Inspection on 16/07/08 for Tall Trees Nursing Home

This inspection was carried out on 16th July 2008.

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

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 Nursing Home 27/09/07

Tall Trees Nursing Home 13/09/06

Tall Trees Nursing Home 06/12/05

Tall Trees Nursing Home 22/04/05

Tall Trees Nursing Home 05/11/04

Tall Trees Nursing Home 14/05/04

Tall Trees Nursing Home 12/01/04

Tall Trees Nursing Home 12/06/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Tall Trees Nursing Home Oaks Place Mile End Road Colchester Essex CO4 5XR Lead Inspector Deborah Kerr Unannounced Inspection 16th July 2008 09:30 X10015.doc Version 1.40 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 Nursing Home DS0000015342.V368513.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tall Trees Nursing Home Address Oaks Place Mile End Road Colchester Essex CO4 5XR 01206 844425 01206 855230 manager.talltrees@careuk.com 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) Lanemile Limited Mrs Penelope Irene Heap Care Home 48 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Old age, not falling within any other of places category (3), Physical disability (24), Physical disability over 65 years of age (24), Terminally ill (3), Terminally ill over 65 years of age (3) Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 4 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 65 years and over, who require general palliative care (not to exceed 3 persons) Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) The total number of service users accommodated must not exceed 48 persons 27th September 2007 Date of last inspection Brief Description of the Service: Lanemile Ltd is the proprietor of Tall Trees who are part of the Care UK group. Tall Trees is situated in the grounds of a private hospital, in Colchester. It is a modern, purpose built care home providing short and long term nursing care for up to 48 frail older people and dementia. It is set in attractive and secure gardens within walking distance of the town centre, railway station, pubs, shops and a church. The building has two floors, divided into two separate units. Rowan is on the ground floor and provides care for people with dementia. Aspen is on the first floor providing care to frail elderly people. The home is fully wheelchair accessible, with a passenger lift to the first floor. There are 40 single rooms and 4 double rooms. All double rooms have en-suite toilet facilities and all single rooms are fitted with their own hand washbasin. Fees charged by the home are between £600.00 to £713.00. This was the information provided at the time of the key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The inspection was unannounced and lasted nine hours on a weekday. This was a key inspection, which focused on the core standards relating to older people and to follow up concerns raised by an anonymous caller with the Commission for Social Care Inspection (CSCI) about staffing levels and lack of stimulation for people who live in the home. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from ten residents, five relatives, one health professional and four staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the CSCI. This document gives providers the opportunity to inform us (The Commission) about their service and how well they are performing. We (The Commission) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home, their relatives and staff. The manager was available during the inspection and fully contributed to the inspection process What the service does well: What has improved since the last inspection? Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 6 Three requirements were made at the previous inspection. Information provided in the AQAA and verified at the inspection confirmed improvements have been made to address all but one of the requirements with regards to medication. A previous requirement was made to ensure improvements were made to the internal décor of the home. A tour of the premises confirmed the home has been decorated to a good standard, new furniture has been purchased and carpets and laminate style flooring have been laid throughout the home. Improvements have been made to promote an enabling environment for the people with dementia who live in Rowan unit. Following a dementia care mapping assessment corridors have been painted in a bright colour, with grab rails and doors painted different colours, marking out distinguishable features, which help people identify key areas, such as bathrooms and toilets. There are further plans to replace bedroom furnishings, install a new heating and water system and improve car parking facilities. Staff working at the home are now receiving formal supervision and appraisals to assess their performance and development and identify training needs. This ensures they have the right approach and skills to meet the needs of the people living in the home. During the inspection we (The Commission) looked into the concerns raised about staffing levels and lack of stimulation of people living in the home. The introduction of the Activity Based Care (ABC) project has addressed these issues, by providing additional staff and developing individual activity plans which will provide a more holistic approach to ensure all aspects of the health, personal and social needs of the people living in the home are met. What they could do better: To make information accessible to people with visual and/or other sensory impairments, consideration should be given to providing information about the home and how to make a complaint in a suitable format. Additionally, to ensure people using the service know their rights and obligations whilst living in the home and the amount they need to pay, they must be provided with a contract setting out their terms and conditions of residence and which reflects their current fees. The manager must take steps to ensure staff adhere to the homes medication policies and procedures, this will ensure medication is properly administered and clear records are kept. This will ensure that people using this service will receive the correct levels of medication. Meal times should be regarded as an important part of the service, the way in which staff assist people at mealtimes should be monitored and supervised to Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 7 ensure support is provided sensativley, unhurried and which give the individual sufficient time to eat and enjoy their meal. Additionally, to ensure the cultural dietary needs of an individual living in the home are met, catering staff need to discuss the preferences and style of cooking with the individual. They should also update their knowledge of cuisine associated with the individual’s country of origin. 