Inspection on 24/05/05 for Tall Trees

This inspection was carried out on 24th 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.

Other inspections for this house

Tall Trees 13/03/07

Tall Trees 23/11/05

Tall Trees 23/11/04

Tall Trees 02/06/04

Tall Trees 05/11/02

Similar services:

Southfields

Thorndene

Insight - Eastchurch

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33 St John`s Church Road

Dovedale Court

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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 Mike Flint Unannounced 24 May 2005 10:00 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 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 None Care Management Group Limited 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) Vacant Care Home 6 Category(ies) of Learning Disability (LD), 6. registration, with number of places Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of residents must not exceed six (6) 2. The people accommodated will be between the ages of eighteen and sixty five on admission Date of last inspection 23 November 2004 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. Leonard’s-on-Sea and Hastings, within easy walking distance to shops and local amenities. A secluded rear garden is accessed via steps from a patio seating area. The home provides residential and social care for six adults with learning disabilities. 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 car, provided by the owners, for taking service users on trips and outings. There is a parking area at the front of the building, sufficient for a small number of vehicles. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out during a morning in May 2005, when there were six residents. The deputy manager assisted with the inspection, when each of the four duty staff were spoken with and those residents who were present. Two of the residents were off site, attending day centre activities. The inspection included a tour of the premises. 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. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 6 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 Standards Statutory Requirements Identified During the Inspection Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 7 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 standard(s) 2, 3, 4, 5 People who are referred to the home are fully assessed enabling decisions to be taken in respect of the home’s ability to meet individual resident’s needs. EVIDENCE: Initial pre-admission assessments are carried out centrally by the CMG organisation. Relatives and prospective service users are consulted with; social care assessments are made available and there are discussions with Social Services in every case. There has been one new admission to the home during the last twelve months. When a vacancy occurs an introductory visit then an overnight stay is arranged, followed by a two-week assessment period; during this time a draft care plan is drawn up. Individual care plans are reviewed at 6-12 weeks, post admission, dependant upon the length of trial period, thereafter annually. Where there is a specific health care need, service users receive on-going support from their medical Consultant. Each resident has a key worker, who is responsible for completing the care plan and risk assessments. All staff receive in-house training relevant to their work, the detailed record of this was seen during the inspection. For each resident there is a Social Services contract and a form of agreement, produced by the home and that outlines the rights and responsibilities, terms and conditions and the plan for personal support. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 8 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 standard(s) 7, 8, 9, 10 The staff have a good understanding of the residents’ support needs. This is evident from the positive relationships, apparent between staff and residents. EVIDENCE: Residents are encouraged to take personal responsibility and make choices about their day-to-day living. One of the six residents manages their own pocket money expenditure. The home has details of an independent advocacy service, should any resident require this. Staff at the home liaise with the staff at the day centres attended by the residents. In this way support is provided, promoting independence and decision-making within risk assessed limits. Based on risk assessments and personal choice, residents participate in daily household tasks, including food preparation, washing up and doing their own laundry. All staff are informed of the home’s policy on confidentiality at the time of their induction. Staff said they would know when confidential information should be shared with their manager, with parents, or others. Residents are entitled to read information recorded about themselves, should they so wish. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 9 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 standard(s) 13, 14, 16, 17 Links with the community are good, supporting and enriching the residents’ social lives and their opportunities for recreational activity. EVIDENCE: Residents access local community facilities on a daily basis e.g. the library, shops, club evenings and the local church. The home maintains satisfactory relations with neighbours and in the wider community. Weekly activities and outings are shown on the residents’ notice board. Individual day trips, group outings and holiday breaks are arranged. The Inspector was told of the arrangements for each resident’s holiday plans. There are regular visits to the pub, bowling alley and swimming sessions, assisted by staff. The home has a car for resident’s appointments and outings. Staff at the home show respect the residents’ right to privacy; they are attentive to the needs of residents, whilst at the same time giving encouragement to develop self-help skills and promote independence. The residents treat the home as their own, choosing to spend time in the communal rooms, or in the privacy of their own rooms. A satisfactory level of social interaction amongst the residents and with the staff was observed. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 10 Residents may choose to assist in the preparation of meals. A four weekly menu plan is agreed in consultation with residents. There is always a choice at mealtimes, a record being kept of any special diets or preferences. Mealtimes are flexible e.g. breakfasts and lunches, depending on what service users have planned for the day. Residents may invite friends in for meals by prior arrangement. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 11 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 standard(s) 18, 19, 20 The health needs of residents are well met with evidence of good multidisciplinary working with the Community Teams on a regular basis. EVIDENCE: The process of assessment, care planning and review is carried out as far as possible with the involvement of the residents concerned. The goals, agreed through this process, form an important part of their daily life-styles. Key workers give personal support and guidance where needed and residents are encouraged to exercise self-determination and control over their own lives, within risk-assessed limits. The home receives good support from the local Community Health Care services. Residents see a chiropodist every 3 months and arrangements are made for dental treatment. Staff work together with the residents to promote healthy living e.g. weight watching. The Inspector suggests that further efforts to engage in meaningful activity the one, or two residents who may otherwise suffer from apathy. All staff receive in-house training in the administration of medicines, some have attended a college course. The dispensing pharmacist visits the home on a quarterly basis. None of the service users are assessed as being able to administer their own medicines. