Inspection on 06/12/05 for Tall Trees Nursing Home

This inspection was carried out on 6th December 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tall Trees Nursing Home 16/07/08

Tall Trees Nursing Home 27/09/07

Tall Trees Nursing Home 13/09/06

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 Lysette Butler Unannounced Inspection 08:30 Tuesday 6 December 2005 th 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.V271032.R02.S.doc Version 5.0 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.V271032.R02.S.doc Version 5.0 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 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 Manager post vacant 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.V271032.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. 9. The total number of service users accommodated must not exceed 48 persons 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 65 years and over, who require general palliative care (not to exceed 3 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, only falling within the category of old age (not to exceed 3 persons) 22nd April 2005 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 are in of need palliative care. It is in the grounds of a private hospital, in Colchester. Lanemile Ltd, part of the Care UK group, is the proprietor 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, to which all service users have access. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took eight hours on one day in December 2005. Twenty-two of the thirty-eight National Minimum Standards were inspected during this visit. It was found that many of the standards had been met or partially met. The overall care and well being of the residents was very good; staff and residents were welcoming and happy to speak to the inspector. During this visit the inspector spoke to two residents; two relatives/ visitors; nine staff members including the administrator; the new acting manager; one of the housekeeping staff; two registered nurses and four care assistants. The inspector also spent time with the support manager who had been allocated to the home following the resignation of the previous registered manager. Residents and their relatives expressed satisfaction with the care they received and with the quality of the food offered. Following the inspection the inspector received four completed resident comment sheets and three visitor comment sheets. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 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 the following standard(s): 1, 2 & 3 Admission assessment is based on resident need and the welfare of the current residents. Ensuring that all residents receive care appropriate to their needs. EVIDENCE: The statement of purpose and service users guide had both been reviewed and combined by Care UK to become the Welcome Pack. Further modification of this document was needed to insert the name and details of the new manager. Contracts and terms of residence had not changed since last year and a copy of each document is kept on file at the local Commission for Social Care Inspection office. Since the last inspection a number of problems regarding the assessment and admission of prospective residents for the dementia unit (Rowan) of the home had occurred. The support manager and the new home manager were in the process of sorting the problems out at the time of this inspection. They had made good progress with improving the relationship with the local dementia assessment unit and admissions were appropriate to the levels of care the home can offer. The admission assessment of all prospective residents would in future incorporate a range of assessment tools to ensure that prospective residents are suitable for the home. Prospective admissions to the frail elderly unit (Aspen) were assessed based on the new NHS continuing care Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 8 documentation. The new manager is a registered nurse and is enabled to assess residents from a nursing care point of view. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 9 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 the following standard(s): 7&9 Care plans were generally fair, but reviews are not carried out enough meaning that they were not always as up to date as they should be. Medication procedures were safe and appropriate for the level of care the residents were receiving. EVIDENCE: Five care plans were reviewed during this visit, two on Rowan and three on Aspen. One of the plans looked at was for a resident on respite in the home. The initial assessment documents were detailed and covered all aspects of care. The resident had signed the document and on talking to them they stated that it had been fully discussed with them. Changes had been made to care plans when reviews had been undertaken. The overall quality of the daily records was good, but not all incident report numbers were included within the prose. The information about the wishes of the residents or their relatives regarding funeral arrangements has improved. All files contained a picture of the resident, but many were out of date and needed to be updated. Rowan - Reviews of care were spasmodic. One of the plans evaluated had only been reviewed every four to five months and the other had not been reviewed between May and September. The resident or their representative had signed neither of the care plans reviewed on this unit. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 10 Aspen – Of the three plans evaluated one was for a respite resident who had been in the home for ten days; one had been reviewed every month and the third had only been reviewed two-monthly. All the care plans on this unit had been signed by either the resident or their representative. No residents were self-administering their own medication at the time of this inspection. Medication administration records were checked on both units; all were correct. The majority of the medication ‘front sheets’ contained out of date information and resident photographs. Both units kept medication care plans in the medication administration records file, which detailed medication special needs and procedures for individual residents. The detail in these care plans was very detailed and specific, however they were not being evaluate as part of the regular care plan review process. Stock levels on both units were good. Medication blister pack delivery systems were in use on both units. Fridge and room temperatures were regularly recorded on Rowan, but had not been done for a couple of weeks on Aspen and the fridge was in need of immediate defrosting. The registered nurse and the manager were informed about this and the inspector was informed that it was being carried out before the end of this inspection. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 11 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 the following standard(s): 13 & 14 Residents were enabled to make choices in their day-to-day lives so that they can control aspects that are important to them. EVIDENCE: Visitors were complimentary about the home and the staff. They stated they were always welcomed and that there were no restrictions to the times they could visit. One visitor told the inspector that they were pleased to be able to tell someone ‘official’ how good the home was and the care that the staff gave too the residents. Local community groups were in contact with the home occasionally especially now as Christmas was coming up. Residents and their relatives were given information about advocacy services in the area as necessary and one resident was using an advocate at the time of this inspection. The residents spoken to stated that they were enabled to choose how they lived within the home, the only restriction being the effect their wishes would have on the other residents. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 12 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 the following standard(s): Not applicable at this inspection. EVIDENCE: None of these standards were inspected at this visit. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 13 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 This home is well cited and the grounds are well kept; however the decoration on Rowan is beginning to look tired and the ongoing redecoration plan is needed. EVIDENCE: 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. Rowan remains in need of redecoration. There was no clear plan for the redecoration at the time of this inspection, however there was evidence that this was in hand and that appropriate Care UK staff were going to come to the home in the near future to assess the needs. The acting manager and support manager had been researching colours and types of decoration to assist recognition of different areas with the residents who had a deteriorating mental condition. Hedges around the home had been trimmed back to allow more light into the ground floor of the home. Furnishing throughout the home was in generally good repair. On arrival the home was generally clean and tidy even though it was early and residents were still in the process of getting up. There were no mal odours on Aspen and new carpets make the whole area bright and inviting. There was a Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 14 very slight odour on Rowan. However as part of the redecoration on the unit, new carpets should eradicate this. The sluices were clean and tidy and laundry bags were used for collection of all dirty laundry. Maintenance records checked during this inspection would benefit from being more formulated. On records reviewed some water temperatures had been above 43oC on more than one occasion. Information supplied to the commission following this inspection demonstrated these fluctuations had been reported to Care UK, but there was no evidence of actions undertaken. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Staffing numbers were improved and training is generally comprehensive to ensure appropriate care is offered for the individual needs of the residents. EVIDENCE: Since the last inspection there has been a reassessment of dependencies in the home with subsequent changes to the staff rota’s being made. There has also been a staff recruitment drive that has reduced the agency use from 300 hours per week to approximately 50 hours per week. The overall dependencies on Rowan have dropped following the reassessment of one resident who has been moved to a more appropriate placement. Extra staff had been allocated to the unit whilst the resident was still in the home. There had also been a general reduction of accidents/incidents on Rowan since the reassessment of the resident’s dependencies. At the time of this inspection there was one registered nurse and four care assistants on each duty on Rowan. It was observed that staff were kind and helpful to the residents, although a little more interactive work with the residents would have been more stimulating. Staff training schedules were being reviewed at the time of this inspection and a copy of the most recent training matrix was made available to the inspector. Staff were responsible for keeping their own training files up-to-date. The matrix showed that four staff were not up-to-date with their moving & handling training; nine staff were not up-to-date with their abuse training and no staff had undertaken recent infection control training. However the manager was aware of the areas of concern and was in the process of rectifying the problem. All grades of staff spoken to felt that the amount and level of training offered by the home were appropriate to their individual skill needs. Felt they could Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 16 ask, and would generally be enabled to attend, any training they thought they needed. Non-statutory training was not reviewed during this inspection. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 & 38 Management and administration procedures in the home protect the health and welfare of the residents. EVIDENCE: Since the last inspection the manager had resigned and a new acting manager, Ms Jean Browne started at the home on 28/11/05. Ms Browne had previously been deputy manager at the home. She is a registered nurse and it is planned for her to start the Registered Managers Award in January 2006. She had received the Commission for Social Care Inspection registration pack and was in the process pf completing it at the time of this inspection. A support manager from Care UK was in the home to help Ms Browne to achieve the changes/improvements needed to meet the National Minimum Standards. During the transition of management styles the staff were feeling unsettled but staff spoken to were generally happy about the way the new manager works. The new manager had arranged a number of staff meetings to get to know all the staff and find out what their opinions were. Staff stated that she had appeared to be very open and explained what she wanted to achieve. One Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 18 registered nurse spoken to said they were giving the new manager “..the benefit of the doubt.” They also said “All change is difficult, but I like to judge each individual on their own merits – but so far she seems to have some good ideas, which are very helpful.” The staff, residents and visitors, felt that the general atmosphere in the home was more relaxed. Everyone spoken to said she was approachable and friendly. One resident and their visitor said “Can’t speak highly enough about the home and care given. The new manager is very nice and we see her every day. She is always willing to have a chat.” At the time of this inspection the regular Care UK audits were due to be carried out. Resident and relative questionnaires had not been sent out before this inspection, but was commenced whilst the inspection was being conducted. A Care UK compliance manager was due to come to the home and do a complete audit and then generate an action plan to deal with what is found during the audit. As well as being a general audit for the home it is to help the manager focus on the specific needs of the staff and residents. Financial procedures and insurances reviewed were up-to-date and as required by the National Minimum Standards. Budgets and business plans were held at Care UK head office and are available for viewing by the inspector as needed. All health and safety certificates checked during this inspection were up to date and complied with the standards. Record keeping within the home was generally good, although as already indicated some of these need to be more formal, than they were at the time of this inspection. The acting manager was going to follow this up after the site visit. Legionella tests had been carried out two weeks before this inspection and the certificate was awaited. Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 19 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 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 X X X 2 Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15(2b-c) Requirement The manager must ensure that all care plans are regularly reviewed. Timescale for action 28/02/06 (The standards state that this would normally be once a month.) 2 OP25 3 4 OP30 OP33 5 OP38 13(3&4a-c) The manager must ensure that water temperatures are kept within accepted limits, at the point of delivery. 12(1a-b), The manager must ensure that all 18(1a-c) staff attend all statutory training as required. 24(1a-b, The manager must ensure that a 2&3) yearly quality assurance programme is carried out and any actions arising from the programme are implemented. 12(1a) The manager must ensure that the ancillary staff are appropriately trained in all aspects of their job descriptions, with special reference to health & safety issues. 28/02/06 28/02/06 31/05/06 28/02/06 Tall Trees Nursing Home DS0000015342.V271032.R02.S.doc Version 5.0 Page 21 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 4 5 Refer to Standard OP7, OP9 & OP37 OP7 OP7 OP25 OP30 Good Practice Recommendations All resident photographs should be kept updated to ensure accurate identification and record keeping. Incident/accident report numbers should be included in the daily progress notes for easy reference. The resident or their representative should sign all care plans. The registered person should ensure that Care UK policies & procedures regarding regular maintenance checks are followed throughout the home. All staff should be encouraged to attend individual training, to enable them to offer all care needed to the residents. 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