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. The summary of this inspection report can be made available in other formats on request. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6, People who use the service experience adequate quality outcomes in this area. People considering moving into this home will be provided with information they need to make a decision if the home is suitable for them, however not all people are in receipt of a contract, which tells them about their rights and obligations whilst living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care UK has developed a brochure, with photographs of the premises and a welcome pack with information about the services provided. Additionally, they have a statement of purpose, which clearly sets out the objectives and philosophy of care, specialist services, quality of the accommodation, qualifications and experience of the staff and how to make a complaint. The manager stated in the AQAA they are considering producing a newsletter to keep people living in the home and their relatives informed of events occurring within the home. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 10 The AQAA reflects 28 people living in the home have impaired vision and 11 have impaired hearing. Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. The AQAA does reflect that documents can be accessed in different languages, if required. Information provided in the AQAA and verified at the inspection confirmed pre admission assessments are completed to assess the needs of people considering moving into the home. This process ensures the manager has all the information they need to ensure the service will be able to meet the individual’s specific needs. The files of three people who have recently moved into the home were looked at as part of the inspection process. All three contained the required assessments, which provided a comprehensive overview of their health, personal and social care needs. The AQAA states every person who uses the service has a signed contract. Examination of personal files reflected that Care UK had issued residents who pay privately with a contract. However, people who had recently moved to the home and those funded by the local authority had not been provided with a contract and / or a copy of the terms and conditions of residence. The AQAA states admission procedures are in place and all prospective residents and their families are encouraged to visit the home prior to admission, without an appointment. People told us about their different experiences and reasons for moving into residential care and why they had chosen Tall Trees. One individual had been admitted to the home from hospital for a period of respite and is looking to return home. Another described moving to be nearer their family and their relatives had arranged the move. A third person confirmed the homes manager had visited them in hospital to complete an assessment of their needs and provided them with information about the home. These people told us that they are “very satisfied and happy with the care and support being provided, and that staff are lovely, and the food is nice”. Tall Trees does not provide intermediate care, however they do offer respite care to support family carers to take a break. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11, People who use the service experience adequate quality outcomes in this area. The health and personal care people receive is based on their individual needs, however, more stringent auditing of medication and further staff training is required to ensure people using this service will receive their correct levels of medication to maintain their health and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed care plans are based on the assessed needs of the individual, which have been discussed and agreed with the person and their representative at the point of moving into the home. Once agreed the care plans are transferred on to a computer-based system, designed to make information easily accessible by staff. All staff have their own password and access to a computor in each of the units. Time was spent accessing the care plans of three people being tracked as part of the inspection process. Each plan is broken down into sections of the individuals assessed need, the actions staff are required to take and the level of support required by the individual to meet their needs. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 12 Care plans contained supporting assessments relating to mental and physical health as well as nutrition, risk of falls, skin integrity, waterlow and pressure area care and moving and handling. The personal health, nursing and dietary charts linked to these assessments are being monitored to identify where there have been changes in an individuals health and to assist with planning the their future care. In addition to the computerised plans, ‘Care Needs’ folders are being implemented, which will be held by the individual in their room. This will ensure staff have access to information they need on a daily basis to monitor and meet the individuals needs. This will also make it easier for staff who are not familiar with the individual to deliver personalised and consistent care. Comments received in health professional ‘Have Your Say’ survey’s suggested that now records are on line, staff need to ensure good record keeping, for resident’s weight, bowel and food