CARE HOMES FOR OLDER PEOPLE
Tall Trees Nursing Home Oaks Place Mile End Road Colchester Essex CO4 5XR Lead Inspector
Lysette Butler Unannounced 22 April 2005 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 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 I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 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 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) Lanemile Limited Kathleen Perriera Care Home with Nursing & Dementia Care beds 48 Category(ies) of Physical disability (PD) 24 registration, with number Physical disability over 65 years of age (PD(E)) of places Dementia (DE) 24 Dementia - over 65 years of age (DE(E)) Terminally ill (TI) 3 Both Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1 Persons of either sex, aged 60 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) 2 Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 4 persons) 3 Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 24 persons) 4 Persons of either sex, aged 60 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) 5 Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 24 persons) 6 Persons of either sex, aged 55 years and over, who require general palliative care (not to exceed 3 persons) 7 Persons of either sex, aged 65 years and over, who require general palliative care (not to exceed 3 persons) 8 Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 3 persons) 9 The total number of service users accommodated must not exceed 48 persons Date of last inspection 5th November 2005 Brief Description of the Service: Tall Trees is a purpose built home on two floors, registered to provide care for forty-eight service users. Twenty-four who are mentally frail, twenty-one who are elderly frail and three who need palliative care. It is in the grounds of a private hospital, in Colchester. Lanemile Ltd, part of the Care UK group, are the proprietors of Tall Trees. The home is divided into two separate units; Rowan on the ground floor and Aspen on the first floor. Rowan is the dementia unit and Aspen is the frail elderly unit. A multidisciplinary team that includes Registered Nurses, Care Assistants and other professionals allied to medicine deliver care that enables the service users to live safely. Forty beds are offered in single rooms with the remaining eight being offered in four double rooms. The home has neat, with well laid out grounds to the rear of the building, which all service users have access to. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection.
This inspection took eight hours on Friday 22nd April 2005. Nineteen of the thirtyeight National Minimum Standards were inspected during this visit. The overall care and well being of the service users was very good; staff and service users were welcoming and happy to speak to the inspector. During this visit the inspector spoke to four service users; two relatives/significant others; eleven staff members including the administrator; two housekeeping staff; the laundry person; the cook; one of the activities coordinators; two Registered Nurses and three care assistants. The inspector also spent time with the registered manager; two of Care UK’s support managers and was enabled to attend the biannual housekeeping staff meeting that was taking place at the time of this inspection. Service users and their relatives expressed satisfaction with the care they received and with the quality of the food offered. What the service does well: What has improved since the last inspection? What they could do better:
The home needs to continue with its redecoration plan as the decoration is generally ‘tired’ looking. Further carpets are in need of replacement. An occupational therapy assessment or assessment by suitably qualified person has not been undertaken in the home. Further improvement in the individual care plans is needed. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1; 4; 5 and 6 during this inspection.
Documentation reviewed at the time of this inspection demonstrated a good understanding of the needs of the current residents. EVIDENCE:
The Statement of Purpose was about to be reviewed at the time of this inspection. No major changes to the document were needed except for the inclusion of further information on the recent ‘no smoking’ policy instituted throughout the home. Staff, residents and their relatives were informed of the change in policy before the policy started on 1st March 2005, this change was not clear in the Statement of Purpose This home caters for two distinct groups of residents, those with a dementia and frail elderly with a range of illnesses. The staff work mainly on one floor or the other, however all staff are offered training in all the conditions experienced by the residents. The staff spoke to the inspector and were observed demonstrating the skills needed to look after the needs of both these groups. Residents or their representatives rarely visit the home for a trial visit before admission, although this is always offered. This is mainly due to the mental or physical problems the residents are experiencing at the time of admission. This home does accept emergency admissions if they have empty rooms but this rarely happens. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 during this inspection.
The oveall healthcare of the residents was very good and staff communicated well enabling the residents to receive good continous care. EVIDENCE:
Care plans had greatly improved since the last inspection. Six were reviewed during this visit, three on each floor. As highlighted in the last Commission for Social Care Inspection report Care UK had identified similar problems with care planning as the inspector during a regular audit; Care UK had consequently been helping the staff to improve the care plans with the manager. Each plan reviewed had a form at the beginning detailing the changes needed to bring them up to Care UK standards. Alterations in care were highlighted at regular reviews, or following accidents/incidents. Reviews were much more regular and relevant to the care of the resident. However the reviews were not yet undertaken every month. The residents had signed the three care plans reviewed on Aspen (frail elderly,) and the relatives had signed two of the three on Rowan (dementia). One care plan reviewed on Rowan had been for a resident who had been in the home for just seventy-two hours, but it contained enough information to care for that person safely. A meeting had already been arranged to discuss the care plan with the relatives. Regular mental health evaluation had been carried out for the residents, whose files had been reviewed, using appropriate risk assessment tools. Funeral arrangements/resident wishes, were documented in the care plans. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 9 All written healthcare information was good throughout the home. There were regular GP visits to the home so that all residents were reviewed on a regular basis as well as assessing residents who had not been well. The optician had recently seen all residents in the home and a number had recently been seen for auditory assessment. At the time of this inspection two residents had pressure sores; both had been admitted to the home with them. Care plans demonstrated a consistent healing pattern and that the staff were able to access advice from the tissue viability nurse if necessary. Advice was also sought from other appropriate healthcare professionals as needed. A hairdresser and a chiropodist attended the home on a regular basis. The inspector observed all residents being treated with privacy and dignity. Interactions observed were very good and residents spoken to were appreciative of the attention and time the staff gave them. Staff communicated well about the care of the residents throughout the home. Residents and visitors spoken to, all stated that the staff were approachable, helpful and respected the residents. All residents were dressed in age appropriate clothes, which were clean and well laundered. They all looked clean and well cared for. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 during this inspection.
