Inspection on 27/09/07 for Tall Trees Nursing Home

This inspection was carried out on 27th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 16/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tall Trees Nursing Home Oaks Place Mile End Road Colchester Essex CO4 5XR Lead Inspector Neal Cranmer Key Unannounced Inspection 27th September 2007 09:00 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.V351863.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.V351863.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.V351863.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 13th September 2006 Date of last inspection 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. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 5 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. The fee range for staying in the home is between £600.00 to £713.00, this information was provided by the registered manager at the time of the inspection visit. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report is the outcome of an unannounced inspection visit, which took place over one day in September 2007, which lasted 7 hours. The inspection process included a review of evidence provided by the provider and residents. During the site visit to the service the premises were inspected, this included inspection the premises as well as the external grounds. A sample of records and residents care plans were also reviewed. On the day of the site visit the home was found to be clean and well maintained. The overall care and well being of the residents was the focus of the inspection, and both residents and staff were welcoming and happy to speak to the inspector. What the service does well: What has improved since the last inspection? Care plans throughout the home are now being reviewed on a monthly basis, or more frequently if the needs of the residents dictate. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tall Trees Nursing Home DS0000015342.V351863.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.V351863.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): 3. Standard 6 was not applicable to this service, and was therefore not inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can expect their needs to be thoroughly assessed prior to a service being provided. EVIDENCE: Pre-admission assessments are carried out for all new prospective residents either by the registered manager or a member of the registered nursing team, these assessments are then used as the basis for formulating the resident’s plan of care. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 10 The assessments sampled during the course of the inspection visit covered the following areas of need; • Reason for admission • Cultural needs • Religious observance • Dietary needs • Vision • Hearing • Communication • Past and present physical/medical history • Mental Health status • Medication • Continence • Any additional identified needs. The assessments sampled on the day of the inspection visit were all very detailed and informative. Tall Trees Nursing Home DS0000015342.V351863.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s can expect their care plans to address all aspects of their health and social care needs and be supported by staff in a way that ensures their privacy and dignity. However Not all areas of the home’s medication practice are sufficiently well addressed to ensure that residents are adequately protected by the home’s practice. EVIDENCE: Care plans are developed from the detailed pre admission assessments carried out by the home, the care planning process has now been moved across to the computerised system and those sampled during the course of the inspection were detailed and informative, all of the plans sampled were seen to be being kept under review. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 12 Each of the two units are always staffed by a registered nurse, as a consequence of which district nurses do not visit the home. However discussion with staff indicated that they do access input from the tissue viability nurse and the Macmillan nurse team who attend the home regularly to provide the staff with training. Medication practice in the home was inspected, and although generally good there were some discrepancies noted in the Aspen unit relating to the recording of administration records, these included medication being signed for which had not been administered, controlled medicines of residents who had passed away over two months ago still being held in the home, in addition four full bottles of scotch whiskey were being stored in the cabinet, although it was stressed that these were the property of one of the residents, however more appropriate storage should be arranged. Policies and procedures seen during the course of the inspection visit indicated that the privacy and dignity of residents was at all times to be of paramount importance, and observation of interactions by staff towards residents indicated that this was the case, interactions with residents were observed to be respectful and polite. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can expect to be supported to exercise choice and control over how they spend their time and to maintain links with their families and friends and the community. EVIDENCE: The home provides a range of activities, and a list of forthcoming events is displayed in the entrance halls to each of the two units, these activities included: • Discussing current affairs • Ball games • Coffee mornings • Hand massages • Table games • Cookery • Walks to the local shops • Monthly Holy Communion for those who wished to partake Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 14 • Music entertainers who visit the home bi-monthly. The home operates an open door policy on the receiving of visitors, and visitors are enabled to visit their friends and relatives in the privacy of their own rooms or in communal areas if they so wish. Relatives of those who are receiving palliative care are supported to have meals in the home whilst visiting, and may if necessary be supported to stay at the home overnight. The home operates four weekly rotational menus, those sampled were varied and nutritious, and provided evidence of a choice of main meals and deserts, in addition to providing three meals a day a late supper snack was also available. Food stocks on the day of the inspection were good. Residents who required their meal to be presented pureed had each item of the meal individually pureed which enabled them to enjoy the texture and taste of each item. