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Inspection on 31/05/05 for High Trees Residential Care Home

Also see our care home review for High Trees Residential Care Home for more information

This inspection was carried out on 31st May 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People living at the home said that staff understood their needs. The home ensures that service users needs are assessed and planned for. People who live at the home felt that their views were listened to and that staff ensured their safety. The home provided a safe and well-maintained environment. Those living at the home said their bedrooms were well decorated and the inspector saw that the bedrooms were personalised.

What has improved since the last inspection?

The inspector found that all the eight areas for improvement identified at the last inspection had been addressed. The home now has a statement of terms and conditions that give all the information on the rights and responsibilities of those living at the home. The people living at the home told the inspector that they had been consulted about the help they need. There is detailed information available on the needs of those living at the home. Staff who had recently started at the home said they received a detailed induction. The inspector was able to see information that confirmed the home`s financial stability. The home has been refurbished and has the necessary adaptations to meet the needs of those who live there.

What the care home could do better:

This inspection identified four areas where the home needs to make improvement. Those living at the home felt that the menu did not provide a varied diet. Staff need to receive training in care to the National Minimum Standards. Staff also need training in first aid. Testing needs to be carried out to prevent the risk of infection.

CARE HOMES FOR OLDER PEOPLE HIGH TREES RESIDENTIAL CARE 24 Clay Hill Enfield Middlesex EN2 9AA Lead Inspector Tony Brennan Announced 31 May 2005 @ 10.00am 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 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 Version 1.10 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 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 Hurril PC Care Home Only 12 Category(ies) of OP Old Age registration, with number of places HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9 September 2004 Brief Description of the Service: High Trees is a registered care home, which provides care for 12 older people of mixed gender. Mr. K. 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the eight areas for improvement found at the last inspection were addressed. The inspection took place over one day. The registered persons assisted the inspector. The inspector spoke with seven people who live at the home, two relatives and three staff. 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 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 Standards Statutory Requirements Identified During the Inspection HIGH TREES RESIDENTIAL CARE HOME Version 1.10 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 standard(s) 1 2 3 4 5 Services users and prospective service users are provided with comprehensive information about the service so that they can choose if they want to live there and are clear about what services are offered. All service users have a contract outlining their rights and responsibilities while living at the home. Service users needs are assessed prior to admission to the home. The home meets all the assessed needs of service users. Service users visited the home prior to admission to determine if it could meet their needs. EVIDENCE: The inspector spoke with service users and one relative who confirmed that they understood how the home would meet their needs. The statement of purpose and service users guide contained all the required information and was clearly written. The inspector examined four files of service users who had recently entered the home. These all contained assessments from the home, social workers and medical professionals. These provided information on the needs of service users that had been used as the basis for care plans. The statement of terms and conditions has been updated since the last inspection and now includes all the information required as outlined in the standard. The inspector examined service user files, which contained signed copies of the statement. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 8 Service users spoken to said that the staff understand their needs. There was a clear assessment and care plans to identify and detail how the needs of service users should be met. A service user who had recently come to live at the home said that they had visited prior to deciding to enter the home. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 Care plans provided detailed information on how the needs of service users would be met. The medical needs of service users are being met. Service users are protected by safe procedures for handling medication. EVIDENCE: Since the last inspection care plans have been updated so that they contain more information on how the needs of service users should be met. Service users spoken to said that staff understood their needs and that their care plans had been discussed with them. The inspector found that since the last inspection the care plans had been signed by service users or their representatives to show that they had agreed the care plans. Care plans are reviewed monthly and this was recorded. A service user spoken to said that staff understood their personal care needs. The records of medical treatment were detailed and showed that the appropriate medical attention had been provided. There were records which showed that a service user with a pressure sore had received appropriate treatment with the support from the district nurse. Falls and manual handling risk assessments were in place. The inspector found that a number of service users had been assessed for self administering their creams and inhalers. The records of medicines received, administered and returned were complete. The medication policy was HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 10 complete. Staff had received training and a list giving the names of those staff who had received training was seen. The registered manager explained that further training had been planned. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The dietary needs of service users is not met in that service users are not offered a sufficient range of choice of meals. EVIDENCE: The inspector spoke with three service users who felt that the meals offered were repetitive and boring. The inspector discussed this with the registered manager who agreed to review the menus with service users. Service users confirmed that they were consulted about the choice of meals offered. The inspector observed that lunch was offered in a relaxed atmosphere with staff providing support in a sensitive manner. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 12 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 standard(s) 16 18 Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse by the policies and procedures in place in the home. EVIDENCE: Service users said that they felt confident in making their concerns known to staff. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. Service users said that they felt safe and could approach staff if they had any concerns regarding how they are treated. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. Records showed that staff had received training on adult protection and further training is planned. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 13 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 standard(s) 19 22 24 26 The home provides service users with a safe and well-maintained environment. The home is adapted to meet the needs of service users. Service users bedrooms are comfortable and they have their personal possessions. Service users live in a clean and hygienic home. EVIDENCE: Since the last inspection the old vanity units had been replaced. A programme for the routine maintenance of the home is in place. The garden was tidy and safe. The inspector found that the home was adapted to meet the needs of service users. Service users were able to access all areas of the home. Service users bedrooms are appropriately decorated, furnished and carpeted. The bedrooms seen were personalised. Service users commented that they had chosen the items they wanted in their bedrooms. The inspector found that the home was clean and hygienic. Staff spoken to understood how to prevent cross infection and equipment was provided for this purpose. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 30 Sufficient staff are available at all times to meet service users needs. Staff don’t have all the skills and knowledge necessary to meet the needs of service users which places people at risk of their needs not being fully met. Service users are protected by the home’s recruitment practices. EVIDENCE: The rota was seen and showed that a consistent staffing level was being maintained. There are two staff and a manager on duty throughout the day. Service users spoken to said that they felt there were enough staff. Training records showed that two staff have achieved NVQ level 2 and one member of staff has NVQ level 3 in care. Another three staff are doing the qualification. The home needs to get 50 of staff qualified to NVQ level 2 in care. The inspector spoke with staff and found that they understood and knew how to meet the needs of service users. Since the last inspection an induction process is in place that is in line with the national guidance and standards on induction. Training records showed that the necessary statutory training had been provided, apart from first aid. Since the last inspection there had been training on care planning. Staff files were checked. These were found to contain all the required information. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 36 37 38 Service users are safeguarded by the accounting and financial procedure in place. Staff are appropriately supervised so as to protect service users. Records are maintained to ensure the rights of service users are met. Generally service users and staff health and safety is promoted. EVIDENCE: The registered person was able to show the inspector accounts for the home that confirmed its financial viability. Certificates for insurance were seen that confirmed the appropriate insurance was in place. All records seen were up to date and accurate. The records of supervision showed that all staff had not received supervision regularly. The inspector found that staff had training on health and safety topics. The hoists had been checked and first aid boxes had all the necessary items. Fire procedures and a risk assessment were in place. The inspector examined the home’s records and found that the alarm system had been inspected and checked regularly. Fire drills had occurred regularly and were recorded. The HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 16 training records showed that staff had received training on fire prevention. The necessary records of food temperatures and of the fridge and freezers had been maintained. Gas and electrical certificates were seen and in date. Testing had not taken place for Legionella. The home had all the necessary policies and procedures in place to ensure the safety of service users and staff. HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x 3 x 3 3 2 HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 18 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 15 Regulation 16(2)(i) Requirement The registered persons must ensure that the menus are reviewed to ensure they offer a varied diet that reflects the preference of service users. The registered persons must ensure that 50 of staff achieve NVQ in care at level 2. The registered persons must ensure that staff have training on first aid. The registered persons must ensure that the testing for legionella is carried out. Timescale for action 1/10/05 2. 3. 4. 28 30 38 18(2)(a) 18(2)(a) 13(3) 1/12/05 1/10/05 1/9/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 19 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI HIGH TREES RESIDENTIAL CARE HOME Version 1.10 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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