The activities coordinator was enthusiastic and activities were varied. The food was good and well presented. EVIDENCE:
The activities coordinator was enthusiastic and demonstrated a very good attitude to the residents with a wide breath of knowledge. Residents spoken to said that they were happy with the level and variety of activities offered. They also said that they appreciated the time taken by the coordinator to spend one to one time with them. The coordinator was relatively new, but it was planned for her to go on various training courses in the near future. She demonstrated a good understanding of the needs of the residents and what she could do with/ for them. The inspector and manager discussed how she and Care UK could support the coordinator in her personal aims and objectives, so preserving her enthusiasm. Food in this home looked good and was presented well. The cook demonstrated a good understanding of the likes and dislikes of the residents. One resident said they had a preference for a particular food that was not popular with the other residents, but the cook was very happy to make it and freeze portions for him. Other residents felt that the choice and quality of the food was very good. Liquidised food was well presented with each item being separate on the plate. During the lunchtime meal staff were helpful and relaxed with the residents. They were helping to feed residents only if the resident wanted help. The dining area was generally ‘contented’ and calm. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 11 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 during this inspection. Complaints and protection procedures within the home are good. The information obtained during the investigations is used to improve the care and life style of the service users.
Complaints and protection procedures within the home are good. The information obtained during the investigations is used to improve the care and life style of the service users. EVIDENCE: The manager and staff demonstrated a very positive approach to complaints handling. The manager carried out very thorough investigations that often exceeded what is required by this standard. She supplied copies to the Commission for Social Care Inspection and to her line managers as necessary. The results of investigations and the information revealed during the investigations were used to improve care for the service users. Regulation 37 notifications were always sent to the Commission for Social Care Inspection in good time and fully completed. Care UK forms were comprehensive and detailed. All service users were on the electoral register and the administrator had applied for postal votes for the forthcoming national elections. The postal and in person voting cards arrived at the home on the morning of this inspection. No service users were using the services of an advocate at the time of this inspection. One service user said that the staff had offered to take them to the polling station on polling day. There had been one Protection of Vulnerable Adults meeting since the last inspection, which was handled well by the manager and staff involved. Information obtained during the investigation was used in a positive manner to improve the facilities offered to the service users. Staff spoken to had all been to Protection of Vulnerable Adults training and demonstrated a good understanding of the principles discussed at the training. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22 and 26 during this inspection.
This home is well cited and the grounds are well kept; however the decoration is beginning to look tired and the ongoing redecoration plan is needed. EVIDENCE: Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 13 There had been no change to the fabric of the building since the last inspection. All areas of the home were toured during this visit. The domestic staff kept the home clean, light and airy. All furnishings and lighting were domestic in character. All rooms had natural light and ventilation. There was a mix of furniture provided by the home and the service users’ own in their rooms. Various types of beds were observed in use throughout the home to meet the needs of the service users. A new maintenance person had recently started at the home and was getting to know Care UK procedures. The home was well maintained but in need of redecoration. The manager told the inspector that there was an allocated budget for a planned redecoration this year. The grounds were well laid out and user friendly. There were ramps out into the grounds from all downstairs areas. The activities coordinator had been working with the service users in the garden earlier in the week. They had been putting in some new plants and pruning. Two service users told the inspector that they had helped choose the decoration of their rooms. New carpets had been fitted throughout the communal areas on the first floor, two days before this inspection. Further carpets were in need of replacement. Care UK had not yet been able to access an occupational therapy assessment for this or any of their other homes. On my arrival the home did hot have any unpleasant odours throughout and the housekeeping staff kept the home very clean. The laundry was clean, tidy and well maintained, although it was first thing in the morning. Linen cupboards were clean, tidy and well stocked. Infection control procedures throughout the home were good. There were two sluice rooms that were clean and tidy. During this inspection I was able to attend the three-monthly ancillary staff meeting, held by the manager. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 during this inspection.
Staffing numbers are good and overall training is comprehensive. EVIDENCE: A number of care staff had achieved National Vocational Qualifications at level two, or above and the remaining care staff had commenced a National Vocational Qualification course. The manager estimated that 95 of the care staff at this home will have National Vocational Qualifications at level two and above by the end of the year. Staffing in general had improved since the last inspection and was more settled. Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 and 37 during this inspection. Financial procedures and recordkeeping was good throughout the home. There is good team work in this home.
Financial procedures and recordkeeping was good throughout the home. There is good team work in this home. EVIDENCE: The manager and staff were generally more settled during this inspection. Staff numbers had improved and continued training had ensured that staff were equipped to care for the residents at the time. There had been a recent restructuring of Care UK and two of the new managers were present in the home at the time of this inspection. The manager operated an open door policy and the proprietor’s whistle blowing policy was robust. The staff worked well as a team and supported each other. Resident’s money was handled well. Four resident accounts were checked and were correct. The documentation was clear and easy to use. The administrator and manager work well together to ensure that the finances of the residents are protected. Access to resident’s money was restricted to prevent inaccuracies occurring. They regularly audit the accounts and the administrator was appointee for two residents. Record keeping throughout the home was good and adhered to all Care UK procedures.
Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x 2 x x x 3 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x 3 x 3 x Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 17 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 1 19 22 Good Practice Recommendations The should clearly state the smoking policy of the home. Consideration should be given to redecorating the ground floor unit Rowan. (This is a repeat recommendation.) The registered manager should arrange for an occupational therapy assessment of the home. (This is a repeat recommendation.) Tall Trees Nursing Home I56-I05 S15342 Tall Trees V221992 UI 220405 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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