intake. This supported where an individuals weight chart showed they had lost 5.5kg weight over a period of 2 months. Although, there was a note recorded to refer the individual to the GP no appointment had been made. The manager followed this up at the inspection contacting the surgery to make the required appointment. To make sure peoples needs are being monitored and assessed regularly the home have introduced a ‘resident of the day’, which incorporates a complete evaluation of the residents care plan, weight, observation, nail care, bath and a deep clean of their room. There was clear evidence to show care plans are being reviewed and updated monthly. Daily records are well written providing a good overview of how each person has spent their day, including what has worked for the individual, where there has been progress, achievements or any concerns about their health and welfare. People living in the home are supported to have access to health care services. Dates and details of appointments are clearly recorded in the care plans. Healthcare needs of the people using the service are managed by visits from the local General Practitioner (GP) and specialists, where required, such as the tissue viability nurse to help in the management of pressure area care. They have also provided training for the prevention of pressure sores to staff. People moving into the service are supported to make a choice if they wish to keep their previous GP or to be registered with the surgery used by the home. Observation and discussion with staff confirmed they are aware of the need to treat people with respect and dignity when delivering personal care. The interactions between residents and staff were observed to be friendly and appropriate. Staff were observed calling people by their preferred name. All of the people living in the home were appropriately dressed and well presented on the day of inspection. The home employs both male and female staff. Care plans confirmed people using the service are asked their preference of male or female carers, during the assessment process. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 13 During our visit we looked at Medication Administration Records (MAR) charts and blister packed medication belonging to people living in both Aspen and Rowan units. Each persons MAR chart had a front page with their name, any known allergies, a description of how the individual prefers to take their medication and a photograph to avoid mistakes with identity. Previous inspections dated 31/10/06 and 20/09/07 have resulted in requirements being made to make proper provision for the safe administration of medication. Examination of the monthly MAR charts in Rowan unit highlighted twenty separate occasions where staff had not signed to reflect they had administered people’s medication, with no reason or explanation recorded on the reverse of the MAR chart. Although, it was noted some improvement has been made to audit administration of medication and that staff have received further training on how to use the Monitored Dosage System (MDS), administration of people’s medication remains a concern. The manager was left an immediate requirement to deal with these issues to ensure people using this service receive the correct levels of medication. The manager has notified us (The Commission) following the inspection, in writing, of what they have done to address these issues. They have put new measures in place, which have reduced the risk to people using the service and which will monitor medication practises. Tall Trees provides care to existing people who use the service at the end of their life and admit people who require palliative care. Staff have received training to implement the Liverpool Pathway plan, when a person is nearing the end of their life. They have also received training from the Mc Millian Nurses and have access to ongoing monthly training, which covers topics related to death, and dying. Staff training records confirmed staff have recently completed training in palliative care and end of life, including funeral and bereavment study days. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, People who use the service experience good quality outcomes in this area. The introduction of Activity Based Care (ABC) is encouraging people who use the service to participate in their own care and exercise more choice and control over how they spend their time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback obtained from conversation with people using the service and in residents and relatives ‘Have Your Say’ surveys provided mixed reaction to the provision of daily activities. Comments included, “although my relative has Alzheimer’s staff still do things with them and are very caring” and “I am bed bound most of the time, but staff do encourage me to draw and “I prefer to remain in my room watching television, I do enjoy going into the garden and talking to other residents that may be out there”. However other comments included, “the staff provide good care, however more activities could be provided” and “they could do with more staff, to look at more holistic care for people able to do things, for example support people to go out and access different activities”. An anonymous caller also raised concerns with us (The Commission) about the lack of stimulation for people living in the home. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 15 Information provided in the AQAA and verified at the inspection confirmed staff are being trained to use a toolkit produced by Care UK, called Activity Based Care (ABC). This project has been designed to encourage people who use the service to participate in their own care and activities. The objective of ABC is to provide tailor made activity plans, which will meet the unique needs of each resident to lead to a better quality of life. An example of how these plans will work was provided, which identified a plan for an individual who has lost the ability to be independent at meal times, to still be encouraged, if only to hold a fork or spoon. This will support them to retain as much independence and inclusion at mealtimes. Once the implementation of the ABC plans have been fully implemented, the manager confirmed this will address the issue of providing a more holistic approach for people living in the home. The notice board in each unit displays details of daily activities, which include arts and crafts, foot spa, hand massage and nail care, word games and quizzes, coach outings, walks and garden picnics (weather permitting). People living in the home are encouraged and supported to choose how they spend their recreational time and social life. During the inspection people were observed watching daytime television and reading newspapers and magazines, others spoken with had chosen to stay in the room. A group of residents were seen engaged in a crafts session and a family were seen visiting their relative, eating their lunch in garden. The lounges in each unit are large L-shaped rooms, which include an eating area, television area and a quite area for people to sit. Staff were observed spending one to one time with residents looking through magazines and playing stimulating games, such as connect. Additionally a relaxation (snoozlem) room is available for small groups and for individual use. A quiet room is available for people living in the home to receive their visitors in private. Information in the homes brochure and the AQAA states that the home assists residents to maintain contact with the local community, family and friends. This was confirmed observing and speaking to a number of relatives and friends visiting people in the home during the inspection. Visitors are made welcome and confirmed they are able to visit at any reasonable time. Community links are maintained by encouraging people who use the service to attend coffee mornings, luncheons, local reglious services or functions. The local Reverend attends Tall Trees bi-weekly to conduct a service for all donominations, additionally conversation with an individual using the service confirmed they receive visits from a brother from the local Pentecostal church. Breakfast and lunchtime meals were observed, in both units. Food seen was nicely presented and appetising. Where individuals required a soft food diet, their meals were pureed. Each food item was pureed individually to ensure the individual could identify the different tastes and textures. People spoken with confirmed they were enjoying their meal. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 16 Observation of staff during mealtimes was mostly supportive and understanding of the needs of the individuals they were assisting to eat their meal. However, one member of staff sat down and starting feeding an individual, there was no communication and the individual was seen to move their head backwards to take the forcefulness at which the carer had offered the spoonful of food. After the initial mouthful of food, the carer did acknowledge their actions and continued to support the individual at a more appropriate pace, suitable for the individual to enjoy their food. A training and practice session had already been arranged for the afternoon of the inspection, which the manager used to remind staff that meal times need to be carried out sensativley, unhurried and which give the individual sufficient time to eat and enjoy their meal. Time was spent with the cook, who demonstrated a good understanding of the dietary needs of the people living in the home. Menus seen provided a good range of meals with two choices of a main meal each day. Additionally, hot and cold drinks are available either from the kitchen or on each unit throughout the day. Food stores showed a good range of foods, including fresh fruit, vegetables and home made cakes. The chef was aware of the cultural dietary requirements of an individual living in the home, however discussion with the individual identified they were not always being offered the food of their choice. Some effort had been made to encourage the individual to take part in the preparation of their own meal, however this was discussed at length with the chef and kitchen assistant, who agreed to discuss the preferences and style of cooking with the individual further. All foods are being stored in accordance with food safety standards and the required documentation of temperature checks for fridges and freezers are being kept. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience good quality outcomes in this area. People who use this service are able to express their concerns and have access to robust, effective complaints procedure, and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the home has a clear and effective complaints procedure. All complaints are recorded on the computor system, used by the Care UK. This means all complaints are acknowledged and logged by the manager and reviewed by staff at head office. The AQAA identifies that the home has received three complaints in the last twelve months. These have been investigated in line with the homes complaints procedure, with one complaint upheld. Prior to the inspection, the Commission received an anonymous call, raising concerns about staff working long hours, the number of staff available and lack of stimulation for people who live in the home. These issues were looked at during the inspection process and the outcomes are described in the staffing section of this report. Staff spoken with are aware of residents rights and how to refer a complainant to a senior member of staff and / or the manager. They were clear about their duty of care and what they would do if they had concerns about the welfare of a resident. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 18 Relatives ‘Have Your Say’ Survey’s and discussion with people visiting the home confirmed they know how to make a complaint about the service. People told us they have not had any concerns, but were sure any concerns they had would be dealt with. The home has a ‘suggestions and comments’ book in reception area, which relatives are encourgaed to write any comments about the service. Additionally, a number of thank you cards were seen on display, thanking staff “ for the care and kindness you showed to my darling relative” and “to all of the team at Tall Trees, thank you so much for your kind words, I will miss my visits to the home, you are a great bunch”. Care UK has detailed safeguarding adults from abuse policy. The policy includes a flow chart directing staff of the appropriate reporting procedures, including other organisations, such as the local authority safeguarding team and the Commission for Social Care Inspection (CSCI). Staff spoken with and records confirmed they had received training to help recognise and respond to complaints and allegations of abuse. Training included, Protection of Vulneable Adults (POVA), customer care, managing complaints and effective communication and the impact of the introduction of the Mental Capacity Act. People who use the service with challenging behaviour have detailed support plans in place, which guide staff of the actions they need to take to deal with situations as they arise. Staff records showed the majority of staff have recieved training for dealing with challenging behaviour. The manager advised further training has been scheduled to ensure all staff have the knowledge and skills to understand and deal with inappropraite or threatening behavior. The AQAA states to protect people who use the service from abuse, no person comences employment until an enhanced Criminal Records Bureau (CRB) and Protection Of Vulneable Adults (POVA) checks have been receivied. Examination of staff files confirmed the home operates a robust recruitment process. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25, 26, People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables people who use the service to live in a well maintained and comfortable environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that Tall Trees is a purpose built home, with wheelchair access throughout. It is situated in attractive and secure gardens close to Colchester town centre and all local amenities. The home is nicely decorated providing a clean, safe and comfortable environment. Garden areas are wheelchair accessible and maintained to a high standard, incorporating raised gardens to enable wheelchair users to participate in gardening. A Pagoda has been fitted with ultra violet netting to protect people when out side in the sun. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 20 The home is divided in two units, Rowan, which is the dementia care unit, is on the ground floor, with Aspen on the first floor. There are 24 beds in each unit, arranged in to groups of twelve. Forty rooms are for single occupancy with a further four, which provide shared accommodation. The double rooms have ensuite toilet facilities, all single rooms have their own wash hand basin. All rooms are provided with good lighting and safe radiators. Heating is kept at a constant temperature and reduced in hot weather. Radiators can be controlled independently for individual needs. The home has two assisted baths and a walk in shower on each floor. These and toilets are nicely decorated and accessible to all people who use the service. Specialist equipment is provided to enable people with disabilities to have an assisted bath or shower. A previous requirement was made to ensure improvements were made to the internal décor of the home. A tour of the premises confirmed the home has been decorated throughout to a good standard. Corridors in the dementia unit have been painted in accordance with outcomes of a dementia care mapping assessment. The walls are a nice bright colour, with grab rails and doors painted different colours marking out distinguishable features, which help people identify key areas, such as bathrooms and toilets. The sensory room is being improved and redecorated to make it more user friendly. Additionally, new dining chairs and lounge chairs, for both units have been purchased. New carpets and laminate effect flooring has been laid in the ground floor unit, lounge and dining areas and in the corridors. There are further plans to replace bedroom furnishings, install a new heating and water system and improve car parking facilities. The AQAA states people are encouraged to personalise their rooms with their own possessions, such as small items of furniture, pictures and ornaments. This was confirmed when touring the home, rooms are nicely decorated reflecting the individual personalities and interests of the occupier. People who use the service have the choice to hold the key to lock their bedroom doors for privacy. A relative raised concerns in the ‘Have Your Say’ survey, that “only fault is I find residents, during the daytime are in and out of other peoples rooms and are often found sleeping in other peoples beds, otherwise the home is very good”. To address this issue some people have request a safety gate to be fitted to the doorway of their room, which deters people from entering. Appropriate aids and equipment to transfer immobile people safely and comfortably and to encourage independence are available throughout the home. These include hoists, a range of slings and grab rails in all corridors, bedrooms and bathrooms. Where people are assessed as a high risk of falling from their beds and pressure areas developing they have been provided with adjustable beds fitted with bedrails and pressure relieving equipment. The required supporting risk assessments were seen in peoples care plans. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 21 Comments received in residents and relative’s ‘Have Your Say’ surveys, stated, “the home is fresh and clean” and “the home is lovely, kept very clean every day” and “the home is kept very clean”. This was confirmed by the information provided in the AQAA and verified at the inspection. The home was found to be clean and free from offensive odours. Cleaning is carried out daily on each unit and all other areas of the home. Carpet cleaning is done frequently and as required. Once a month on each unit, the ‘resident of the days’ room has a total deep clean. All laundry services are provided within the home, personal and linen. The laundry facilities seen were clean and tidy with appropriate equipment to launder clothing and bedding and soiled linen. Appropriate handwashing facilities of liquid soap and towels are situated in bathrooms and toilets where staff may be required to provide assistance with personal care. