Inspection on 07/10/09 for Tall Trees

This inspection was carried out on 7th October 2009.

CQC found this care home to be providing an Adequate service.

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

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Tall Trees Tall Trees Burford Road Shipton-Under-Wychwood Chipping Norton Oxon OX7 6DB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kate Harrison     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Tall Trees Tall Trees Burford Road Shipton-Under-Wychwood Chipping Norton Oxon OX7 6DB 01993833833 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caring Homes Healthcare Group Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 60 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Tall Trees is a purpose built care home situated in the village of Shipton under Wychwood near Chipping Norton in the north of Oxfordshire. The accommodation is Care Homes for Older People Page 4 of 24 Over 65 0 60 60 0 Brief description of the care home provided over two floors in four 15 bedded units, with access via a passenger lift, and there are three quiet sitting rooms and four lounge/diner rooms. All the private rooms have ensuite toilet and shower and there are communal assisted bathrooms. Some of the rooms open onto their own garden areas, and there is a courtyard garden with an orchard and meadow at the rear of the home. There is a kitchen and laundry room, and hairdressing salon and treatment room. The home is run by the manager with the care team, the housekeeping and maintenance team, supported by the wider Caring Homes Healthcare Group Limited . Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the home was an unannounced Key Inspection, and was carried out by one inspector between 9.15am and 5.15pm the same day. It was our first inspection visit since the home opened earlier in the year and was a thorough look at how well the service is doing. It took into account detailed information provided by the home through the homes self assessment document, the Annual Quality Assurance Assessment (the AQAA) and other information we received about the home. The AQAA was completed and received by the expected date and contained some of the information we needed to plan our visit. We took into account information we received about the management of skin and pressure wounds from the local safeguarding team and we looked at records and documents relating to the care of the people living in the home. We saw recruitment records and information about staff training and looked at how peoples medication was managed. We saw the communal areas of the home, the gardens and some private rooms used by people living there. We asked the views of the people who live in the home, through questionnaires we had Care Homes for Older People Page 6 of 24 sent out. Altogether we received 6 completed surveys from people living in the home, and their views are reflected in this report. We spoke to several other people living in the home during our visit, to the acting manager, some staff members, and senior managers from the company who were in the home on the day, and discussed the running of the home with them. This inspection was a thorough look at how well the home is meeting the standards set by the government and in this report we make judgements about the outcomes for the people living in the home. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A senior person from the home carries out a pre-admission assessment of need before admitting people to the home. The home does not provide an intermediate care service. Evidence: We saw from records that following a referral to the home, the homes manager or acting manager visits the individual and completes the homes 12 page pre-admission assessment form to gather information about an individuals care needs. We noted from the two pre-admission assessments we checked that other information is also available to the home, from the individuals general practitioner (GP) and care manager if applicable, so that a full picture of the individuals needs is gained before the decision is taken that the home is suitable. The home supplies information about the home through the service user guide to people on admission, and all the people who responded to our survey said that they had received enough information about the home before they decided to move in. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working to make sure that people living in the home have their needs recognised and met, by auditing care records and addressing any shortfalls. Evidence: We looked in depth at the care records for two people. We saw that the home has documentation available for staff to record all the necessary information about individuals, such as an assessment of peoples daily living skills and risk assessment forms. Most of the information was recorded for one individual but was not personalised to reflect the individuals preferences, while most of the information was missing in several areas for the other individual. Risk assessments were completed for one individual and led to the development of care plans showing staff how to look after the individual. There were some risk assessments completed for the other individual, showing that action needed to be taken by staff but care plans were not developed to detail the necessary actions. For example the falls risk assessment showed that the individual needed help to move about the home, but no care plan was developed to tell staff how to safely help the individual. The cognitive assessment and life history were not completed although the individual was admitted because of Care Homes for Older People Page 11 of 24 Evidence: dementia, and no care plan was available for staff to help the individual spend time in a relaxing meaningful way. Some risk assessment information was not recorded, such as the individuals body mass index to help determine the persons state of nutrition. The home uses two nutritional assessment tools, and this can be very confusing for staff as key information may be missed, so the home needs to consider using only the best tool available, including the individuals body mass index so that the individuals state of nutrition is known. We