Inspection on 13/03/07 for Tall Trees

This inspection was carried out on 13th March 2007.

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 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 23/11/05

Tall Trees 24/05/05

Tall Trees 23/11/04

Tall Trees 02/06/04

Tall Trees 05/11/02

Similar services:

Southfields

Thorndene

Insight - Eastchurch

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 148 De La Warr Road Bexhill-on-Sea East Sussex TN40 2JP Lead Inspector Debbie Sullivan Key Unannounced Inspection 13th March 2007 09.15 Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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 DS0000021236.V312100.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 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 DS0000021236.V312100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tall Trees Address 148 De La Warr Road Bexhill-on-Sea East Sussex TN40 2JP 01424 211990 01424 819104 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) www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Karen Billings Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is six (6) Service users must be aged between eighteen (18) and sixty-five (65) years on admission Service users with a learning disability only to be accommodated. Date of last inspection 23rd November 2005 Brief Description of the Service: Tall Trees is a detached property in a residential area of Bexhill. It is located on the main road to St. Leonards-on-Sea and Hastings, within easy walking distance of shops and local amenities. A secluded rear garden is accessed via steps from a patio area. The home provides twenty-four hour residential and social care for six adults with learning disabilities; there are opportunities for service users to attend local day services and participate in community and social activities. It is one of around 80 homes owned by the Care Management Group, providing services for people with learning disabilities who may also present challenging needs. Service users private accommodation is on two floors. Each bedroom is provided with en suite facilities. There is no passenger lift and Tall Trees would not be suited to service users with restricted mobility. The home has a rented car used to transport service users. There is a parking area at the front of the building, sufficient for a small number of vehicles. The fee for the service ranges from £757.53 per week to £1,400.00 per week. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was carried out over 6 hours. During the visit time was spent with the team leader, members of the support staff and service users, as well as the team leader two members of staff were spoken with individually. Three service users were present throughout the visit; others were out at day activities, a hospital appointment and bowling, or undertaking a daily walk. A tour of the property took place and a sample of care plans and other documentation and records was read. Throughout the inspection staff were helpful in supplying information and the usual routines of the house ran smoothly whilst workmen were present inside and outdoors, painting and mending the roof. At the time of the site visit the home was fully occupied and well staffed by permanent and bank Care Management Group staff. What the service does well: What has improved since the last inspection? Procedures for recording the administration of medication have improved with a procedure in place for the manager or deputy to check the completion of MAR sheets daily. A new manager for the home has become registered. Care plans are more regularly reviewed and staff supervision takes place more frequently and is recorded. The lounge and three bedrooms have been redecorated. During the site visit two stairways and the hall were being painted and repairs being made to the roof. New furniture has been ordered for the lounge/dining room and some bedrooms. Fire doors are no longer propped open. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 6 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 DS0000021236.V312100.R01.S.doc Version 5.2 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 DS0000021236.V312100.R01.S.doc Version 5.2 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): 1,2,3,4 and 5 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users are able to access information about the home and spend time there before choosing to move in. Needs are fully assessed prior to admission. EVIDENCE: The home has a statement of purpose and each service user is provided with information about the service. Most of the service users have lived at the home for a number of years; a service user who moved in mid 2006 had spent time at the home, and had a trial stay before they chose to move in. Care plans read contained comprehensive assessments and a large amount of information had been obtained before the decision was made to admit the most recent resident. Care plans contained contracts between the home and the sponsoring authority, and a service user spoken with who had moved from another residential service said they much preferred Tall Trees as they did more than before and liked the home as it was not so crowded. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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): 6,7,8,9 and 10 The quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Service users are supported to make decisions about their lives and to be involved in the running of the home. Care plans are up to date and reflect goals and needs in depth. Information is kept confidentially and is accessible to service users. EVIDENCE: Each service user has a care plan, up to date health and relevant personal information and risk assessments are also held on individual files for ease of access. The care plans of three service users were read along with the health information, all had been completed to a high standard and the information was clear, easy to find, comprehensive and regularly reviewed. Service users all have a keyworker. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 10 Life plans are being completed with each service user and one had already been compiled with a good deal of personal contribution from the service user giving very good insight into their views, needs and interests. Staffing levels allow for one to one support to be regularly provided and service users are supported at a level that matches their ability, for example with managing personal finances, accessing the community, housework and personal care. Service users are advised of any risks involved in activities and one service user who goes out alone had been encouraged to think about risk in the winter when it is cold and dark, whilst being supported in continuing to go out earlier in the day. Thorough risk assessments are in place for individual and house activities, and service users are involved in the running of the house as far as possible. They are consulted daily about meal choices and key workers meet monthly with service users to discuss their views and any issues they wish to raise. Service users help with the housework dependant upon ability and are consulted about activities and outings. Information about service users is stored and treated confidentially with service users having access to personal records. