religious needs and that they had regular contact with the priest while in hospital. These issues were raised with the registered manager. Service users spoken to confirmed they had a choice as to whom they wished to see. Service users also said that there were no restrictions on visiting times. Service users spoken to confirmed that they could make choices and control their lives. Service users said the quality of the food was good. Since the last inspection the menu had been reviewed and now reflects the preferences of service users.
High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 10 The menu showed that varied and balanced meals were offered. Service users said they were consulted about the choices being offered each week. The inspector saw that meals were well presented and they were provided in a relaxed environment. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. EVIDENCE: High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 30 Staff do not have the skills to meet all the needs of service users. EVIDENCE: The inspector was able to confirm that most staff are now working towards the NVQ in care. Staff spoken to were positive about the benefits of doing this course. The manager explained that there still needs to be training on first aid. Training had taken place on infection control, health and safety, and care practice. The home has a detailed training analysis of the skills needed to meet the needs of service users. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 The manager has the necessary qualifications to manage the home effectively. Service users have been consulted about the quality of the service provided and encouraged to make suggestions for improvement. Service users financial interests are protected by the home’s procedures. EVIDENCE: The manager has completed the Registered Manager’s award and has a nursing qualification. Service users and staff said that the manager was supportive and understanding of their needs. Service users spoken to said they had been consulted about the quality of the service provided. The home has a system in place for consulting service users on the quality of the service. The inspector saw examples of a recent survey of service users and relatives views of the service provided by the home. These were generally positive. Either relatives or social service departments manage most of service user’s money. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 15 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 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 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 16 yes Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15(1) Requirement The registered persons must ensure that all service users have a care plan that outlines their needs and how these should be met. The registered persons must ensure that a falls risk assessment and prevention plan is in place for all service users at risk of falling. The registered persons must ensure that service users are supported to express their religious beliefs. The registered persons must ensure that staff have training on first aid. (The time scale of 01/10/05 was not met). Timescale for action 01/12/05 2 OP7 15(1) 01/12/05 3 OP12 16(3) 01/12/05 4 OP30 18(2)(a) 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 17 1 OP28 The registered persons should ensure that 50 of staff achieve NVQ at level 2 in care by 31/12/2005. High Trees Residential Care Home DS0000010570.V265558.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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