made an immediate requirement that the home develop care plans to meet all the needs of the people living in the home, and the home confirmed within 24 hours that the requirement was met. The home has recently improved communication with health care professionals such as the tissue viability nurse, so that people in the home receive appropriate health care advice. We checked individuals medication to see how the home managed medication. At present there is a locked cupboard in each individuals room designed to hold medication, but the cupboard is often not capable of holding all the individuals medication, resulting in some opportunities for errors. We understood from a senior manager that following some initial problems the home is reconsidering how best to manage medication, so that a reliable safe system will be in operation. We noted that medication received the previous day was not recorded as received, although it was stored securely. The managers had recognised the problems arising with the management of medication and the home had very recently appointed a registered nurse to have responsibility for the management of medication, and the medication was recorded as received before we left the home. The majority of people who responded to our survey said that they usually received the medical care they needed, and that the staff always listen and act on what they say. We saw that the staff treated people with respect and had meaningful conversations with individuals. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to live as they choose, and the home is making sure that records are updated to show peoples preferences. Evidence: The daily routines of the home are relaxed and organised to suit the needs of the people living in the home. The homes document, Assessment of Daily Living Skills, allows individuals to have their preferences such as for food and drink recorded, but the records we saw were only partly completed, and the homes managers said that all the records were being audited to make sure that the necessary information was available. The home recognises that meaningful activity needs to be available for individuals as and when they want it, and we noted that this was happening for some people. A member of staff is responsible for providing regular activities and an activity schedule is available, showing that there are regular activities available. We noted that staff members were available to support individuals and we saw that the staff knew how to engage with and encourage individuals. The majority of people who responded to our survey said that there were usually activities available that they could take part in. There is a kitchenette available in the lounge, and this allows staff to offer drinks and snacks without leaving the room, so that people feel supported and safe. The homes Care Homes for Older People Page 13 of 24 Evidence: environment is designed to help people recognise key areas, such as bathrooms and their own bedrooms, by the use of colour and memory boxes, and this helps individuals feel supported and safe. Visitors are welcome to the home, and regular visitors are provided with the door key code so that they do not have to wait to enter. The homes AQAA states that families can eat together on special occasions and that visitors are welcome, with suitable spaces available with refreshments so that relatives can enjoy time together. The home encourages individuals to practise their religion if they wish to, and a senior manager told us that ministers of religion are welcome to visit individuals who wish to see them. We spoke to the chef who told us how she meets people new to the home, and their relatives if possible, to discuss the needs of the individual. We saw how lunchtime was organised and noted that there were enough staff members available to help individuals manage their food, in a supportive relaxed way. People told us that they liked the food, and two people said that they particularly loved the gardens. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Following recent experience the home is now in a better position to make sure people are protected from harm and have their complaints listened to and investigated. Evidence: The homes complaints procedure was displayed in the hall but did not include important information, such as the timescale for the home to respond to complaints. The procedure was amended during our visit and now includes all the necessary information. We saw the homes complaints record and understood that it is possible that not all the complaints received had been recorded. The home is carrying out an audit to check that all the complaints received are recorded and to make sure that in future all complaints are recorded and responded to, according to the complaints procedure. The home has a policy and procedure for staff about safeguarding vulnerable people. New staff members receive information about safeguarding during their induction period and have training about safeguarding. Trainers were in the home during our visit, to make sure that all the staff knew how to recognise and respond to safeguarding issues if they suspected an individual was suffering harm at the home, and training was organised for the following week. An investigation is currently taking place to check the circumstances about how some individuals developed pressure wounds in the past months. Senior managers from the organisation have acted to help the investigation and have followed the organisations processes to address shortcomings. Nursing staff have received more training about wound care and there Care Homes for Older People Page 15 of 24 Evidence: is a system in place to make sure there is better liaison between the home and NHS professionals, so that the home can now deliver the best practice in skin and wound care. All the people who responded to our survey said that they knew how to complain and most knew how to make a formal complaint. