Inspection on 01/12/05 for Tall Trees

This inspection was carried out on 1st December 2005.

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 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

Tall Trees 19/07/05

Tall Trees 20/12/04

Tall Trees 02/07/02

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Tall Trees Tall Trees Guildford Road Chertsey Surrey KT16 0PL Lead Inspector Sandra Holland Announced Inspection 1st December 2005 10:30 Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 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 Tall Trees DS0000013812.V257389.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 Adults 18-65. 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. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tall Trees Address Tall Trees Guildford Road Chertsey Surrey KT16 0PL 01932 844044 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) Welmede Housing Association Ltd Mrs Jennifer McArthur Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (1) of places Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The age/age range of the persons to be accommodated will be 30-65 Years One service user can be accomodated who is over 65 years of age. Date of last inspection 19th July 2005 Brief Description of the Service: Tall Trees is a residential home for up to 3 adults who have learning disabilities. The service is managed by Welmede Housing Association and the staff are employed by the North Surrey Primary Care Trust (NSPCT). The service is a detached property and the facilities and accommodation are set on two floors. There is no mechanical means to access the upper floor and none is required for the existing service users. All service users have a single bedroom and access to a separate lounge, dining room and kitchen. There is a garden area to the rear and front of the house. The location of the home is near to a busy motorway and roundabout and is such, that transport is required for all activities and appointments. The service users living at the home require full support and supervision from staff for all their daily living activities, both inside and outside of the home. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. As the inspection was announced, everyone at the home should have been aware that it was taking place. The inspection was carried out over a period of five hours by Mrs. Sandra Holland, Lead Inspector for the service. Mrs. Jennifer McArthur, Registered Manager was present representing the service. A number of records and documents were examined, including individual plans, a number of policies and procedures and staff training records. All three service users and two members of staff were spoken with. Further information was gathered from the pre-inspection questionnaire that was supplied to the home. This was completed and returned to CSCI within the timescale provided. A number of CSCI comment cards and addressed envelopes were also supplied to the home. These were to be sent or given to service users’ families or friends and to healthcare professionals involved in the support of the service users. This provides an opportunity for independent feedback to CSCI of views on the quality of the service provided. Two CSCI comment card responses were received from relatives of service users, and one from a general practitioner (G.P.), all of whom were very complimentary and praised the staff for the service they provide. Service users were also provided with their own CSCI comment cards, to enable them to give their views on their home. One service user was assisted to complete his comment card by a parent and two were assisted by their key workers. The responses received from all three service users stated that they were happy in their home and feel safe and well cared for. The inspector wishes to thank the service users and staff for their time, hospitality and assistance. What the service does well: The service users are very well supported in a person centred way, by staff who have a very good understanding of their needs. Staff create a family style atmosphere within the home, to the benefit of the service users. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 6 Meals and refreshments are served in a comfortable and welcoming dining room, with an attractively set table. Service users are actively encouraged to be as independent as possible and to make their own choices. 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. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Any prospective service user would be fully assessed to ensure the home could meet their needs. EVIDENCE: The manager advised that the three service users living at the home have lived there since it opened, a number of years ago. She stated that there is a clear policy which specifies the steps to be taken when a vacancy occurs and a prospective service user is considering joining the home. It was clear that the manager was aware of the requirements of the policy, which include assessing and being able to meet the needs of a prospective service user, ensuring family or other supporters are involved in the process, and ensuring appropriate funding is in place. The manager also advised that the prospective service user would be introduced to the other service users very gradually, over a number of visits to ensure that they were not unsettled by the newcomer. This would also enable staff to fully assess the needs of the prospective service user. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The needs of service users are recorded in detailed individual plans which include assessments of risks to the service users. Service users are fully supported to make decisions. EVIDENCE: A very comprehensive and detailed plan of the individual needs of each service user has been drawn up. These state the specific support each service user needs in all areas of their lives, including personal care, social support, maintaining relationships, communication and health. These named areas are then divided into smaller areas. For example health is divided into physical and mental health needs, dietary needs, foot-care, dental care, hearing and sight. It was pleasing to see the amount of useful detail that was included in the individual plan. For one service user, the dates of his parent’s birthdays are noted in the area relating to relationships. This also refers to guidance for the service user’s key worker, to support the service user to buy presents and send cards. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 10 The information contained in the individual plan was very person centred and showed a thorough understanding of the person. This included the service user’s likes and dislikes in many areas, and the behaviours that may be shown, why they may occur and how to manage them. A record of the service user’s consent to receive support, care and treatment is included in the individual plan and has been signed by service users’ representatives on their behalf, for service users who are not able to sign for themselves and by the manager. The manager stated that any risks to the service users are identified, assessed and minimised as far as possible. The assessments seen covered the risks that had been identified throughout the individual plan, such as the risks of choking, of slipping, tripping or falling and of lack of awareness of dangers. The manager advised that any new risk that is identified would be assessed immediately. Staff advised that service users are supported to make decisions about their daily lives. Due to the disabilities of the service users, the decisions need to be presented in a clear and simple way, such as offering pictures of foods for meals, showing a choice of clothes and offering a choice of items when out shopping. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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 and 17. Service users take part in a range of activities and are part of the local community. A well-balanced and varied diet is offered to service users. EVIDENCE: The manager stated that service users take part in a planned programme of activities, which includes ten-pin bowling, horse-riding, reflexology and until recently, swimming. The time of the swimming session has been changed and now clashes with service users supper time, so is not being taken up at present, staff advised. Some of the activities are arranged for the service users as a group, but other activities are arranged on a one to one basis. An additional “floating” support worker is provided for a short periods each week by Welmede, the organisation that runs the service. This provides the opportunity for individual support, which is very much enjoyed by the service users, staff stated. In addition to arranged activities, service users are supported to be involved in the everyday, household activities, such as shopping, laundry and domestic Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 12 tasks, staff stated. All of the service users enjoy going out in the household car and staff actively involve service users when they are going out on errands or collecting another service user from an activity. The service users are supported to take part in the community and enjoy visits to local pubs, shopping centres and restaurants, as well as picnics, trips to the seaside and to the river nearby. The service users go to a local barbers to have their cut and the staff there have developed an understanding of the service users needs. From the menus supplied with the pre-inspection questionnaire, it is clear that service users are offered a nutritious and healthy diet. Staff advised that they take the service users’ needs and likes and dislikes into account when planning meals. Service users make their own choices for breakfast and lunch, with just the main evening meal planned in advance for practical reasons. Service users were observed to make their own choices and to be encouraged to be independent, with regard to helping themselves and clearing their things from the table. It was pleasing to see service users and staff sitting together family style for meals, in a relaxed but appropriate manner. Service users were cheerful and chatty in their interactions with staff. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. Service users’ healthcare needs are well met. EVIDENCE: It was clear from speaking to staff and from looking at individual plans that service users are supported by a number of healthcare professionals. These include a G.P., psychiatrist and dentist. The manager stated that the local G.P. is very understanding of the needs of the service users and has advised staff of a specific, quiet time at the surgery when he would always be available. He is also willing to visit service users at home as he knows that they can become anxious on visits to the surgery. If a service user is not happy to be examined when the doctor visits, he returns later, when they have had time to relax, the manager advised. This had been necessary recently, when the G.P was carrying out annual healthcare checks for the service users. Records showed that if any change was noted in a service users’ health, this was attended to promptly and appropriately. The manager advised that the service users’ dentist had recently notified them that treatment could not be provided unless the service users gave their consent. Discussion took place with the manager about the difficulties in Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 14 obtaining service users’ consent. As this issue may deny service users treatment, it is advised that this is resolved as soon as possible. It is likely that service users in other Welmede homes are also affected by this decision, and it may be useful for the organisation to liaise with dentists to establish a way forward. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. A complaints procedure is in place. EVIDENCE: Although a written complaints procedure is available the service users are not able to use this, the manager stated, due to the limitations of their disabilities. Staff stated that service users are able to communicate their unhappiness in specific individual ways, which are known to staff. This would usually be shown by a change in behaviour, which staff would monitor, to establish the reason it has developed. A record of complaints is held but no complaints had been recorded. The service user comment cards had been marked to show that service users knew who to speak to if they were unhappy. It is recommended that the complaints procedure is made available to service users’ families or representatives, as from the CSCI comment cards received, one stated that the person was not aware of the complaints procedure and one was left blank at that question. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24. The home was attractively decorated. EVIDENCE: It was pleasing to see the home so attractively decorated for Christmas, with a Christmas tree in the lounge and a number of colourful light arrangements, both in and on the home. Areas of the home that were seen were very well presented, clean and freshly aired. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Staff recruitment and training are effectively managed. EVIDENCE: The manager stated that as the staff team has been stable, no staff have been recruited during the last two years. A member of staff had transferred to the home earlier this year, from the Welmede home next door, for personal reasons. Prior to the transfer, the manager had met with the member of staff and a number of shifts had been worked by the staff member to ensure compatibility with the service users, the manager stated. Staff at the Welmede homes are employed and managed by the North Surrey Primary Care Trust (NSPCT),so the member of staff has transferred under the same employment. Individual staff training records are held and were seen. Training has been undertaken by staff that is required by law, such as first aid and fire safety training and to develop knowledge and skills such as National Vocational Qualifications (NVQ’s) and the control of substances hazardous to health (COSHH). The majority of the staffing team have achieved an NVQ in care, to level 2 or above, ensuring the target figure of 50 is met. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 40. A new quality assessment system is to be introduced. Some of the policies and procedures in the home have been up-dated. EVIDENCE: The Welmede organisation have advised that a new system of reviewing the quality of the service provided, is being developed and is being introduced to all the homes. The manager stated that this has not been supplied as yet. It is recommended that this is obtained and carried out. The majority of the home’s policies and procedures have recently been reviewed and revised if necessary, the manager stated. It was noted that the policy on abuse was dated for review in 2002 and referred to National Care Standards Commission. It is recommended that this be reviewed and revised. Staff advised that they sign to confirm that they have read the homes policies and procedures and new versions as they are issued. Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 2 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tall Trees Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x 2 2 x x x DS0000013812.V257389.R01.S.doc Version 5.0 Page 20 NO 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. 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 2 Refer to Standard YA22 YA39 Good Practice Recommendations It is recommended that a copy of the complaints procedure is supplied to the family or representative of each service user, on their behalf. An effective system of reviewing the quality of the service provided should be set up and maintained. This should provide for consultation with service user and their representatives. It is good practice to review and revise policies and procedures to ensure they meet up to date requirements. 3 YA40 Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Tall Trees DS0000013812.V257389.R01.S.doc Version 5.0 Page 22 - 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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