Inspection on 19/07/05 for The Conifers

This inspection was carried out on 19th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Conifers 30/03/10

The Conifers 11/02/09

The Conifers 26/10/06

The Conifers 23/01/06

The Conifers 21/03/05

The Conifers 05/04/04

The Conifers 09/12/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Conifers 253 - 255 Seymour Grove Old Trafford Manchester M16 0DS Lead Inspector Joe Kenny Unannounced 19 July 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. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Conifers Address 253 - 255 Seymour Grove Old Trafford Manchester M16 0DS 0161 881 9380 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) Mrs Santosh Trehan Mrs Santosh Trehan CRH Care home PC Care home only 12 Category(ies) of DE(E) Dementia over 65 registration, with number OP Old age of places The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: All service users fall within the category of old age and may additionally have a physical disability. A variation has been granted in respect of four named older service users who require care by reason of dementia. The home provides day care for up to three service users in a specially designated area of the home. Date of last inspection 21 March 2005 Brief Description of the Service: The Conifers provides residential accommodation with personal care for up to twelve service users within the category of old age (OP) and who may have a physical disability (PD) and four with dementia. The Conifers also provides additional day care for up to three (3) service users. On the day of the inspection there were ten service users living at the home. The home is owned and managed by Dr & Mrs Trehan and is located in an established residential area of Old Trafford close to the village of Chorlton, close to shops, bus and train routes and other amenities. The home is a two storey Victorian property set in its own grounds and consists of 10 bedrooms (eight single and two double),one dining room and two lounges. Stair lifts are installed on both sets of stairs. The home has gardens to front and rear of the property, which are well maintained. Parking is available to the rear of the premises. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the Conifers was carried out unannounced and took place on the 19 July 2005. On the date of the inspection 10 residents were accommodated. The deputy manager and three care assistants were on duty. The inspection involved a tour of the home, inspection of records/care plans and procedures such as administration of medication, discussions with staff and residents. The registered manager attended the home following a planned appointment and participated in the inspection. The home had taken appropriate steps to address requirements and recommendations made at the last inspection of the home. Whilst touring the premises the opportunity was taken to spend some time in discussion with residents about life in the home. Residents spoke positively of the support they received from staff. Residents indicated in conversation that they could choose how they spent their day, choose what time they got up and when they went to bed. The manager confirmed that visitors are welcome and there are no restrictions on visiting times to the home. The home continued to monitor and develop recorded information on care plans and risk assessments carried out on residents. The homes registration allows for provision of day care for three clients. This service was not in use at the time of the inspection. What the service does well: The home continues to maintain a stable staff team to support residents living at the home. The service continues to respond to and meet the choices and needs of residents. Residents stated that staff were supportive and respected their wishes. Records of the outcomes of support offered were well maintained and regularly reviewed by staff. A homely approach to care delivery and aspects of daily living was evident in the home. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 6 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. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 7 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 The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 8 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) 3 and 6 The referral and admission process ensures residents or their representatives are given the appropriate information to assist them in making a decision about moving to the home. EVIDENCE: Admissions to the home are for long term care with the possibility of day care offered also. At the time of the inspection this aspect of the service was not in use. Admissions to the home are planned and are co-ordinated by the manager and senior staff working at the home. The process included provision of information to residents or their relatives about the service offered at the home. The process includes the opportunity to visit the home on a trial basis, to visit for the day, to have a meal and meet other residents and staff. Staff at the home will visit prospective clients in their home setting or in hospital. This enables the home to gather information to assist in the development of care plans, identify any associated risks to the client and set The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 9 out strategies to meet the resident’s needs. A service user’s guide is located in each resident bedroom. The manager stated that links with family are established at the time of admission as family members are consulted with to assist the home in establishing an agreed plan of care. The home does not provide intermediate care. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 10 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 9 Residents’ care plans set out their health, personal and social care needs. Plans are regularly reviewed to ensure outcomes of support are being met. Medication procedures ensure residents’ medication is administered as prescribed. EVIDENCE: A sample of residents’ files were viewed on the date of the inspection. Files contained a profile of each individual, their health needs and visits undertaken by professionals. Regular monitoring of residents personal health care such as weight are undertaken and recorded on monthly charts. The daily records maintained by staff are contributed to regularly with three recorded entries per day covering morning evening and night times. The plans are located in the main office and can be accessed by staff in order to record care issues during their shift. The care plans are detailed using a standardised format for all residents to ensure consistency in information assessed and reported upon. The home had taken action to ensure associated risk to individuals had been assessed and The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 11 appropriate strategies of intervention put in place. Information on the files demonstrated that a review of care is conducted on a monthly basis. The review process was evident in relation to one resident who had been reassessed for nursing care. The formal review process commenced in 2004. The district nurse service attend to support two residents, one in relation to Diabetes and one for a toe infection. Discussions were held with the manager in relation to reporting styles and the need to further monitor the content of reports. This comment related to one entry in the daily sheets which recorded “she is lazy”. Discussion and training must be provided to staff in relation to report writing to ensure all records evidence respect for residents. Discussions were also held on the need to review use of the term ‘Nursing’ on documents as the home is not registered to provide nursing care. Issues relating to privacy and dignity are detailed in care plans in relation to supporting residents with personal care. Each resident is also designated to a named carer/key worker to support them. The information in the service user guide also indicated that the home had access to an advocacy service if required. Residents can receive visitors in the privacy of their room. There were no rules relating to visiting times. Medication is administered by senior staff (6 in total) and the manager. Medication is administered through use of a monitored dosage system supplied by the pharmacist. The medication trolley and records were examined as part of the inspection. The trolley is held securely. On examination of the records it was noted that medication for one resident, confirmed by staff as given out had not been signed for on the medication administration records. This must be monitored by the manager and training provided where identified. The procedures relating to medication also evidence a trail of medication into the home and medication returned for disposal. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 12 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 The personal and social interests of residents are respected and responded to by the management and staff team working in the home. EVIDENCE: Residents spoke positively of the care provided and choices on offer in terms of catering arrangements. Residents confirmed that they choose what time to get up and what time they went to bed. The home operates an open policy on visiting times to the home and residents can receive their visitors in the lounge or in the privacy of their bedroom. There was a programme of activities for the week. A designated area at the gable exit door, is set aside for smokers and a sheltered area had been set up to enable residents of sit out in the fine weather experienced at the time of the inspection. A programme of movement to music is held each afternoon and an entertainer attends the home every six weeks. There was evidence of board games and the home also accessed the mobile library service. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 13 Residents are assisted by staff to go out to local churches and religious ministers attend the home on a regular basis. Staff working in the kitchen confirmed that the choices of residents are respected and an alternative is offered. Meal arrangements are planned using a menu plan. The plan evidenced that choices are available and that a cooked breakfast is available at weekends. Staff confirmed that they consulted with residents regarding alternatives at meal times. There were ample provision in the home and evidence of fresh produce such as fruit and vegetables. The home retains samples of meals served for up to three days as part of quality control measures and all staff working in the kitchen had received Basic Food Hygiene training. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 14 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 and 18 The home’s complaints procedures is available to residents and relatives to raise concerns about the service. Procedures relating to protection of vulnerable adults protected residents from risk of abuse. EVIDENCE: The home has an established procedure and policy in relation to dealing with complaints. The information informed residents and relatives about who to contact if you have a concern or complaint about the service provided at the home. The information included the role of the Commission for Social Care Inspection. The procedure is detailed in the service users guide. No complaints had been received by the home or by the Commission in the period since the last inspection. The home had a copy of the adult protection procedure developed by the Local Authority on Protection of Vulnerable Adults. The manager confirmed that staff have attended training provided by Trafford Local Authority in adult protection and received certificates to confirm this. Staff have been given the opportunity to read the Local Authority guidelines and have signed the tracking form to confirm they had read and understood the documents. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 15 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, 23 and 26 The home required some identified repairs to ensure the environment is safe for residents who live there. EVIDENCE: The home has eight single bedrooms and two double bedrooms. Bedrooms are accessed by residents when they wish without restriction. The home was clean and well set out. However, some repairs and maintenance required addressing to ensure the safety of residents living there. To prevent residents accessing radiators which may be hot to touch, the home will place furniture in front of the radiator. This is not an appropriate response to the risk and a full and comprehensive risk assessment must be carried out. The positioning of screens or low surface radiators would be a more appropriate response. The window panels in room 6 and 7 required replacing and a full glazing safety assessment should be carried out throughout the house. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 16 On touring the home it was noted that none of the doors were fitted with fire seals. This requires attention to ensure containment in the event of a fire. There was no privacy lock on bedroom 2 and the privacy lock in the bathroom required repairing. All doors must be checked to ensure they shut securely into the frame. The exit door to the side of the building has a series of steps down to the left and a ramped access to the right. The home is advised to isolate/block off the steps down as they are very steep and the bottom step is not level. The home was further advised to remove the exposed rusted screws on the metal handrail as they present as a risk of injury (sharps hazard) to staff and residents. The home must carry out and record tests and checks on the routes of evacuation (weekly) and checks on fire extinguishers (monthly) at the required intervals. All other tests and checks and fire drill were being completed. Bathroom temperatures were regulated to the required safe temperature. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 17 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) 27 and 30 The home was well managed and residents benefited from a staff team that were skilled, trained and supervised. The staff team were stable and offered residents the support necessary to address and meet their needs. EVIDENCE: The staff team consists of a registered manager, deputy manager and seven other members of staff. The rotas for the period covering the inspection were examined and indicated that 264 day care hours were provided. These hours include the hours worked by the manager. The care hours provided were appropriate to meeting the needs of those residents accommodated at the time of the inspection. The night hours are covered by one staff on waking duty and one person sleeping in on the premises, on call. The manager stated that programmes of training to achieve NVQ level ll and above for all staff were in place. Staff files contained the required information in relation to staff’s application forms, reference checks and training and development issues. Staff files confirmed that supervision is offered to staff every 8 weeks. Records also indicated that staff appraisal takes place on an annual basis. Criminal Record Bureau Checks on all staff had been carried out as part of the recruitment and vetting process. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 18 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 and 38 The management and administration procedures were effective in maintaining the best interests of residents and promoting their welfare. Identified health and safety issues required attention to ensure residents were protected. EVIDENCE: Health and safety issues have been identified in the Environment section of this report to ensure residents are protected. These require addressing to maintain good practices evident in other aspects of management of the service. The manager holds the relevant qualifications and experience of care of older people. The manager demonstrated a commitment to developing and keeping her knowledge current and to supporting staff on development issues. The home has developed a manual of policies and procedures specific to the home. Staff indicated that they were familiar with the content of the manual from induction, ongoing supervision and support by the management team. The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x 2 x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x x x 2 The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 20 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 7 Regulation 17 Requirement The home is requried to monitor the content of reports. Discussion and training must be provided to staff in relation to report writing. The home msut review use of the term Nursing on documents as the home is not registered to provide nursing care. Medication records must be monitored to ensure records are signed by staff once medication is administered. This must be monitored by the manager and training provided where identified. The home must review and reassess positioning of furniture in front of radiators. This is not an appropriate response to the risk and a full and comprehensive risk assessment must be carried out. The window panels in rooms 6 and 7 required replacing. All doors must be checked to ensure they shut into the frame and all doors must be fitted with a fire seal to ensure containment in event of a fire F55 F05 s5605 conifers v2335501 190705 stage 4.doc Timescale for action 21 October 2005 2. 7 4 21 October 2005 21 October 2005 3. 9 13 4. 19 23 21 October 2005 5. 6. 19 19 23 23 21 October 2005 21 October 2005 The Conifers Version 1.40 Page 21 7. 19 23 8. 19 17 9. 38 12 A privacy lock must be provided on bedroom 2 and the bathroom lock must be repaired to ensure privacy for reisdents. The home must carry out and record tests and checks on the routes of evacuation (weekly) and checks on fire extinguishers (monthly) at the required intervals. Health and safety issues require addressing to maintain good practices evident in other aspects of management of the service. 21 October 2005 21 October 2005 21 October 2005 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 19 Good Practice Recommendations The home is advised to isolate/block off the steps down from the gable end exit as they are very steep and the bottom step is not level. The home was further advised to remove the exposed rusted screws on the metal hand rail as they present as a risk of injury (sharps hazard) to staff and residents A glazing risk assessment should be extended to all glazed panels. 2. 19 The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 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 The Conifers F55 F05 s5605 conifers v2335501 190705 stage 4.doc Version 1.40 Page 23 - 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!