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and clean and provides a bright homely environment for the people living there. Evidence: The home opened in April 2009 following the completion of the building works, and is working to resolve an outstanding issue regarding the roof, so that the upper floor can be used to accommodate people. The home is bright and comfortable and offers private accommodation with en suite facilities. The communal areas are well furnished with rummage boxes and games, and there are features to help people with dementia, such as colour coded bathroom doors and memory boxes by bedroom doors. There are communal assisted bathrooms and we noted that the temperature of the hot water in a ground floor was within normal range. The person responsible for the homes maintenance has a system in place to address any maintenance issue, and is working to address the outstanding issues regarding the commission of the first floor. The homes laundry is in the basement and has hand wash and drying facilities and the laundry staff have received infection control training. The majority of people living in the home said that the home is always fresh and clean. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by kind, trained and caring staff. Evidence: The homes staffing rota shows the monthly duty shifts with a registered nurse on duty over the 24 hours. There were 17 people living in the home on the day of the inspection, spread between 2 groundfloor units. There were three senior managers in the home, including the homes acting manager, three registered nurses and two carers. There were also administration staff, housekeeping staff and catering staff on duty. We observed that there were enough staff members available during the day of our inspection but the response to our survey about staffing was mixed. Some people said that there are enough staff always available when needed, but others commented that what the home could do better was to have more staff available. Comments included: It is sometimes difficult to find a member of staff and I think there should be more staff around the building and more staff. We discussed the issue of staffing with the homes managers and understood that some staff have recently left the home and more staff are being recruited. The managers are aware of the changing needs of the home, the difficulties presented by the separate units and the need to plan so that there will be enough trained staff available when the home admits more people. We met with one of the homes trainers who was checking the competencies of the work force to make sure that all the staff were trained to the expected standard. Care Homes for Older People Page 18 of 24 Evidence: Nurses in the home have received more training recently about skin and pressure area care, due to issues arising about pressure wounds. All the staff have received induction training or are in the induction process so that they can safely care for people living in the home, and the home is working towards having 50 staff trained to National Vocational Qualification (NVQ) Level 2 in Care. The home has a three monthly training programme so that there is regular provision of important training for staff, including nurses, and there is a system in place so that the training needs of staff are recognised on a regular basis. All of the staff including housekeeping and administrative staff are expected to have training about dementia, and most already have received training from the companys dementia specialist. We saw three staff files to check the homes recruitment process. We saw that all the necessary information was requested and received, except one reference for one individual, and the home is checking to make sure that the reference is found or re requested and is satisfactory. We observed staff members look after individuals with kindness and skill, so that they were respected and encouraged to be as independent as possible. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes management was slow to identify shortcomings but once issues were known has acted in the best interests of people living in the home. Evidence: The homes manager was not in the home during our inspection and has since resigned from her post. The home is managed by an acting manager supported by senior managers from the company, and we met some who were in the home during the inspection following up on issues arising from their quality assurance checks. The company has a quality assurance documentation system in place to check all aspects of how the home operates, but there has been shortfalls in that it had not been implemented effectively at Tall Trees. We noted that the managers had already started an audit to check all aspects of the homes management. Care plans were in the process of being developed for individuals identified as needing them, but we identified one whose needs were not identified, and we made an Immediate Requirement that care plans be developed for all those at the home without care plans. This was met within the following 24 hours. Care Homes for Older People Page 20 of 24 Evidence: The home is planning to conduct the first survey about the quality of the service since opening earlier this year, to include the views of people living in the home and their supporters, in November and to feed back the findings and response so that people who contributed can see the results. The home keeps small amounts of petty cash securely for some people living in the home, and we saw that records are kept so that it is easy to see what transactions have been made and that the records are correct. The home has a health and safety policy statement and has provided training for staff about health and safety. More training is planned including about managing Legionella, so that the risks at the home are minimised. The person responsible for maintaining the building keeps records to show what regular checks are made and we discussed the homes fire plan and risk assessment with him. We noted that contracts are in place for the maintenance of the facilities and services at the home, such as the assisted baths, hoists and the lifts. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 7 12 That the registered person 08/10/2009 ensure that the care home is conducted so as to promote and make proper provision for the care of service users. So that people living in the home have care plans showing how all their needs will be met. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!