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 12 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 standard(s) 22, 23 The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. EVIDENCE: The staff/ key workers are trained to respond positively to the wishes, suggestions and concerns that residents may present. A record is kept in the home of any complaints made, when they have been subject to action, or investigation. Details of the complaints procedure are included in the terms and conditions of residence. All staff receive training in the protection of vulnerable adults. There is clear policy guidance for staff to adhere to. The home keeps satisfactory records of all monies, managed on behalf of residents and this was discussed with the deputy manager e.g. pocket money savings and expenditure. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 13 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 standard(s) 24, 25, 27, 28, 30 The overall standard of the environment within this home is good, providing residents with an attractive and homely place to live. Some limitations within the building preclude the home from meeting all the environmental Standards. EVIDENCE: Most of the outstanding maintenance tasks, requiring attention at the time of the last inspection, have since been satisfactorily addressed. However, still remaining is some external redecoration, where woodwork at the rear of the building has rotted, and the overgrown Lellandii fir trees in the garden. All six residents are provided with single room accommodation with en suite toilet and hand basin. Two of these private rooms are below the NMS size standard; future admissions are to be made aware of this fact, prior to the room concerned being occupied. There is a fire exit between two of the bedrooms, the current residents accept the arrangement, but consent is required by both parties should there be a change of residents. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 14 The home provides a sufficient number of en suite toilets and there is a bathroom and separate walk-in shower room facility on the first floor. However, there is no communal washing, or toilet facility on the ground floor, which fails to meet the standard for care homes providing services for residents with poor mobility. The home has a suitably furnished communal lounge/ diner, where the state of décor is good but the furnishings appeared heavily worn. A second communal area is used for music and crafts, though at the time of the inspection this was out of use and being used for temporary storage. The home is kept clean and tidy by the care staff. Laundry equipment is sited in a small storage area, leading off the kitchen. It is required that the laundry equipment be re-sited to an area with separate access and whereby soiled laundry will no longer be carried through the kitchen e.g. where the freezer is presently sited. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 35 Staff morale is good resulting in an enthusiastic workforce that works positively with residents to improve their whole quality of life. EVIDENCE: The staff employed bring a range of qualities and experiences to the home. Three staff have gained the NVQ award at levels 2, or 3 in care, others are working towards these qualifications. The attitude of staff, observed during the inspection, towards residents was attentive and calm. The staff observed, appeared to be as experienced and competent in their work. The Organisation has its own training department, which arranges and provides in-house training in the required core skills. The Care Management Group has a thorough recruitment process, which is followed in all of their homes. Staff receive contracts and detailed terms and conditions of their employment. The home has a staff training and development plan, which includes the Organisation’s core skills training and any other training which meets the Learning Disability Award Framework targets. Individual training plans are produced and followed for all staff. An in-house induction-training checklist is used. This specifies the areas to be covered in the initial stages of employment at the home. Additionally, there is an organisational inductiontraining course that is made available to new members of staff. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 40, 42, 43 The manager appears to have a good understanding of the areas in which the home needs to improve, judging by the significant progress that has been achieved since the last inspection. EVIDENCE: The acting manager is suitably experienced and competent to run the home, though has yet to attain the NVQ at level 4 in Management and the Registered Managers Award. The Inspector understood that the manager’s application to register with the Commission is in process. The home’s written policies and procedures are those of the CMG organisation. These are comprehensive, well documented and reviewed at least annually. They cover all aspects of running the care home and are readily available for staff advice and guidance. t is recommended that staff are to be involved in helping to formulate policies and procedures, specific to Tall Trees and in the drafting of the annual plan. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 17 The standard of record keeping in the home is high as was evidenced by the records inspected concerning residents, which were well maintained, accurate and up to date. Monthly visits are carried out by the registered provider with detailed records kept, copies of which are forwarded to the Commission. Although the growth of the parent organisation is rapid in its acquisition of care homes in the south and east of the country, the management and administrative infrastructure appears to be keeping pace with the programme of expansion. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 18 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 x 1 3 x 2 Standard No 11 12 13 14 15 16 17 x x 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Tall Trees Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 2 x x 3 x 3 3 H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 19 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 24 Regulation 23(2)(b) Requirement The the premises are satisfactorily maintained, in particular the external woodwork at the rear of the building and the homes garden boundary trees, which are excessively overgrown. (Timescale from previous inspection not met) That laundry facilities are sited so that soiled articles and clothing are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on residents. (Timescale outstanding from previous inspections) That the home employs a registered manager who is suitably experienced and qualified. Timescale for action 01.11.05. 2. 30 16(2)(j) 01.11.05. 3. 37 9(2)(b)(i) 01.11.05. 4. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Tall Trees Refer to Standard Good Practice Recommendations H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 20 1. 19 2. 25 3. 40 That further steps are taken in developing meaningful activities, which engage residents interests and participation, whilst addressing their physical health and welfare needs. That any future admissions to the undersized private rooms are to be made aware of this fact, which is also to be included as information given in the homes Statement of Purpose. That staff are to be involved in helping to formulate policies and procedures, specific to Tall Trees and in the drafting of the annual development plan. Tall Trees H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 H59-H10 S21236 Tall Trees V220606 240505 Stage 4.doc Version 1.20 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. 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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