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in appropriate numbers to support the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that the home is staffed by qualified nurses and carers who have the skills and exeprience to work on both units. The duty rota reflects twenty-four hour care is provided by a registered nurse and four care staff, throughout the day, with a nurse and two carers at night, on each unit. Prior to the inspection, the Commission received an anonymous call, raising concerns about staff working long hours, the number of staff available and lack of stimulation for people who live in the home. The person raising the concerns noted “the majority of the staff working at the home are pleasant and caring and doing a brilliant job, in what seems to be understaffed and overworked conditions. Staff are working very long hours and sometimes only one member of staff to a floor of residents”. Feedback in residents, relatives and health professionals ‘Have Your Say’ surveys also comment on the number of staff available. These included, “my relative has dementia, residents are well looked after, however they could improve with extra carers sometimes” and “staff are very friendly, supportive and kind, in the past the turn over of staff was bad, but in the last six months it has greatly improved, but this needs to be maintained and “good supportive and caring staff, sometimes short of staff”. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 23 Information provided in the AQAA and verified at the inspection confirmed recruitment of new staff has lessened the need to use agency. The duty roster does reflect that some staff are working long hours or double shifts. However, the roster shows their shift patterns are within their contractual hours and the hours worked in a week, unless it is an emergency situation, amount to a normal working week. The manager, staff and relativies confirmed that the reduction of agency use has provided stability and enabled more continous care to people who use the service. Additionally, the manager stated the introduction of the Activity Based Care (ABC) project has increased staffing numbers to six staff per unit, each shift. An extra member of staff is designated to each unit between the hours of 9am – 6pm and is in addition to care staff, with the aim of spending time with individuals on a one to one basis. Information provided in the AQAA and verified at the inspection confirmed that the home ensure all the appropriate checks are undertaken before a person commences employment. Three staff files seen confirmed the home operate a thorough recruitment process, which includes obtaining all the appropriate paper work including Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. In line with the introduction of ABC, staff are currently being issued with new terms and conditions of employment to reflect the change in their role from care assistant to life skills support worker. All staff are exepected to complete the induction process within six weeks of commencing employment. Care UK have developed an ‘orientation and induction pogramme, which links with the Skills for Care Induction standards. The workbooks cover an introduction to the service, the policies and procedures and ways of working with people using the service. They also introduce staff to ways of learning and development whilst employed by the company, including access to the El-box, computer work based learning sets. Information provided in the AQAA stated staff undertake specialist training to enable them to provide care and support to people using the service. This was confirmed through discussion with staff and in information received in four staff ‘Have Your Say’ Surveys. Staff were divided on staffing levels, but overall confirmed these are sufficient to meet the needs of the people living in the home. They confirmed they had not used agency staff over past few months and there has been little staff sickness. Staff confirmed they were kept up to date with information about residents, received training relevant to their job and which helped them to understand and meet needs of residents. Most recent training has included ABC, palliative and end of life care, dementia awareness, falls management, safe handling and administration of medication, safeguarding adults, first aid, fire safety, food safety, moving and handling, health and safety, Control of Substances Hazardous to Health (COSHH), infection control training and skin care and pressure area care. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 24 The AQAA shows that further training is planned for staff who have not yet attended courses in dementia awareness and palliative care. The AQAA also confirmed staff are trained to National Vocational Qualification (NVQ) standards. The home employs twelve qualified nurses, plus a total of twentynine care staff. Twelve care staff have completed NVQ Level 2 or above, with fourteen staff currently working towards completion. These figures reflect the service has achieved the National Minimum Standard (NMS) target of 50 of care staff to hold a recognised qualification. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38, People who use the service experience adequate quality outcomes in this area. The home is run by a qualified manager, however to protect the safety and welfare of service users, they need to be more proactive in monitoring staffs practice and compliance with the medication policies and procedures of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has the relevant qualifications and experience for their role. They are a qualified nurse and have completed the Registered Managers Award (RMA). They have thirteen years experience of managing care homes and working with people with dementia. However, the manager must be more proactive in monitoring staffs practice and compliance with policies and procedures of the home. This includes regular checks to ensure medication is being properly administered and clear records are being kept, to ensure people Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 26 using this service receive the correct levels of medication. The manager completed the AQAA, which provides clear and relevant information and informed us about changes that have been made to improve the service. The manager identified where further improvements need to be made and how these are to be implemented. People using the service and staff told us that they found the manager and team leader supportive and approachable, comments included, “the manager has an open door policy, they are available to speak to at any time” and “the manager is lovely” and “it is a pleasure working here”. Staff confirmed they are kept informed and up to date with information and attend regular staff meetings, to discuss issues about the service. Information provided in the AQAA stated an annual quality assurance assessment is undertaken. Customer Satisfaction Surveys have been given to residents and sent to relatives to be completed, additional copies were seen available in the entrance foyer. The manager confirmed they have received two completed surveys so far, these reflect people remain satisfied with the service they are receiving. Once all the surveys are returned these are sent to the head office for analysis and a quality audit summary is produced to reflect the views of people using the service and their relatives. The feedback is used to make improvements, where required to the service. The manager agreed to forward a copy of the completed summary to us (The commission). The AQQA also reflects a designated responsible individual from Care UK visits the home monthly to carry out quality monitoring audits. People who use the service are encouraged to deal with their own financial affairs, if they are unable to do so, relatives or an advocacy service are approached to support the individual. People are provided with lockable cabinets in their rooms to keep small items of value and personal monies. The manager confirmed they hold small amounts of some residents’ personal monies, deposited by their relatives. All transactions are recorded in an individual ledger and monies are kept safe in office, to which only the manager and administrator have access. Records of three people being tracked as part of the inspection showed a clear audit trail of all financial transactions. Monies held for each person were checked against the balance sheets and were found to be accurate. A previous requirement was made to ensure all staff working at the home receives formal supervision. The AQAA states this task has been delegated on a mentor system, which enables all staff to develop within their role. Records indicated that regular supervision and staff appraisals are now taking place, this was confirmed in conversation with staff. Documentation reflects that sessions include discussion of general work objectives, performance and development and identify training needs. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 27 Maintenance records and information provided in the AQAA confirmed the home takes steps to ensure the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment is being regularly checked and serviced. Records also showed the assisted baths, hoists and the passenger lift are regular serviced to ensure they remain in good working order. Hot water is available at all times. Records showed that water temperatures are tested weekly, and recorded. The records and random testing of water temperatures in some of the bathrooms reflected the water supply is below the maximum recommended 43 degrees centigrade. The manager contacted an engineer during the inspection to visit the home to readjust the thermostats. The fire logbook confirmed the home has an up to date fire risk assessment, which is carried out by an indpendant assessor. The fire alarm is tested weekly using different zones and regular fire training and drills take place, with a record of the staff in attendance and outcomes of the drill are recorded. The fire and rescue service visited the home in January 2008 and made a requirement for all fire doors to be fitted with self closing devices and fitted with smoke seals top and sides of the doors. An engineer was present during the inspection carrying out the work to meet these requirements. Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5 (b) Requirement All people using the service must be provided with a contract setting out their terms and conditions of residence and which reflects their current fees. This will ensure people using the service will know their rights and obligations whilst living in the home and the amount they need to pay. The registered manager must make sure staff adhere to the homes medication policies and procedures to ensure that medication is properly administered and clear records are kept. This will ensure that people using this service will receive the correct levels of medication. This is a repeat requirement from 31/10/06 and 27/09/07. Timescale for action 05/09/08 2. OP9 13(2) 16/07/08 Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations Consideration should be given to providing information about the home and how to make a complaint in a format suitable for people with a visual and/or other sensory impairments. Meal times should be regarded as an important part of the service, the way in which staff assist people at mealtimes should be monitored and supervised to ensure support is provided sensativley, unhurried and which give the individual sufficient time to eat and enjoy their meal. To ensure the home is providing meals, which cater for the cultural dietary, needs of an individual living in the home, catering staff need to discuss the preferences and style of cooking with the individual and update their knowledge of cuisine associated with the individuals country of origin. 2. OP15 3. OP15 Tall Trees Nursing Home DS0000015342.V368513.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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