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 15 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can be assured that the home has in place sound polices and procedures for dealing with complaints and allegations. EVIDENCE: Since the previous visit to the home six complaints have been received, all of which were investigated and responded to within home’s timescale of twentyeight days. In addition to the above complaints one adult protection referral has been made, once again this was appropriately referred to all of the relevant agencies. All staff except those most recently appointed have received training in adult protection, arrangements were being made for the newly appointed staff to receive this training as soon as possible. The home’s policies and procedures for dealing with complaints and adult protection issues are checked centrally with Care UK by the Commission for Social Care Inspection. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home that was safe and well maintained, however in the unit known as Aspen some remedial redecoration was required. Residents can however expect to be supported in an environment that was kept clean and tidy. EVIDENCE: There has been no significant change to the fabric of the building since the last inspection. On the day of the inspection the home was clean and tidy and generally well decorated, apart from some areas of the Aspen unit where it was noted that some remedial redecoration work was required. The home benefits from pleasant gardens, which were seen to be accessible to the residents. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 17 On the day of the inspection the laundry was clean and tidy and well organised, the laundry is situated next door to the kitchen, but is separated by doors and a corridor, the laundry was equipped with industrial style washing machines and dryers. On the day of the inspection the home was clean and tidy, and was free of any unpleasant odours Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 18 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can expect to be supported by a team of staff who are competent and well trained. They can further expect to be protected by the home’s recruitment practice. EVIDENCE: The home is staffed by five staff throughout the daytime, this complement is made up of one first level registered nurse and four care staff in each of the two units. Night cover is provided by one registered nurse in each unit and one member of care plus a floating member of the care team. In addition to the care staff the home employs activities co-ordinators, cooks, kitchen assistants, domestics, laundry staff, a maintenance man and an administrator. The home does employ staff under the age of eighteen, but only in ancillary positions. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 19 A number of the care team hold National Vocational Qualifications, and ongoing training is provided. Five staff files were sampled in respect of the home’s recruitment practice, all were in order, and indicated that the home’s recruitment practice is sufficiently robust to ensure the protection of residents. The training records of the staff whose files were sampled above indicated that they were provided with a good level of training, this included training in the following areas: • First aid at work • Food hygiene • Adult protection • Fire safety • Manual handling • Health and safety. Discussion with members of the staff team during the course of the inspection confirmed that they felt access to staff training to be good. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 20 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, 33, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s can expect to be supported in a home that is generally well managed and run in their best interests, where their views are sought, and where policies are in place to protect their interests. EVIDENCE: The home is managed and run by a manager who has significant previous experience of working in and managing services. Surveys returned by both residents and relatives indicated that the manager was approachable and responsive to any concerns raised. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 21 The home addresses issues of quality through the use of questionnaires, which are disseminated to both residents, and relatives twice yearly. In addition to this audits and monthly reports are undertaken. The home’s registered provider carries out regular regulation 26 visits, in line with the requirements of the Care Homes Regulations. The home has in place a process for supervising staff, and discussion with the registered manager indicated that supervisions are planned to be undertaken every three monthly, however the registered manager was honest by saying that at the point of inspection supervision had become lax. Four residents’ accounts were checked during the site visit, all were found to be in order, and documentation showed a clear audit trail. All residents receive their full weekly allowance to be used how they choose. Resident’s accounts are regularly checked by the manager and the administrator, who are the only two staff members who have access to the accounts. All Monies are held and stored in a locked safe. A range of the home’s safety certificates were inspected as part of the assessment of the home’s safe working practices, these included: • Record of weekly hot water checks • Portable appliance test records • Food hygiene report • Electrical installation certificate • Gas safety inspection report • Record of fire alarm tests. Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X x X X 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 X 3 X X 2 X 3 Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 23 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 OP36 Regulation 18 (2) Requirement Provision must be made to ensure that all staff receive formal supervision. This is to ensure that staff training needs are identified. The registered manager must ensure that all medications administered are signed for; this is to ensure that residents are adequately protected by the home’s practice. The previous timescale set of the 31/10/06 was not met. The registered manager must ensure that the ongoing decoration of the home continues. This is to ensure that residents are supported in an environment that is clean and well maintained. The previous timescale set of the 31/12/06 was not met. Timescale for action 30/11/07 2. OP9 13(2) 30/11/07 3. OP19 23(2b) 30/11/07 Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Tall Trees Nursing Home DS0000015342.V351863.R01.S.doc Version 5.2 Page 26 - 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!