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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): 11,12,13,14,15,16 and 17 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are able to participate in activities of their choice within the house and community and independence is promoted. Service users are involved in menu planning and meals are healthy and nutritious. EVIDENCE: Each service user has a weekly programme that is individually tailored to include activities that they enjoy, encourage independence and community participation out of the house. Staff take service users out on a one or two to one basis and activities include swimming, shopping, bowling, going out for meals, attending a day service and visiting the library. During the site visit one service user was at their day service, another went out bowling and had a hospital appointment, and a third was out much of the time on their daily walk in the local area. Those who remained at home Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 12 enjoyed watching TV or listening to music whilst doing craft based activities such as rug making. The house has a hired car and there are plenty of opportunities to go out. Each service user has an annual holiday supported by staff, venues have included the Isle of Wight, Butlins and the team leader said one service user hopes to go to the Lake District this year. Not all service users have relatives or friends who are able to visit, one service user has very regular visits and phone calls and any contact is welcomed. The team leader said that investigations were to be made into the whereabouts of the family of one service user who had had no contact for some time, but this would be managed extremely carefully. Throughout the site visit staff were respectful towards service users and acknowledged their preferences such as wishing to stay in their room, whilst offering opportunities for involvement or to go out, although understandably access to some bedrooms was a little temporarily curtailed due to the stairway being decorated. Meals are healthy and varied, service users are consulted weekly and daily as regards choices, meals are freshly cooked and there are plenty of fruit and vegetables. Service users chose their lunch during the visit and it was clear that those with limited verbal communication are able to make their choices known by gesture and demeanour and that staff understand these. Service users assist with the shopping and one service user went out with a staff member during the visit to the supermarket. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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): 18,19 and 20 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Health and personal care needs are well met and documented. Preferences are recorded and any health concerns promptly addressed. EVIDENCE: Health and personal care needs are clearly and thoroughly documented on care plans and in the health file. Preferences are recorded and where they cannot always be met compromise is reached, for example a service user who prefers to be assisted with bathing by more mature staff, is supported by younger staff if on occasions only they are available, with them being outside the bathroom to offer help if needed. Service users vary in the amount of personal care each requires, during the site visit those needing help were gently prompted or helped discreetly. Health needs are very well supported and staff are knowledgeable about each persons’ health issues and needs. The involvement of outside professionals is sought where needed, for instance recently in respect of bereavement leading to changes in behaviour, and the need for corrective eye surgery. Care is taken Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 14 to ensure that any health problems are promptly dealt with or referred on and records included contacts with the GP, consultants and community nurses. Where health problems could compromise quality of life or activities staff try to minimise consequences, for instance the service user who enjoyed rug making was not able to read a pattern so a member of staff had handwritten it out, the service user clearly appreciated this. Medication is given by staff trained to do so and all stored correctly with the exception of some external creams that were stored in a cupboard containing food, the team leader took immediate action to store them safely in the medication cupboard. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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 and 23 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users have opportunities to raise any concerns or complaints. Service users are protected from harm by the policies and procedures in place and the homes’ recruitment processes. EVIDENCE: The home has a complaints procedure that is on display. Some service users are very able to make any concerns known, whilst others would require more support. To enable all service users to have opportunities to raise any concerns keyworkers spend time on a monthly basis with each service user to discuss any dissatisfaction or problems they may have with the service. No complaints had been recorded since the last inspection and there were no adult protection alerts in relation to the home. Some service users display challenging behaviour on occasions, staff are trained to manage this and are careful to protect the more vulnerable people. There is an adult protection procedure in place and some staff had received adult protection training. Staff newly recruited are subject to CRB and POVA checks before commencing work. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 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): 24,25,26,27,28,29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a pleasant environment for service users to live in and is well maintained. Individual space is personalised and reflects personal interests. The resiting of the laundry must be kept under review by the service. EVIDENCE: The house is well maintained, clean and well furnished. A programme of ongoing maintenance is in place and during the site visit outside contractors were mending the roof, and a member of the internal maintenance team was painting in the house. Service users’ individual rooms were all clean and tidy and included lots of personal items reflecting interests, some new bedroom and dining room furniture was on order. Most bedrooms are on the first floor with one on the Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 17 ground floor occupied by a service user with restricted mobility. One service user spoken with said they were very happy with their room and liked the house. The kitchen had been replaced at the time of the last inspection, it was cleaned to a good standard and an annual deep clean is recommended. There is a pleasant garden with a patio area, the main garden is accessed via rather steep steps, the organisation needs to consider accessibility to it for service users as they age and any mobility problems become more apparent. The house offers space for service users to be with others or to be private and there is a small quiet room adjoining the kitchen, the team leader said that one service user in particular likes to use it. The laundry is sited in a small storage area off the kitchen; the home has looked into resiting it into another storage room and although this had been a previous requirement it is assessed by the service as not possible to implement due to physical restrictions within the property, should major refurbishment take place this must be reconsidered. Measures are in place to minimise any risk of infection and laundry is never done at times when food is being prepared or eaten. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 18 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): 31,32,33,34,35 and 36 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A competent staff team who like working at the home supports service users. Staff are well supported and supervised. Training needs to be made easily accessible to all staff in Adult Protection. EVIDENCE: Service users are supported by a staff team who are clear about their roles and are confidant in working with them. The home is well staffed and whilst bank staff are regularly used, they are those very familiar with the home and service users. During the site visit the team leader stated that agreement had just been given to the employment of a new full time staff member. Staff spoken with felt there were enough people on duty and they were able to give sufficient time and opportunities to each service user. A sample of staff files was read, each included the necessary checks and documents and a records of supervision and training. Staff are not employed until CRB checks are through and a period of induction is given. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 19 Staff felt well supported and enjoyed working at the home, comments was that “The residents are brilliant” and “I love it, there is more responsibility than where I was before”. The organisation has a comprehensive training programme and some staff had recently had updates on some mandatory topics, first aid training was due in April 2007. A range of service specific topics is also provided such as risk assessment and epilepsy. Two staff members are awaiting verification of NVQ in care level 2;more staff will need to complete this to meet the required 50 of staff with the qualification. Adult protection training was available and some staff had done the course although others need to complete it and no local venue for it was arranged, the nearest was in Kent. Staff relate well to service users and are genuinely interested in their welfare and well being. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 20 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): 37,38,39,40,41,42 and 43 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The health, safety and welfare of service users and staff are protected by the homes policies and procedures, and safe working practices are employed. Quality assurance is seen as important and service users and staff are asked for their views. EVIDENCE: The manager was unavoidably not present for the site visit, the team leader in charge was very competent in managing the home in her absence, and the deputy manager came on duty in the afternoon. The manager has become registered since the last inspection. The home has a friendly and homely atmosphere and service users are consulted about it’s running. Safety checks are done thoroughly and recorded, Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 21 and fire practices are held quarterly, records of these were read and an inspection by the fire authority had recently taken place. Safe working practices are followed and any incidents or accidents recorded, a recent incident where a service user had exhibited a brief period of aggression was well documented. The organisation undertakes monthly Regulation 26 visits, and staff and senior staff meetings are held. Organisational and service specific policies and procedures are in place, and the home takes quality assurance seriously, surveying service users and staff annually, the team leader said that outside professionals and relatives were also soon to be sent survey forms. A programme of maintenance is in place and work is taking place to improve the property. A valid insurance certificate is displayed. The attitude of staff was that the welfare and health and safety of service users are highly important and any concern or risk is reported and addressed. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 2 30 2 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 3 3 3 3 3 3 Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? The requirement made at the last inspection regarding resisting of the laundry R 16(2)(j), cannot be actioned, but is included below as a recommendation that the home must continue to review. 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. YA29 Refer to Standard Good Practice Recommendations It is recommended that the service give consideration to the accessibility of the garden due to the increasing age of service users and possible future restrictions on their mobility. It is strongly recommended that the home keep under review arrangements for the siting of the laundry and should any considerable rebuilding of the premises take DS0000021236.V312100.R01.S.doc Version 5.2 Page 24 2. YA30 Tall Trees place relocation be part of the planning. 3. YA32 It is strongly recommended that staff who are not NVQ qualified commence NVQ level 2 or 3 training in care. Tall Trees DS0000021236.V312100.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent..ME16 9NT 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. 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